Evaluation of the medicine procurement and supply management system in public hospitals in Lesotho
Tema, Matsepo Aniva
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In a well-functioning medicine supply chain management system, procurement forms an integral part that needs to be closely monitored and integrated with other functions. Good procurement practices in the public health sector ensure that good quality efficacious medicines are distributed in the country in the right quantities and at reasonable costs. Pharmaceutical procurement is a major determinant of drug availability and total health costs. It is indicated that medicine expenditure represents the single largest expenditure after salaries and accounts for approximately 20 to 40% of the total healthcare budget, and up to 90% of household budgets in the Sub-Saharan region (MSH, 2012:1). Moreover, effective and efficient public sector procurement systems are essential for the achievement of millennium development goals and the promotion of sustainable development (WHO, 2011:2). The general aim of the study was to evaluate the current status of procurement and supply chain management systems in the public healthcare hospitals in Lesotho. The study set out to understand the policies, guidelines and practices governing medicine procurement in the public hospitals in Lesotho, and also to outline the impact of procurement activities on the overall operation and effectiveness of the healthcare services. A descriptive, cross-sectional study was conducted, focusing on all levels of medicine procurement and supply management systems in all public hospitals in Lesotho. The study period stretched over nine months, from January 2014 to September 2014. The study population was inclusive of 17 public healthcare hospitals in the country and the central medical store (CMS). The findings revealed that all hospitals studied (n=17) perform the functions of selection, procurement, quantification, ordering, inventory management, distribution as well as utilisation. Although an essential medicine list (EML) and standard treatment guidelines (STGs) are available for use, public hospitals do not adhere to the use of EML and STGs for medicine procurement (n=17). Therefore, procurement is not limited to medicines on the EML, it is based on the intensity of healthcare services provided, and public hospitals often request medicines that do not occur on the EML, but are necessary to address the different diseases and public health priorities in respective facilities. According to the Ministry of Health, all public facilities are mandated to procure medicines from the CMS. Public hospitals use their allocated funds for medicine to buy from the CMS, which will, in turn, procure medicines on behalf of the government and distribute to the hospitals as per request, since procurement is pooled at a central level (MOH, 2011:62). However, it was observed that only government facilities (n=11) procure medicines from the CMS only. Facilities that are owned by the Christian health association of Lesotho (CHAL) procure medicines from other places concurrently (n=6). Moreover, CHAL hospitals (n=6) indicated that they are not fully mandated to procure medicines only from the CMS; they can also procure from other agencies based on stock-outs at the CMS, price differences and urgency of obtaining the medicines required. Therefore, procurement practices at government and CHAL hospitals are not similar. The total expenditure on medicines for government hospitals was 7 088 754.50 Maloti and 121 338 713.05 Maloti in the years 2010/2011 and 2011/2012, respectively. The total expenditure for CHAL hospitals was 2 520 590 Maloti and 3 577 360 Maloti in 2010/2011 and 2011/2012, respectively. According to the findings, variance of budget and expenditure for government hospitals were 15 623 446.50 Maloti in 2010/2011 and 9 490 341.22 Maloti in 2011/2012. Variance of the budget and expenditure for CHAL Hospitals were 912 570 million Maloti in 2010/2011 and 922 640 million Maloti in 2011/2012. Most hospitals showed a variance of above 50% in 2010/2011. However, in 2011/2012, a shift pattern was observed indicating an improvement in the utilisation of funds allocated. This shift pattern may indicate a possible improvement in procurement practices, including the quantification and budgeting and commitment to procurement plans. Pharmaceutical management systems require sound policies and a legal framework that will provide a solid foundation for the systems. It is equally important that these policies and regulations are periodically updated to ensure that they address the current health situation in the country and are in line with international standards (MSH, 2012:4). However, some documents are very outdated, and therefore they do not reflect the current health situation in the country as well as procurement trends internationally, and these include national medicine policy, EML and STGs. In conclusion, the medicine procurement system in public hospitals should be strengthened and should incorporate continuous supportive supervision in order to facilitate and encourage adherence to good procurement practices, and therefore the constant availability of good quality, cost-effective essential medicines in the country.
- Health Sciences