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CHALLENGES FACING INVENTORY MANAGEMENT OF


ESSENTIAL MEDICINES IN CHUNYA DISTRICT - MBEYA




By

Kabandika, Twaha

A project paper submitted in Partial Fulfillment of the Requirements for the
award Postgraduate Diploma in Procurement and Logistics Management
(PGDPLM) of Tanzania Institute of Accountancy




Tanzania Institute of Accountancy
September, 2014
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CERTIFICATION
The below undersigned certify that, he read and hereby recommend for examination of
project paper entitled Challenges facing inventory management of essential
medicines in Chunya District in partial fulfilment of the requirements for the award
Post Graduate Diploma in Procurement and Logistic management








_____________________________________

Mr. Swallo C.G
(Supervisor)


Date: _________________________________









ii



CERTIFICATION
The below undersigned certify that, he read and hereby recommend for examination of
project paper entitled Challenges facing inventory management of essential
medicines in Chunya district in partial fulfilment of the requirements for the
Postgraduate Diploma of Procurement of Logistics management








_____________________________________

Mr. Swallo C.G.
(Supervisor)


Date: _________________________________






iii

DECLARATION
AND
COPYRIGHT



I, Kabandika Twaha declare that this Project report is my original work and that it has
not been presented and will not be presented to any other university for a similar or any
degree award.



Signature: ...................................................... Date: .............................................

This dissertation is a copyright material protected under the Berne Convention, the
Copyright Act 1999 and other international and national enactments, in that behalf, on
intellectual property. It may not be reproduced by any means, in full or in part, except
for short extracts in fair dealing, for research or private study, critical scholarly review
or discourse with an acknowledgement, without the written permission of the
Directorate of Postgraduate Studies, on behalf of both the authors and the Tanzania
Institute of Accountancy.
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ACKNOWLEDGEMENT
My special thanks and appreciation to Mr. Swallo C. G. as my supervisors for his
dedication and tireless guidance provided throughout the time to complete this project.
I wish to thanks, the course facilitators at Mbeya campus for their support and
organization throughout the course.
Also my thanks must go to the Executive Director of Chunya District for the
encouragement and permission to pursue my course.
I wish to thank the following for their valuable support and efforts provide to me,
District Medical Officer for granting permission to collect data from respective survey
setting.
I would like to acknowledge the Medical Officers In charges (MOI)/ Facility In charges
for providing relevant information/data from their respective working station (survey
setting).
I am grateful too for the support and input from all members/colleagues who made my
course successful through their contribution and good cooperation throughout the
course.







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DEDICATION



To my lovely wife Nasra Twaha and my daughter Fatma Twaha.














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ABSTRACT
Background: Poor inventory management of medicines leads to unnecessary increase of
operational costs and create difficultness in quantifying and forecasting of consumptions
as well as poor medicines storage environment. Additionally, these make large populations
particularly in rural areas do not have constant access to even the most essential medicines and
better services. However, factors contributing poor inventory management of essential medicines
at the lower level health facilities was still not clear.

Objectives: The main objective of this study was to assess challenges facing inventory
management of essential medicines at the lower level public health facilities.

Methods: A descriptive cross-sectional study was conducted to assess the challenges facing
inventory management of essential medicines at the lower level public health facilities such as
Dispensaries and Health Centers. A study population included 35 lower level public health
facilities. Questionnaires were used to gather data and the analysis employed both quantitative
and qualitative procedures by using both SPSS program version 16 and excel program

Results: 42.8 % of the participants were clinical officers, 37.1% were Nurses, 14.3% were
Medical attendant and 8.7% were Assistant Medical Officer (AMO). The survey found 74% of
the participant had moderate knowledge on inventory management of essential medicine. Also it
was found that lack of enough space and shortages of trained staff were the main challenges
facing management of health related commodities.

Conclusion: The study reveals that all staff manage essential medicines in lower level of
public health facilities, however they do not posses enough skill on it. Storage conditions at
the health facilities were not good. Through adopting alternative sources of essential medicines
for public health facilities, training staffs on procurement and inventory management will
make these commodities readily available and improve the service level.

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Table of Contents
CERTIFICATION .............................................................................................................. i
DECLARATION ............................................................................................................. iii
ACKNOWLEDGEMENT ................................................................................................ iv
DEDICATION ................................................................................................................... v
ABSTRACT ...................................................................................................................... vi
List of figures ..................................................................................................................... x
List of tables ....................................................................................................................... x
List of Abbreviations....................................................................................................... xii
CHAPTER ONE: INTRODUCTION ............................................................................ 1
1.2. Problem Statement .................................................................................................. 5
1.3. Research Questions ................................................................................................. 6
1.3.1 General Research Question ................................................................................... 6
1.3.2 Specific Research Question................................................................................... 6
1.4.0 Research Objectives ............................................................................................ 7
1.4.1 General Research Objective .................................................................................. 7
1.4.2 Specific Research Objectives ................................................................................ 7
1.5 Rationale of the Study .............................................................................................. 8
1.6 Limitations of the Study ........................................................................................... 9
CHAPTER TWO: LITERATURE REVIEW .................................................................. 10
CHAPTER THREE: METHODOLOGY ........................................................................ 13
3.0. Methods and materials .......................................................................................... 13
3.1. Overview of Study area ......................................................................................... 13
3.1.2. Selection criteria................................................................................................. 13
viii

