Poor supply chain management and stock-outs of point-of-care diagnostic tests in Upper East Region’s primary healthcare clinics, Ghana
Several supply chain components are important to sustain point-of-care (POC) testing services in rural settings. To evaluate the availability of POC diagnostic tests in rural Ghana's primary healthcare (PHC) clinics, we conducted an audit of the supply chain management for POC diagnostic servic...
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| Published in: | PloS one Vol. 14; no. 2; p. e0211498 |
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27.02.2019
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| ISSN: | 1932-6203, 1932-6203 |
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| Abstract | Several supply chain components are important to sustain point-of-care (POC) testing services in rural settings. To evaluate the availability of POC diagnostic tests in rural Ghana's primary healthcare (PHC) clinics, we conducted an audit of the supply chain management for POC diagnostic services in rural Upper East Region's (UER) PHC clinics, Ghana to determine the reasons/causes of POC tests deficiencies.
We conducted a review of accessible POC diagnostics in 100 PHC clinics in UER, Ghana from February to March 2018. We used a monitoring audit tool adopted from the World Health Organization and Management Science for Health guidelines for supply chain management of diagnostics for compliance. We determined a clinic's compliance with the stipulated guidelines, and a composite compliant score was defined as a percentage rating of 90 to 100%. We used univariate logistic regression analysis in Stata 14 to determine the level of association between supply chain management and the audit variables.
Overall, the composite compliant score of supply chain management for existing POC tests was at 81% (95%CI: 79%-82%). The mean compliance with distribution guidelines was at 93.8% (95%CI: 91.9%-95.6%) the highest score, whilst inventory management scored the lowest, at 53.5% (95%CI: 49.5%-57.5%) compliance. Of the 13 districts in the region, the results showed complete stock-out of blood glucose test in all selected PHC clinics in seven (53.8%) districts, haemoglobin and hepatitis B virus test in three (23.1%), and urine protein test in two (15.4%) districts. Based on our univariate logistics regression models, stock-out of tests at the Regional Medical and District Health Directorates stores in the region, high clinic attendance, lack of documentation of expiry date/expired tests, poor documentation of inventory level, poor monitoring of monthly consumption level, and failure to document unexplained losses of the various POC tests were significant predictors of complete test stock-out in most of the clinics in the Upper East Region.
There is poor supply chain management of POC diagnostic tests in UER's PHC clinics. Improvement in inventory management and human resource capacity for POC testing is critical to ensure accessibility and sustainability of POC diagnostic services in resource-limited settings PHC clinics. |
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| AbstractList | Several supply chain components are important to sustain point-of-care (POC) testing services in rural settings. To evaluate the availability of POC diagnostic tests in rural Ghana's primary healthcare (PHC) clinics, we conducted an audit of the supply chain management for POC diagnostic services in rural Upper East Region's (UER) PHC clinics, Ghana to determine the reasons/causes of POC tests deficiencies.INTRODUCTIONSeveral supply chain components are important to sustain point-of-care (POC) testing services in rural settings. To evaluate the availability of POC diagnostic tests in rural Ghana's primary healthcare (PHC) clinics, we conducted an audit of the supply chain management for POC diagnostic services in rural Upper East Region's (UER) PHC clinics, Ghana to determine the reasons/causes of POC tests deficiencies.We conducted a review of accessible POC diagnostics in 100 PHC clinics in UER, Ghana from February to March 2018. We used a monitoring audit tool adopted from the World Health Organization and Management Science for Health guidelines for supply chain management of diagnostics for compliance. We determined a clinic's compliance with the stipulated guidelines, and a composite compliant score was defined as a percentage rating of 90 to 100%. We used univariate logistic regression analysis in Stata 14 to determine the level of association between supply chain management and the audit variables.MATERIAL AND METHODSWe conducted a review of accessible POC diagnostics in 100 PHC clinics in UER, Ghana from February to March 2018. We used a monitoring audit tool adopted from the World Health Organization and Management Science for Health guidelines for supply chain management of diagnostics for compliance. We determined a clinic's compliance with the stipulated guidelines, and a composite compliant score was defined as a percentage rating of 90 to 100%. We used univariate logistic regression analysis in Stata 14 to determine the level of association between supply chain management and the audit variables.Overall, the composite compliant score of supply chain management for existing POC tests was at 81% (95%CI: 79%-82%). The mean