3.1.3. Inclusion and Exclusion criteria ......................................................................... 14
3.2. Methodology ......................................................................................................... 14
3.2.1. Study Design .................................................................................................. 14
3.2.2. Survey setting ................................................................................................. 15
3.2.3. Survey period and duration ............................................................................ 15
3.2.4. Survey areas ................................................................................................... 15
3.2.5. Selecting the sample size ............................................................................... 15
3.3. Data collection .................................................................................................. 15
3.4. Study variables .................................................................................................. 15
3.5. Data management and analysis ............................................................................. 16
3.6. Study limitation ..................................................................................................... 16
3.7. Ethical consideration ............................................................................................. 17
CHAPTER FOUR: RESULTS ........................................................................................ 18
4.1. Age and sex distribution among Participants ........................................................ 18
4.2. Professional level among the study participants ................................................... 18
4.3. Knowledge on inventory management of essential medicines ............................. 20
4.4. Storage conditions of essential medicine .............................................................. 22
4.5. Problem encountered during ordering processing ................................................ 23
4.6. Reported stock out of essential medicines ............................................................ 24
4.7. Challenges on proper management of health commodities .................................. 25
4.8. Recommendation on essential medicine availability and control ......................... 25
CHAPTER FIVE: DISCUSSION .................................................................................... 27
CHAPTER SIX: CONCLUSION AND RECOMMENDATIONS ................................. 31
Conclusion ................................................................................................................... 31
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Recommendations ........................................................................................................ 32
CHAPTER SEVEN: REFERENCES .............................................................................. 33
APPENDICES ............................................................................................................. 36
APPENDIX I: Questionnaire: ...................................................................................... 36
APPENDIX II: Informed consent agreement .............................................................. 40


















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List of figures
Figure 1: MAP OF CHUNYA ......................................................................................... 14
Figure 2: Knowledge level on inventory management of essential medicines. ............... 21
Figure 3: Storage Condition level among the Surveyed health facilities ......................... 23



















List of tables
Table 4.1 Age and sex distribution among participants ................................................ 18
xi

Table 4.2 Professional level among the study participants ............................................. 19
Table 4.3.1 Respondent on inventory control .................................................................. 20
Table 4.3.2 Awareness on variables used during ordering .............................................. 21
Table 4.4 Storage conditions standards at the facilities surveyed ................................... 22
Table 4.5 Reported problems encountered during preparation and sending an order of
the essential medicines ..................................................................................................... 24
Table 4.6 Reported reasons for out of stock for essential medicines ............................... 25
Table 4.7 Reported challenges on proper management of health commodities .............. 25














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List of Abbreviations
AMO : Assistant Medical Offices
CO : Clinical Officer
DMO : District Medical Officer
EDP : Essential Drug Program
EML : Essential Medicine List
FEFO : First Expire First Out
FIFO : First in First Out
HC : Health Center
LMIS : Logistic Management Information System
MOHSW : Ministry of Health and Social Welfare
MOI : Medical Officer In charge
MSD : Medical Store Department
MSH : Management Science for Health
NHIF : National Health Insurance Fund
PV : Prime Vendor
RA : Researcher Assistances
R & R forms : Report and Request Forms
SOP : Standard Operating Procedure
STG : Standard Treatment Guideline
VMI : Vendor Managed Inventory




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CHAPTER ONE: INTRODUCTION
Inventory management is the heart of the drug supply system; it involves
ordering, receiving, storing, issuing and then reordering a limited list of items.
In reality, the task is difficult, and in many countries like Tanzania, poor
inventory management in the public drug supply system lead to waste of
financial resources, shortage of essential and vital medicines ( MSH, 2000).
These eventually reduce the quality of patients care services. Inventory
management involves more than just purchasing supplies; it also involves
handling, storing, moving, and restocking those supplies. Thus, inventory
management is an important area for health facilities to consider during
provision of services.
Essential medicines are those that satisfy the health care needs of the population
and are intended to be available within the context of a functioning health
system at all times in adequate amount, in the appropriate dosage form, and at
the price the community can afford (WHO 1997).

Its not uncommon to find that public health facilities from dispensaries to
Consultant hospitals lack vital medicines and the situation is very serious in
district and lower level heath facilities such as dispensaries and health centers,
this condition leads to loss of confidence to the public health facilities by the
public, (Battersbery et al, 2003).

In early 1970s, Tanzania had scarcity of health professions especially
pharmaceutical personnel, in order ensure that pharmaceutical services are
provided uninterruptedly, medicines were handled by non-pharmaceutical
personnels , (Pharmacy board,1978). Due to poor knowledge, improper
documentation, it was not possible to exactly quantify the medicines
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consumption of the health facilities; the forecasting of medicines was not
possible. Due to this, the country opted to adopt the EDP kit system (Bhattari,
2004), in this system, the quantification of medicines consumption for all
facilities in the country was done centrally through MSD and the medicines
were distributed to the facilities quarterly. However, a number of facilities
received medicines which were not demanded by the catchment population
because the order was not initiated by the facilities, medicines ended up with
expiring and prolonged out of stocks of essential medicines. Therefore, these
were the unnecessary costs that government was incurring simply because of
poor medicine inventory management

The EDP Kit system was used by health facilities and dispensaries until early
2000s; currently the Integrated Logistic system (Indent system) is used whereby
each facility initiates its own according to the actual consumption with regard to
the diseases prevailing in the catchment areas.

Unlike lower health facilities, hospitals had to adopt a separate system of
medicines supply as population and the number of pharmaceutical personnel
increased. At the end of each financial year, prior to budgeting all government
hospitals including district hospitals are required to budget for their annual
medicines consumption and expenditure. This quantification is usually done by
adopting one or combination of the following methods: consumption method,
morbidity method, adjusted consumption method and service level projection of
budget requirements; this can be manually or computerized (MSH, 2007). These
involves estimating the quantities of essential medicines for procurement, it also
estimates financial requirements to purchase the medicines, the complete order
3

is finally handled to MOHSW for further financial processes and deliveries
through MSD, funding and deliveries is normally done on quarterly basis.

Accurate and stock records are source of information used to calculate needs
and inaccurate records produce inaccurate need estimation and this causes stock
out and expiry. Each inventory system should monitor performance with
indicators and produce regular reports on inventory and order status, operating
costs and consumption patterns.

Poor medicines stock management can lead to irrational medicine use, when no
overview exists of the available medicines in stock. The good inventory control
makes ordering and medicines management easier, essential medicines
programs place a high priority on improving inventory control to ensure a
reliable supply of essential medicines, vaccines, and other items at health
facilities (MSH, 1997). To achieve this aim, staff need to be trained in inventory
control, storage and ordering procedure. The choice of appropriate inventory
control method varies according to the types of facility, scale of operations as
well as staff capabilities

The stock record and reports form the foundation of effective inventory
management. Stock records are core records in inventory management system,
they are the primary source of information used in the various reordering
formulas and they are also the source of data used to compile the reports. The
stock records can be either manual or computerized, commonly used manual
records include ledger system, and bin card.

4

Additionally, recently MSD introduce direct delivery system to the health
facilities (dispensaries) to reduce some of problems incurred before such as
reducing lead time. However currently there are still stock outs in the health
facilities as well as huge stocks of expired medicines. However, there is no much
studies which has been recently done to explain what are real challenges facing
the inventory control despite of long outstanding stock outs of medicines and
poor quality of pharmaceutical services provided by lower level public health
facilities such as Dispensaries and Health centers

The information obtained from this study will be used to devise appropriate
strategies for improvement of inventory management of essential medicines and
quality of services at the lower level of public health facilities.















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1.2. Problem Statement
In Tanzania essential medicines are expensive and constitute a large proportion
of MOHSW expenditure as well as donor funds, they require very efficient
management in order to realize its impact to the health service provision. Lack
of skills on inventory management of medicines in Tanzania contributes to the
interruption of the supply chain of essential medicines (MSH/WHO, 1997). This
may result into patient not being able to receive medicines promptly, frequent
stock-outs, late deliveries and unnecessary expire of medicines at the facility.
These causes not only lose confidence in the facilities by patients but also waste
of financial resources and decrease in quality of patient care.

Most of the studies in supply chain areas have been concerned with efficiency
and competence and used of the products market at higher level health facilities
(hospitals), but only limited studies have been done regarding inventory
management in supply chains (Kagashe etal, 2012). Additionally there is a
limited study which has been done on inventory management of essential
medicines in Tanzania at the lower level of public health facilities; this study is
thought to lists of important challenges facing the inventory management of
essential medicines in the lower level health facilities of Chunya District in
Mbeya region, Tanzania.





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1.3. Research Questions
1.3.1 General Research Question
What are the challenges facing inventory management of essential medicines at
the Public health facilities in Chunya distict council?

1.3.2 Specific Research Question
1. Do the health facilities have staff of required knowledge to handle
medicines inventory?
2. What do HCP knows and practice regarding inventory management of
essential medicines?
3. What are factors contribute to poor inventory management essential
medicines?



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1.4.0 Research Objectives
1.4.1 General Research Objective
To assess challenges facing inventory management of essential medicines in
Chunya district Mbeya region.

1.4.2 Specific Research Objectives
1. To explore the level of staff who are responsible to handle medicine inventory in
the lower level public health facilities.
2. To assess knowledge, practical competence and reported practice regarding
inventory management of essential medicines among health care provider (HCP)
in Chunya district
3. To assess factors contribute to the poor inventory management of essential
medicines





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1.5 Rationale of the Study
Effective inventory management is very important in the supply system of
essential medicines because it is the source of information used to calculate and
forecasting the medicines needs and safe storage , It provides the basis of
trading off between the level of inventory to be kept and the required service
level at optimal operating cost.

It is expected that these findings can be utilized in many ways in providing
better solutions of inventory management for essential medicines, hence,
improving availability of essential medicine at the lower level public health
facilities in Chunya District. Also policy-makers and health managers that are
involved in planning training activities will help to address these challenges of
inventory management, and thus ensuring constant availability of these
important and life-saving medicines and properly manage.


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1.6 Limitations of the Study
Private health facilities were excluded from the survey due to financial and time
constraints. Additionally, it was not easy to access some of the information,
since other participants perceived the study as inspection and therefore did not
provide full participations





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CHAPTER TWO: LITERATURE REVIEW
Pharmaceutical inventory management is the set of practices aimed at ensuring the
timely availability and appropriate use of safe, effective, quality medicines and related
products and services in any health care setting. It has four components that for a cycle,
namely selection, procurement, distribution and its to use to the patients (MSH/WHO,
1997).

Medicines inventory management depend largely on LMIS tools such as Ledger books,
bin cards, EMLs and STGs, however their availability and utilization in health facilities
was found to be 38%, and 52% respectively, various reasons were given for this poor
adherence to the LMIS tools ( MOHSW, 2008). Additionally, it was reported that 33%
of the facilities had registered personnel to handle the essential medicines. (MOHSW
2008).

Some of the studies show some variations in the pattern of availability of individual
medicines, low quality of services, and poor inventory management of essential
medicines. In a study conducted by John Snow Inc. (JSI) showed that there were stock
outs of antiretroviral drugs especially in those health facilities that depended on Medical
Stores Department (MSD) zonal centers for their supply (JSI/Delivery, 2003).

Medicines efficacy can be impaired when poorly stored; normally there are specific
conditions which are recommended by manufactures in which each drug should be
stored as to maintain its efficacy. Poorly stored medicines cannot give the desired
results, however it common to find medicines stored contrally to manufacturers
condition. In study conducted in Dar es salaam city it showed that , 36% of the health
facilities were found to stock medicines not stick on to manufactures recommendations
(Silumbe, 2011).

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Inventory control is the process of managing inventory in order to meet customer
demand at the lowest possible cost and with a minimum investment (Blackburn J, 2010).
Several objectives in inventory control such as minimize inventory investment;
determine the appropriate of customer service level; balance supply and demand;
minimize ordering cost and holding cost; also preservation of inventory control system.

Some of various inventory control model are Economic Order Quantity (EOQ) safety
stock and Replenishment. In order to reduce cost and improve service level, hospital is
considered to implement various innovative supply chain strategies. Based on the
literature, the standard or conventional supply chain was replaced by a number of
initiatives that have been undertaken such as just-in time (JIT) (Garry J, 2006) stockless
inventory (Rivard-Royal H. et al, 2002) and vendor managed inventory (VMI) (Cheng
S. H. and G. J. Whittemore, 2008).