compliance with distribution guidelines was at 93.8% (95%CI: 91.9%-95.6%) the highest score, whilst inventory management scored the lowest, at 53.5% (95%CI: 49.5%-57.5%) compliance. Of the 13 districts in the region, the results showed complete stock-out of blood glucose test in all selected PHC clinics in seven (53.8%) districts, haemoglobin and hepatitis B virus test in three (23.1%), and urine protein test in two (15.4%) districts. Based on our univariate logistics regression models, stock-out of tests at the Regional Medical and District Health Directorates stores in the region, high clinic attendance, lack of documentation of expiry date/expired tests, poor documentation of inventory level, poor monitoring of monthly consumption level, and failure to document unexplained losses of the various POC tests were significant predictors of complete test stock-out in most of the clinics in the Upper East Region.RESULTSOverall, the composite compliant score of supply chain management for existing POC tests was at 81% (95%CI: 79%-82%). The mean compliance with distribution guidelines was at 93.8% (95%CI: 91.9%-95.6%) the highest score, whilst inventory management scored the lowest, at 53.5% (95%CI: 49.5%-57.5%) compliance. Of the 13 districts in the region, the results showed complete stock-out of blood glucose test in all selected PHC clinics in seven (53.8%) districts, haemoglobin and hepatitis B virus test in three (23.1%), and urine protein test in two (15.4%) districts. Based on our univariate logistics regression models, stock-out of tests at the Regional Medical and District Health Directorates stores in the region, high clinic attendance, lack of documentation of expiry date/expired tests, poor documentation of inventory level, poor monitoring of monthly consumption level, and failure to document unexplained losses of the various POC tests were significant predictors of complete test stock-out in most of the clinics in the Upper East Region.There is poor supply chain management of POC diagnostic tests in UER's PHC clinics. Improvement in inventory management and human resource capacity for POC testing is critical to ensure accessibility and sustainability of POC diagnostic services in resource-limited settings PHC clinics.DISCUSSIONThere is poor supply chain management of POC diagnostic tests in UER's PHC clinics. Improvement in inventory management and human resource capacity for POC testing is critical to ensure accessibility and sustainability of POC diagnostic services in resource-limited settings PHC clinics. INTRODUCTION:Several supply chain components are important to sustain point-of-care (POC) testing services in rural settings. To evaluate the availability of POC diagnostic tests in rural Ghana's primary healthcare (PHC) clinics, we conducted an audit of the supply chain management for POC diagnostic services in rural Upper East Region's (UER) PHC clinics, Ghana to determine the reasons/causes of POC tests deficiencies. MATERIAL AND METHODS:We conducted a review of accessible POC diagnostics in 100 PHC clinics in UER, Ghana from February to March 2018. We used a monitoring audit tool adopted from the World Health Organization and Management Science for Health guidelines for supply chain management of diagnostics for compliance. We determined a clinic's compliance with the stipulated guidelines, and a composite compliant score was defined as a percentage rating of 90 to 100%. We used univariate logistic regression analysis in Stata 14 to determine the level of association between supply chain management and the audit variables. RESULTS:Overall, the composite compliant score of supply chain management for existing POC tests was at 81% (95%CI: 79%-82%). The mean compliance with distribution guidelines was at 93.8% (95%CI: 91.9%-95.6%) the highest score, whilst inventory management scored the lowest, at 53.5% (95%CI: 49.5%-57.5%) compliance. Of the 13 districts in the region, the results showed complete stock-out of blood glucose test in all selected PHC clinics in seven (53.8%) districts, haemoglobin and hepatitis B virus test in three (23.1%), and urine protein test in two (15.4%) districts. Based on our univariate logistics regression models, stock-out of tests at the Regional Medical and District Health Directorates stores in the region, high clinic attendance, lack of documentation of expiry date/expired tests, poor documentation of inventory level, poor monitoring of monthly consumption level, and failure to document unexplained losses of the various POC tests were significant predictors of complete test stock-out in most of the clinics in the Upper East Region. DISCUSSION:There is poor supply chain management of POC diagnostic tests in UER's PHC clinics. Improvement in inventory management and human resource capacity for POC testing is critical to ensure accessibility and sustainability of POC diagnostic services in resource-limited settings PHC clinics. Several supply chain components are important to sustain point-of-care (POC) testing services in rural settings. To evaluate the availability of POC diagnostic tests in rural Ghana's primary healthcare (PHC) clinics, we conducted an audit of the supply chain management for POC diagnostic services in rural Upper East Region's (UER) PHC clinics, Ghana to determine the reasons/causes of POC