The problem of expire of essential medicines was found to be common in health
facilities in Uganda, the main reasons given to this were: short lives of donated drugs,
patients preference of brand medicines rather than generic medicines and poor
estimation of medicines to be procured. In Uganda, most of expired medicines were
donated with short expire period and were for special program, (Nakanyazi et al, 2010).

To reduce unnecessary stock outs in the facilities, Lead time is among key factors to be
considered during placing orders. This has been observed to cause drug shortages in
many of health facilities in Malawi, in which only 42% of the personnel who were
handling medicines could competently apply Lead times in drug ordering procedures
(Lufesi and Andrew, 2007).


Additionally large inventories also make it difficult to track expiration dates and to make
sure that items are being billed for correctly. Research shows that annual inventory
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carrying cost averages between 15% and 40 % of the dollar value of the inventory,
which is a huge burden to carry for healthcare providers (Chris, 2003). In most of a
health facility excess inventory may lead to expiry of some medicines (Muyingo S. et al,
2000, Nakyanzi J. K. et al 2010).
In a study conducted by Talafha to assess pharmacy and inventory control in ministry of
health hospitals in Jordan showed that medication quantification requirements are not
estimated according to actual hospital needs and standard procedures. In addition there
were improper stock recording practices in some hospitals (Talafha H, 2006)

Stock management is rarely taught in medicine, nursing or pharmacy courses, this may
results in a negative impact on access to medicines. Factors contributing to stock outs on
one hand and over stocking on the other in a lower health facilities Tanzania are not very
clear. Lack of funds and proper logistics and inventory management skills have been
speculated as contributing factors.









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CHAPTER THREE: METHODOLOGY

3.0. Methods and materials
3.1. Overview of Study area
3.1.1. Geographical locations
Chunya district is located in the North -Western part of Mbeya Region. The district is
among the eight (8) districts of Mbeya region and it lies between 7
0
and 9
0
Latitudes
South of the Equator, and between 32
0
and 34
0
Longitudes East of Greenwich. The
district is bordered by Singida and Tabora regions to the North; Iringa region and
Mbarali districts to the East; Mbozi and Mbeya districts to the South; Rukwa region and
lake Rukwa to the West.
3.1.2. Selection criteria
Chunya districts is among the hardly to reach area in Tanzania. Also from the baseline
survey of the availability and management of medicines and medical supplies, it was
shown order fulfillment rate was 67.6 % from MSD. (MOHSW, 2003). Additionally
Chunya is one of districts where essential medicines direct delivery supply system had
recently introduces.

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Figure 1: MAP OF CHUNYA
3.1.3. Inclusion and Exclusion criteria
Inclusion
Lower level Public Health facilities
Willingness to participate in the study
Exclusion
District hospitals and private health facilities
3.2. Methodology
3.2.1. Study Design
A cross sectional descriptive survey on assessing challenges facing inventory
management of essential medicines at the lower level public health facilities in
Chunya District.
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3.2.2. Survey setting
This study examined the challenges facing inventory management of essential
medicines. Data was collected from lower level public health facilities situated in
Chunya district.
3.2.3. Survey period and duration
The survey was conducted in May 2014. Prior to data collection, the principal
investigator contacted the health facility In charge of the survey area in order to
ensure good cooperation.
3.2.4. Survey areas
The study was conducted at the lower level of public health facilities in Chunya
District.
3.2.5. Selecting the sample size
Selecting of public health facilities:
All 35 lower level public health facilities were selected in Chunya district.
3.3. Data collection
Data collection tools for challenges facing inventory management of essential
medicines included: questionnaire. (Appendix I)
3.4. Study variables
The variables of the study were as follows:
Knowledge (what they know) and practice (how they behave and demonstrate their
knowledge and their action at the working place). The study involves assessment of
knowledge and practice of Health Care Providers.
3.4.1 Knowledge and practice analysis
In the section of assessing knowledge one mark will be award for each correct
answer and zero for each wrong or unsure or disagree.


16


3.4.2. Health care provider knowledge
Arbitrary scoring systems were used to assess the level of knowledge base on the
maximum of 11 correct score. The total knowledge score will be categorize into
three levels indicated by
0 - 3 Poor knowledge
4 7 Moderate knowledge
8 11 Good knowledge
3.4.3 Practices:
For the practice questions on high risk behavior or practice will be assessed, where
reports of at least one behavior associated with poor inventory management will be
considered as high risk behavior marked a score of zero and opposite behavior
marked score of one.
3.5. Data management and analysis
All collected data and completed forms were checked on daily basis by the
investigator. If any of important information was missing, a follow-up by revisiting
or telephone call was made to obtain any of remaining information.
Data was first cleaned and entered into Ms Excel 2007 and SPSS v.16 for analysis
3.6. Study limitation
Cross sectional study collect data at one point in time, presents of competent staffs at
the health facilities was assessed in one day survey. Consequently, some facilities
may usually had a competent staff but it happened on the day of survey were not
available. Private hospitals and district hospital were excluded from the survey due
to financial and time constraints.

17

3.7. Ethical consideration
Permission to do this research was obtained from the DMO and Facility in
charges/MOIs at their respective levels of administration. Principal investigator used
prepared informed consent from participant and explaining the objectives and
confidentiality concerns, as a support if participants asked questions (Appendix II).
Contact information was also supplied for any concern or questions. In order to
ensure confidentiality, no names of the participants were recorded in the
questionnaires. Data were entered into the computer Microsoft excels 2007 using
only study code number. Ethical clearance was obtained from TIA Research and
Publication Committee



18

CHAPTER FOUR: RESULTS

4.1. Age and sex distribution among Participants
Sixty six percent (66%) of respondents were females. The ratio of female to male
was 1.5:1. Similarly, 11 (31.5%) were aged above 45 years, 10 (28.6%) were aged
36 to 45, 9 (25.7%) were aged 26 to 35 and only 5 (14.2%) were aged 15 to 25
(Table 4.1). These two variables were found to have no effect in the status of
inventory management.
Table 4.1 Age and sex distribution among participants (n=35)
S/n Sex Number of participants (%)
1 Male 14 (40)
2 Female 21 (60)
Total 35 (100)
Age
1 15-25 5 (14.2)
2 26-35 9 (25.7)
3 36-45 10 (28.6)
4 Above 45 11(31.5)
Total 35 (100)

4.2. Professional level among the study participants
Respondents were the core and supporting staff of all health facilities. Regarding
professional level of the participants, it was found that 5 were medical attendant, 13
were nurses, 14 were clinical officer and 3 were AMO. This shows that, all staffs
manage essential medicines in lower level health facilities were are not legally
registered to handle medicines (Table 4.2).
19

Table 4.2 Professional level among the study participants (n=35)
S/n Professional No. of professional (%)
1 Medical attendants 4 (14.3)
2 Nurses 13 (37.1)
3 Clinical officer 15 (42.8)
4 Advance medical officer 3 (8.7)
Total 35 (100%)


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4.3. Knowledge on inventory management of essential medicines
4.3.1. Inventory control of essential medicines
The knowledge on safety stock formula was low, nearly 13 (37.1%) of participant
got the correct answer for it. Additionally knowledge on the types of method used for
quantification was low, as it was shown that about12 (34.3%) of the participant
scored the correct answer. However most of the participant had knowledge on the
essential medicines management tools and reasons for holding stock at the facility
(Table 4.3).
Table 4.3.1 Respondent on inventory control
Scenario Respondent
Correct
answer (%)
1 Ledger and bin card are among document used to control
medicines
34 (97.1%)
2 Formula of Safety stock is the is the lead time (LT) multiplied
by the average month consumption
13 (37.1%)
3 Morbidity is one of the methods used during quantification 12 (34.3%)
4 One of the reasons to held stock in hand is to maintain
confidence of the health system
26 (74.3%)

4.3.2. Awareness on variables used during ordering
Most of the respondent said they were aware on variable used in ordering. However,
participants had low awareness on the lead time and re-order level during ordering.
Only 9 (25.7%) and 13 (37.1%) had got the correct answers for reorder level and
lead time respectively (Table 4.3.2).
21

Table 4.3.2 Awareness on variables used during ordering
Scenario Participants correct answer (%)
5 Average consumption 24 (68.6%)
6 Lead time 13 (37.1%)
7 Safety stock 28 (80%)
8 Reorder level 9 (25.7%)
9 Maximum stock level 26 (74.3%)
10 Stock position 25 (71.4%)
11 Procurement period 25 (71.5%)

4.3.3. Level of knowledge on inventory management of essential medicines

Majority of participants (74%) had moderate knowledge on inventory management
of essential medicines. Only 2 (5.7%) had poor knowledge on inventory management
(Figure 2 below).
Figure 2: Knowledge level on inventory management of essential medicines.

0
10
20
30
40
50
60
70
80
2
26
7
5.7
74.3
20.0
H
e
a
l
t
h

f
a
c
i
l
i
t
i
e
s


Level of knowledge on inventory management
No. of respondent
Perentage (%)
22

4.4. Storage conditions of essential medicine
Proper Storage condition such as good labeling and posses of enough storage space
were shown only in a few facilities. However, most of facilities 34 (97.1%) stored
medicines far away from insecticide and chemicals (Table 4.4).
Table 4.4 Storage conditions standards at the facilities surveyed (n=35)
Storage standards as per MSH, 2000. No. of facilities adhering to
the standard (%).
1. Medicines are arranged so that identification
labels and expiry dates and manufacturing dates
are visible.
17 (48.6)
2. Medicines are stored and organized in a manner
accessible for first-expiry, first out counting and
general management.
18 (51.4)
3. The facility makes it a practice to separate
damaged and expired medicines from inventory.
30 (85.7)

4. Medicines are stored at the appropriate
temperature according to temperature
specification.
20 (57.1)
5. Roof is maintained in good condition to avoid
sunlight and water penetration at all times.
22 (62.3)
6. Storeroom is maintained in good condition (e.g.
Clean, shelves are sturdy, boxes are organized).
23 (65.7)
7. Current space and organization is sufficient for
existing medicines
12 (34.3)
8. Product are stacked at least 10cm off the floor. 28 (80%)
9. Medicines are stacked at least 30cm away from
the walls.
15 (42.9)
10. Medicines are stored separately from
insecticides and chemicals.
34 (97.1%)

The storage conditions in various health facilities was categorized as poor (0 - 2),
average (3 - 5), good (6 - 8), and very good (9 - 10). Majority 23 (65.7%) of the
respondent had good storage condition of essential medicines. However, 1 (2.9%)
facility had poor storage condition of essential medicines (Figure 3).
23


Figure 3: Storage Condition level among the Surveyed health facilities

4.5. Problem encountered during ordering processing
51.4 percent (18) of respondents agreed to the fact that they faced problems during
writing an order. While 3 % (1) only said they did not faced any problems.
Poor knowledge on logistics tools and few numbers of staffs were the main problems
encountered during ordering process. Plenty of medicines on the scheduled ordered
form and lack of stationery were the least problems encountered during the ordering
process (Table 4.5 below).



2.9
25.7
65.7
5.7
Poor
Average
Good
Very good
24

Table 4.5 Reported problems encountered during preparation and sending an
order of the essential medicines
Statements No. of
respondent
(%)
1 Difficulties in calculation (formula) 7 38.9
2 Plenty of medicines on the scheduled ordering
forms
5

27.8
3 Lack of stationery material (eg. calculator) 4 22.2
5 Poor knowledge on logistic tools 10 55.6
6 Few number of staffs, 9 50%
7 Transportation and communication problems 8 44.4

4.6. Reported stock out of essential medicines
97% (34) of the facilities had reported that, some of essential medicines were out of
stock recently. While only 3% facility reported that all medicines were available
(Table 4.6). Most of facilities reported that presences of missed items from MSD are
the main causes of stock out of essential medicines.
25

Table 4.6 Reported reasons for out of stock for essential medicines
Statement Number (%)
1 Delay delivery from MSD 11 (32)
2 Presence of many customer (high service
level)
8 (23.5)
3 Presence of missed items or receive less than
what they ordered
17 (50)
4 Limited number of medicines in the scheduled
list
5 (14.2)
5 Lack of funds for self procurement of essential
medicines
5 (14.2)