tests deficiencies. We conducted a review of accessible POC diagnostics in 100 PHC clinics in UER, Ghana from February to March 2018. We used a monitoring audit tool adopted from the World Health Organization and Management Science for Health guidelines for supply chain management of diagnostics for compliance. We determined a clinic's compliance with the stipulated guidelines, and a composite compliant score was defined as a percentage rating of 90 to 100%. We used univariate logistic regression analysis in Stata 14 to determine the level of association between supply chain management and the audit variables. Overall, the composite compliant score of supply chain management for existing POC tests was at 81% (95%CI: 79%-82%). The mean compliance with distribution guidelines was at 93.8% (95%CI: 91.9%-95.6%) the highest score, whilst inventory management scored the lowest, at 53.5% (95%CI: 49.5%-57.5%) compliance. Of the 13 districts in the region, the results showed complete stock-out of blood glucose test in all selected PHC clinics in seven (53.8%) districts, haemoglobin and hepatitis B virus test in three (23.1%), and urine protein test in two (15.4%) districts. Based on our univariate logistics regression models, stock-out of tests at the Regional Medical and District Health Directorates stores in the region, high clinic attendance, lack of documentation of expiry date/expired tests, poor documentation of inventory level, poor monitoring of monthly consumption level, and failure to document unexplained losses of the various POC tests were significant predictors of complete test stock-out in most of the clinics in the Upper East Region. There is poor supply chain management of POC diagnostic tests in UER's PHC clinics. Improvement in inventory management and human resource capacity for POC testing is critical to ensure accessibility and sustainability of POC diagnostic services in resource-limited settings PHC clinics. Several supply chain components are important to sustain point-of-care (POC) testing services in rural settings. To evaluate the availability of POC diagnostic tests in rural Ghana's primary healthcare (PHC) clinics, we conducted an audit of the supply chain management for POC diagnostic services in rural Upper East Region's (UER) PHC clinics, Ghana to determine the reasons/causes of POC tests deficiencies. We conducted a review of accessible POC diagnostics in 100 PHC clinics in UER, Ghana from February to March 2018. We used a monitoring audit tool adopted from the World Health Organization and Management Science for Health guidelines for supply chain management of diagnostics for compliance. We determined a clinic's compliance with the stipulated guidelines, and a composite compliant score was defined as a percentage rating of 90 to 100%. We used univariate logistic regression analysis in Stata 14 to determine the level of association between supply chain management and the audit variables. Overall, the composite compliant score of supply chain management for existing POC tests was at 81% (95%CI: 79%-82%). The mean compliance with distribution guidelines was at 93.8% (95%CI: 91.9%-95.6%) the highest score, whilst inventory management scored the lowest, at 53.5% (95%CI: 49.5%-57.5%) compliance. Of the 13 districts in the region, the results showed complete stock-out of blood glucose test in all selected PHC clinics in seven (53.8%) districts, haemoglobin and hepatitis B virus test in three (23.1%), and urine protein test in two (15.4%) districts. Based on our univariate logistics regression models, stock-out of tests at the Regional Medical and District Health Directorates stores in the region, high clinic attendance, lack of documentation of expiry date/expired tests, poor documentation of inventory level, poor monitoring of monthly consumption level, and failure to document unexplained losses of the various POC tests were significant predictors of complete test stock-out in most of the clinics in the Upper East Region. There is poor supply chain management of POC diagnostic tests in UER's PHC clinics. Improvement in inventory management and human resource capacity for POC testing is critical to ensure accessibility and sustainability of POC diagnostic services in resource-limited settings PHC clinics. |
| Audience | Academic |
| Author | Mashamba-Thompson, Tivani P. Kuupiel, Desmond Tlou, Boikhutso Bawontuo, Vitalis Drain, Paul K. |
| AuthorAffiliation | 2 Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana University of Cape Town Faculty of Health Sciences, SOUTH AFRICA 4 Division of Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, United States of America 3 International Clinical Research Centre, Department of Global Health, University of Washington, Seattle, Washington, United States of America 5 Department of Epidemiology, University of Washington, Seattle, Washington, United States of America 1 Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa |
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| References_xml | – volume: 10 start-page: e0127728 issue: 6 year: 2015 ident: ref8 article-title: Introduction of syphilis point-of-care tests, from pilot study to national programme implementation in Zambia: a qualitative study of healthcare workers’ perspectives on testing, training and quality assurance publication-title: PloS one doi: 10.1371/journal.pone.0127728 – volume: 4 start-page: S7 issue: 12 year: 2006 ident: ref18 article-title: Why do we need quality-assured diagnostic tests for sexually transmitted infections? publication-title: Nature reviews Microbiology doi: 10.1038/nrmicro1569 – volume: 11 start-page: 684 issue: 9 year: 2011 ident: ref26 article-title: Effectiveness of interventions to improve screening for syphilis in pregnancy: a systematic review and meta-analysis publication-title: The Lancet infectious diseases doi: 10.1016/S1473-3099(11)70104-9 – ident: ref1 – ident: ref20 – volume: 7 start-page: 384 issue: 6 year: 2015 ident: ref6 article-title: Diagnostics in a digital age: an opportunity to strengthen health systems and improve health outcomes publication-title: Int Health doi: 10.1093/inthealth/ihv062 – volume: 14 year: 2014 ident: ref2 article-title: Diagnostic point-of-care tests in resource-limited settings publication-title: Lancet Infect Dis doi: 10.1016/S1473-3099(13)70250-0 – ident: ref24 – ident: ref22 doi: 10.1080/14737159.2017.1273773 – volume: 13 start-page: 295 issue: 1 year: 2014 ident: ref10 article-title: Rapid diagnostic test supply chain and consumption study in Cabo Delgado, Mozambique: estimating stock shortages and identifying drivers of stock-outs publication-title: Malaria journal doi: 10.1186/1475-2875-13-295 – volume: 130 start-page: S58 issue: Suppl 1 year: 2015 ident: ref9 article-title: Assessment of the impact of rapid syphilis tests on syphilis screening and treatment of pregnant women in Zambia publication-title: International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics doi: 10.1016/j.ijgo.2015.04.015 – volume: 205 start-page: S181 issue: suppl_2 year: 2012 ident: ref25 article-title: Perspectives on introduction and implementation of new point-of-care diagnostic tests publication-title: Journal of Infectious Diseases doi: 10.1093/infdis/jis203 – volume: 7 start-page: 58 issue: 4 year: 2017 ident: ref5 article-title: Improving the Accessibility and Efficiency of Point-of-Care Diagnostics Services in Low-and Middle-Income Countries: Lean and Agile Supply Chain Management publication-title: Diagnostics doi: 10.3390/diagnostics7040058 – ident: ref32 – ident: ref14 doi: 10.1016/j.heliyon.2019.e01236 – ident: ref13 doi: 10.1016/j.heliyon.2019.e01236 – volume: 62 start-page: 369 issue: 3 year: 2016 ident: ref19 article-title: Access and Quality of HIV-Related Point-of-Care Diagnostic Testing in Global Health Programs publication-title: Clin Infect Dis doi: 10.1093/cid/civ866 – volume: 9 start-page: e1001233 issue: 6 year: 2012 ident: ref21 article-title: Point-of-care tests to strengthen health systems and save newborn lives: the case of syphilis publication-title: PLoS medicine doi: 10.1371/journal.pmed.1001233 – volume: 4 start-page: 1271 issue: 10 year: 2009 ident: ref29 article-title: Diagnostic challenges of sexually transmitted infections in resource-limited settings publication-title: Future microbiology doi: 10.2217/fmb.09.100 – volume: 23 start-page: 814 issue: 7 year: 2011 ident: ref30 article-title: Operational challenges in delivering CD4 diagnostics in sub-Saharan Africa publication-title: AIDS Care doi: 10.1080/09540121.2010.541416 – volume: 130 start-page: S70 issue: Supplement 1 year: 2015 ident: ref7 article-title: Lessons learned from integrating simultaneous triple point-of-care screening for syphilis, hepatitis B, and HIV in prenatal services through rural outreach teams in Guatemala publication-title: International Journal of Gynecology & Obstetrics doi: 10.1016/j.ijgo.2015.04.009 – volume: 18 start-page: 130 issue: 1 year: 2018 ident: ref31 article-title: Rollout of rapid point of care tests for antenatal syphilis screening in Ghana: healthcare provider perspectives and experiences publication-title: BMC health services research doi: 10.1186/s12913-018-2935-y – volume: 9 start-page: e1001306 issue: 9 year: 2012 ident: ref3 article-title: Point-of-care testing for infectious diseases: diversity, complexity, and barriers in low- and middle-income countries publication-title: PLoS Med doi: 10.1371/journal.pmed.1001306 – volume: 12 start-page: 695 issue: 1 year: 2012 ident: ref11 article-title: Parasite-based malaria diagnosis: Are Health Systems in Uganda equipped enough to implement the policy? 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| SubjectTerms | Analysis Biology and Life Sciences Blood glucose Blood glucose tests Business logistics Cross-Sectional Studies Engineering and Technology Ghana Glucose Health care services accessibility Hemoglobins Hepatitis Hepatitis B virus Inventory control Logistic Models Management Management science Medical testing products Medical tests Medicine and Health Sciences People and Places Point-of-Care Testing - organization & administration Point-of-Care Testing - standards Primary Health Care Public health Reagent Kits, Diagnostic - supply & distribution Regression analysis Rural Health Services - organization & administration Rural Health Services - standards Rural Health Services - supply & distribution Stocks Sustainable development |
| Title | Poor supply chain management and stock-outs of point-of-care diagnostic tests in Upper East Region’s primary healthcare clinics, Ghana |
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