4.7. Challenges on proper management of health commodities
97 percent of respondents agreed to the fact that there were a lot of challenges
impairing the proper management of health commodities, whilst 3 percent said they
did not face any challenges.
Lack of enough space and shortage of trained personnel were the main challenges
facing management of commodities. However inadequate of health commodities
tools are the least challenges on proper management of health commodities (Table
4.7).
Table 4.7 Reported challenges on proper management of health commodities
Statement No. of respondent
(%)
1 Lack of enough storage spaces 24 (70.6)
2 Transportation and communication problems 11 (32.4)
3 In adequate of health commodities tools 3 (8.8)
4 Lack of funds 10 (29.4)
5 Shortage of trained personnel 17 (50)
6 Quarterly ordering interval (long interval) 6 (17.7)

4.8. Recommendation on essential medicine availability and control
Majority of participant said that increase storage size and number of trained staff
were the strategies for medicines control and availability. Howe ever 5 (14.2%)
recommend self procurement as good strategy for medicine control and availability,
while 3 (8.5%) had no any recommendation (Table 4.8).

26

Table 4.8 Reported recommendation for medicine control and availability:
Statements No. of respondent
(%)
To increase storage size of essential
medicines
28 (80)
To increase number of trained staff 18 (51)
Self procure of essential medicines which
were missed from MSD
5 (14.2)
Need training of essential medicine on
inventory management
14 (40)
To add some essential medicines to the
scheduled list
4 (11.4)
No recommendation 3 (8.5)
















27

CHAPTER FIVE: DISCUSSION

In Tanzania essential medicines are expensive and constitute a large proportion of MOHSW
expenditure as well as donor funds, hence they require very efficient management in order to
realize its impact to the health service provision. Lack of skills on inventory management of
medicines in Tanzania contributes to the interruption of the supply chain of essential medicines
(MSH/WHO, 1997).This may result into patient not being able to receive medicines promptly,
frequent stock-outs, late deliveries and unnecessary expire of medicines at the facility. These
causes not only lose confidence in the facilities by patients but also waste of financial resources
and decrease in quality of patient care.

It is expected that these findings can be utilized in many ways in providing better solutions of
inventory management for essential medicines, hence, improving availability of essential
medicine in the public health facilities at Chunya District. Also policy-makers and health
managers that are involved in planning training activities will help to address these challenges
facing inventory management, and thus ensuring constant availability of these essential
medicines and properly manage

Across all surveyed lower level of public health facilities (Health centers and Dispensaries) in
Chunya district had no pharmaceutical personnel. This indicates that there is still a shortage of
pharmaceutical personnel in Chunya district especially pharmaceutical technicians and
pharmaceutical assistants. These are responsible in doing operation duties on essential medicines
management and properly delivering the services to the community. Medical attendant, Nurses,
Clinical officers and Assistant Medical Officer were found as the key personnel on stock
management, basically they lack important knowledge and skills in managing medicines. This
was almost the same with the study conducted in public hospitals in Dar es Salaam (Kagashe et
al, 2012 ), Mbeya (Mwakalewesya et al, (2012 )

and private sector Dar es Salaam (Minzi et al,
2008) which shows that nurses and clinical officers involved in essential medicines management.

28

Inventory control is the process of managing inventory in order to meet customer demand at the
lowest possible cost and with a minimum investment (Blackburn J, et al (2010)). Several
objectives in inventory control such as minimize inventory investment; determine the appropriate
of customer service level; balance supply and demand; minimize ordering cost and holding cost;
also preservation of inventory control system.
One of the models in controlling inventory is safety stock. Safety stock must be considered
where there is an uncertainty in demand; also safety stock is needed during the replenishment
lead time when there is a mismatch between actual demand and expected demand (Blackburn J,
2010). This study shows that, the knowledge on safety stock formula was low, nearly only 13
(37.1%) of participant got the correct answer for it. This finding was almost the same compared
to the results of a recent study that was conducted in Dar es Salaam; in which sixty six percent of
respondents said there was no predetermined time for placing orders for different medicines
stored ( Kagashe et al, 2012).
Additionally, about 74.3% and 62.3% of the participant didnt know if reorder level and lead
time respectively as variables used during ordering process. This number is higher compared
with the findings of study that was conducted in Mbeya (Mwakalewesa E, et al (2012), and
Malawi (Lufesi A et al, 2007). These studies shows that, personnel in Mbeya and Malawi who
handle medicines were not able apply the concept of lead-time in managing availability of
medicines in the public hospitals were 39.3% and 52% respectively. These differences were due
to the fact that lower level health facilities lack high number of competent personnel on
inventory management. Also finding was almost the same with the study conduct in Dar es
salaam, Tanzania (Kagashe et al 2012) which shows that no single item (medicine) whose time
for placing order was predetermined. This shows that participants had low awareness on the
variables used during ordering process.
Quantification process of medicines required two methods, the consumption method and the
morbidity method (MSH/WHO 1997). The consumption method look on the average amounts of
medicines consumed monthly as the basis for calculations. The morbidity method involve
knowledge of disease pattern of the area which the health facility is serving and from that the
incidence of common diseases, the expected attendances and standard treatment patterns are
29

considered to estimate the needs (MSH/WHO 1997). The study shows that, knowledge on the
types of method used for quantification was low, as it was reported that about 12 (34.3%) of the
participant scored the correct answer. The same results was obtained from the study conducted
in Dar es Saalam (Kagashe et al 2012) whereby sixty five percent (65%) were incapable to
mention the quantification methods used. This implies that most of the staff involved in
medicines stock control does not know quantification methods.
Storage conditions, dimensions of store buildings in some of the health facilities were not
sufficient enough to store medicines according to recommended guidelines as described by
(MSH,2000). Proper arrangement of medicines was found to be impossible in some of health
facilities due to poor storage space, recommended FIFO system and pharmacological
arrangement were impossible to implement. In some stores, roofs and floor were not as smooth
and intact as recommended and sometimes medicines were found placed on floor without pellets,
the situation which threaten the efficacy of the medicines.
The finding was almost slightly the same with the one conducted in Dar es Salaam whereby
shelved were not enough, no good arrangement and presence of dust in Temeke, Amana and
Mwananyamala hospitals (Kagashe et al 2012). Additionally, same finding from the study
conducted in Mbeya shows poor storage space (Mwakalewesya et al 2012).

On the other hand , this may result into risks for people working in these stores as some dust
from medicines can cause allergy and drug interactions. Also if medicines not well arranged may
lead to mixing up of items especially when the packages of the items are similar. Poor storage
condition, may be due to absence of fund allocation for maintenance and building of new store
buildings

A number of factors were sighted as causes of out of stock. The study reported that delayed
delivery and presence of missed items were the major factors contributing to stock out at the
facility. This was almost quite difference from the study conducted in Public Hospital, Dar es
Salaam (Kagashe et al, 2012) where lack of funds was a major cause. This difference was due to
the fact that lower level health facilities located far away from the MSD offices and made their
30

order on quarterly basis as oppose to hospitals which ordered regularly and bought medicines in
the private pharmacies. Additionally, the difference may due to the fact that these lower level
facilities do not have direct possessed of money/funds to procure medicines for themselves.

However there were great challenges facing these health facilities in managing health
commodities. The study revealed that, lack of enough space and shortages of trained personnel
were the main challenges facing management of commodities. These finding was slightly the
same with the study conducted in Ghana on assessment of Health Commodities Management
Practices in Health Care Delivery (Annan J et al, (2012).















31

CHAPTER SIX: CONCLUSION AND RECOMMENDATIONS
Conclusion
The study reveals that all staff manages essential medicines in lower level health facilities do not
posses enough skill on inventory management. Storage conditions at the health facilities were not
good. Stock outs of medicines in the health facilities is not solely due to poor inventory
management but also lack fund and late delivery from the MSD which is the solely source of
essential medicines. Shortage of skilled staffs and lack of enough storage spaces were the main
challenges facing management of health related commodities at the lower level of public health
facilities.















32

Recommendations
1. Training staff on procurement and inventory management will make these commodities
readily available and improve the service level. The curriculum in the universities and
colleges that provide pharmaceutical education should be reviewed to accommodate the
Inventory management aspects, this should also include other health related colleges
because they play important role in providing pharmaceutical services.

2. Improving the human resources crisis on pharmaceutical management at the lower level of public
health facilities is needed. There is need for the government to work with professional
organizations, regulatory bodies, training institutions to develop long term workforce plans. For
example expanding the ability of existing training institution to train more Pharmaceutical
assistant and Pharmaceutical technician in order to improve pharmaceutical services in the lower
level health facilities where there are few or no registered pharmaceutical personnel

3. On job training on Inventory management should be given priority in all staff dealing in
managing medicines inventories, this is important to equip them with changes that
happening in both pharmaceutical and Inventory management fields. This can be done
through the routinely supervision done by higher level health facilities

4. Sensitization of staff about the benefits of adopting effective commodities management
best practices to boost the performance of our health facilities in terms of the service
delivery.






33

CHAPTER SEVEN: REFERENCES

Annan J et al (2012): An Assessment of Health Commodities Management Practices in Health
Care Delivery in Ghana: The Case of Selected Hospitals in Ashanti Region-Ghana

Battersby, A., Goodman , C, Abondo, C., and Mandike, R. (2003). Improving the supply,
distribution and use of antimalarial drugs by the private sector in Tanzania. Malaria
Consortium.

Bhattari, HR. (2004). Assessment of pharmaceutical management information and monitoring
and evaluation of the republic of Namibia. Lundu: WarnerBook.

Cheng S. H, Graham J. Whittemore, (2008). An Engineering Approach to Improving Hospital
Supply Chains, M.Eng Thesis, Massachusetts Institute of Technology, USA,
Hugo Rivard-Royer, Sylvain Landry, Martin Beaulieu, (2002). Hybrid Stockless: A Case Study:
Lessons for Healthcare Supply Chain Integration, International Journal of Operations
and Production Management. 22: 412-424.

Jeff Blackburn,(2010). Fundamental of Purchasing and Inventory Control for Certified
Pharmacy Technicians: A Knowledge Based Course, The Texas Tech University.

John Snow, Inc./DELIVER( 2003). Baseline Survey for Integrated Logistics System. Arlington,
Va: for the U.S. Agency for International Development.

John Snow, Inc./DELIVER, ( 2003). Tanzania: Commodity Availability for Selected Health
Products

Kagashe et al, (2012). Medicines stock out and inventory management problems in public
hospitals in Tanzania: A case of Dar es Salaam Region Hospitals. Int J Pharm 2: 252-259.
34

Lufesi, N., Andrew, M., and Auresness, I. (2007). Deficient supplies of drugs for Life
threatening diseases in an African Community. BMC-Health Services Research
Journal.2007.

Minzi, OMS et al (2008). Pharmacies in Tanzania: The need for involving the private sector in
policy preparation and implementation. East African Journal of Public Health: 5:117-121.

MOHSW (Ministry of health and social welfare), (2003). In depth assessment of the medicine
supply system .Government Printer

MSH. (1997). Managing drug supply. United state of America by Kumarian pess.

MSH. (Management of science for health), (2000). Pharmaceutical management for malaria
assessment and training manual 12
th
edition.

MSH. (Management Science for Health), 1997. Management Science for health. Managing drug
supply; the selection, procurement, distribution and use of Pharmaceuticals. Kumarian
Press. Second edition, revised and expanded.

MSH. (Management science for Health). (1991). Pharmacy inventory control operations
manual, Belize Ministry of health, Boston.

Muyingo S et al. (2000). Baseline assessment of drug Logistics systems in twelve DISH-
supported District and service delivery points (SDPs); DISH II project report.

Mwakalewesya et al, (2012): Inventory management of essential medicines of topten diseases in
Districct Hospitals of Mbeya Region.

Nakanyazi, JK, Kitutu, KY., Oria, H., and Kamba, PF. (2010). Expire Medicines in supply
outlets inn Uganda. Bull Word Health Organ.
35


Nakyanzi JK et al , (2010). Expiry of medicines in supply outlets in Uganda. Bulletin of World
Health Organization: 88:2.

P. Garry Jarrett, (2006). The Benefits and Implications of Implementing Just-In-Time System
in the Healthcare Industry, Leadership in Health Service. 19:1-9.

Silumbe, R. (2011). Pharmaceutical Management and Prescribing pattern of Antimalarial drugs
in the Public Health facilities in Dar es salaam, July 2011.

Talafha H, (2006). Assessment of Pharmacy and Inventory Control in Ministry of Health
Hospitals in Jordan. Bethesda, MD: The Partners for Health Reform plus Project, Abt
Associates Inc.



36

APPENDICES
APPENDIX I: Questionnaire: Investigation of challenges facing inventory management
of essential medicines.
Self-completed questionnaire:
SECTION A: DEMOGRAPHIC CHARACTERISTICS
1. Sex
2. Age .
3. Name of Health Facility
4. Professional
SECTION B: KNOWLEDGE
A. Please select correct answer by putting a tick ( ) against each correct statement
in the table below.
No. Scenario (classification)
Agree Disagree `Unsure
1 Ledger and bin card are among document
used to control medicines

2 Formula of Safety stock is the is the lead time
(LT) multiplied by the average month
consumption

3 Morbidity is one of the methods used during
quantification

4 One of the reasons to held stock in hand is to
maintain confidence of the health system





37

B. The following is the list of essential variable to be aware with during ordering
Scenario Agree Disagree `Unsure
5 Average consumption
6 Lead time
7 Safety stock
8 Reorder level
9 Maximum stock level
10 Stock position

11
Procurement period

SECTION C: Working place and Storage condition
A. Storage condition of medicine checklist (MSH, 1997):
1. Observation of the following aspects in the medicine storage area
DESCRIPTION Y N COMMENTS
1. Medicines are arranged so that identification labels
and expiry dates and manufacturing dates are visible.

2. Medicines are stored and organized in a manner
accessible for first-expiry, first out counting and
general management.

3. The facility makes it a practice to separate damaged
and expired medicines from inventory.

4. Medicines are stored at the appropriate temperature
according to temperature specification.

5. Roof is maintained in good condition to avoid
sunlight and water penetration at all times.

6. Storeroom is maintained in good condition (eg it
clean, shelves are sturdy, boxes are organized).

7. Current space and organization is sufficient for
existing medicines

38

DESCRIPTION Y N COMMENTS
8. Product are stacked at least 10cm off the floor.
9. Medicines are stacked at least 30cm away from the
walls.

10. Medicines are stored separately from insecticides
and chemicals.


2. Did you encounter any problem during preparation of an order? (Yes/No)
3. The following are problems encountered during preparation and delaying
sending R & R forms during ordering the essential (tick more than one option)
Statements No. of respondent
1 Difficulties in calculation (formula)
2 Plenty of medicines on the scheduled ordering forms

3 Lack of stationery material (eg. calculator)
5 Poor knowledge on logistic tools
6 Few number of staffs,
7 Transportation and communication problems

4. Did you run out of stock for essential medicine recently? Yes/ No.
If Yes, what are the reasons for out of stock?
.
..

39

5. Did you face any challenge during management of health commodities? Yes/No
If yes, what are those challenges?
.
..

SECTION D: OTHERS
1. In your own opinion what should be done in order to improve medicines availability
and control at your health facility?

....
Thank you very much for your time. The information you have provided is very
valuable. We will be happy to discuss our findings with you and are open to any
suggestions you may have. Thanks again for your assistance








40

APPENDIX II: Informed consent agreement
Assessment of the challenges facing inventory management of essential medicines in lower level
of public health facilities.
Introduction
This Consent Form contains information about the research named above. In order to be sure that
you are informed about being in this research, we are asking you to read (or have read to you)
this Consent Form. You will also be asked to sign it (or make your mark in front of a witness).
We will give you a copy of this form. This consent form might contain some words that are
unfamiliar to you. Please ask us to explain anything you may not understand
Reasons for research
You are being invited to take part in a research project, which aims to assess the inventory
management of essential medicines to lower level health facilities.
Your decision to take part in the study is voluntary and you may refuse to take part or to stop
taking part at any time and you may refuse to answer any question asked.
This study has been given approval from the Directorate of research and publication committee
of Tanzania Institute of Accountancy and permission to do research has been obtained from the
Chunya District Excutive Director.
Procedure
If you agree to participate, you will be required to fill questionnaire. The questionnaire will ask
you about your demographic characteristics, knowledge and practices on inventory management
and challenges facing inventory management. The questionnaire will take about 15 30 min.

Benefit
The information you provide will help us to design a better guideline for inventory control of
medicine and address the challenges associated with inventory management of medicine. Your
information will be useful to researchers, policy makers, health professionals, and communities.
Risk/Discomfort
Some of the questions may be sensitive, so you might feel uncomfortable at the same time we are
going to take your time.

41

Alternative
The only alternative is not to take part in this study.
Study withdrawal
You can stop being a study participant at any time. During the interview, you can stop the
interview by asking the interviewer to stop. The interviewer may stop you from being in the
study if he or she believes youre unable to answer questions because of tiredness.
Cost/Compensation
This exercise is voluntary, therefore there will be no payment given to the patients.
Confidentiality
All the information you provide will be confidential. Code number will identify the information
you provide in research record. We will not use your identity in any report or publication about
this research.
Questions
In case you have any question(s) you can ask the principle investigator in this study Twaha
Kabandika whose phone number is 0767918184 ans Mr. Swallo C. G.
(Research Supervisor) (0712468836).
They will be glad to answer any question at any time.
Acceptance
If you have understood and ready to participate please sign below;
Signature of the respondent/or witness. Date