Access to Essential Medications and Equipment for Obstetric and Neonatal Primary Care in Bombali District, Sierra Leone

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Study Justification:
The study aims to address the increased demand for basic emergency obstetric and neonatal care (BEmONC) services in Sierra Leone, which has strained the capacity of the healthcare system to provide high-quality care. The evaluation of gaps in access to BEmONC in Bombali district will provide valuable insights into the challenges faced by primary health-care facilities in delivering essential medications and equipment for obstetric and neonatal care.
Highlights:
1. Evaluation of 97 primary health-care facilities in Bombali district, Sierra Leone.
2. Identification of gaps in access to essential medications and equipment for obstetric and neonatal care.
3. Findings indicate that most facilities have the necessary equipment but in unsatisfactory condition.
4. Lack of stock and proper storage of essential medicines in the majority of facilities.
5. Stronger supply chains are needed to improve health system performance, reduce maternal mortality, and increase neonatal survival.
6. The study aligns with the Sustainable Development Goals (SDGs) and their targets.
Recommendations:
1. Improve the condition of existing equipment in primary health-care facilities.
2. Strengthen the supply chains to ensure an adequate and consistent stock of essential medications.
3. Develop a system for proper storage and expiration monitoring of medications.
4. Increase investment in healthcare infrastructure and resources to meet the growing demand for BEmONC services.
5. Enhance training and capacity-building programs for healthcare providers in obstetric and neonatal care.
Key Role Players:
1. Ministry of Health and Sanitation, Sierra Leone.
2. District Health Management Team, Bombali district.
3. Primary health-care facility staff.
4. Non-governmental organizations working in healthcare.
5. Community leaders and representatives.
Cost Items for Planning Recommendations:
1. Equipment maintenance and repair.
2. Procurement and distribution of essential medications.
3. Infrastructure development and improvement.
4. Training and capacity-building programs for healthcare providers.
5. Monitoring and evaluation of supply chains and medication storage systems.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The research team visited all 97 functioning primary health-care facilities in Bombali district, providing a comprehensive evaluation. The abstract highlights gaps in access to essential medications and equipment for obstetric and neonatal care. However, the abstract does not provide specific data or statistical analysis to support the findings. To improve the strength of the evidence, the researchers could include quantitative data on the availability and condition of equipment, as well as the specific medications that were lacking in the facilities. Additionally, including information on the methodology used for the evaluation would enhance the credibility of the findings.

The increased demand for basic emergency obstetric and neonatal care (BEmONC) services in Sierra Leone since the launch of the nationwide free maternity care initiative in 2010 has strained the capacity of the system to provide high-quality care. In 2014, members of our research team visited all 97 functioning primary health-care facilities in Bombali district in the Northern Province of Sierra Leone to evaluate gaps in access to BEmONC. Although most facilities had the equipment necessary for maternal and neonatal care, these were often not in satisfactory condition. Most of the facilities did not stock all of the essential medicines for BEmONC, and less than 10 percent of the facilities had sufficient stocks of unexpired and properly stored medications. Stronger supply chains will be necessary to improve health system performance in Sierra Leone, reduce maternal mortality, increase neonatal survival, and achieve targets associated with the Sustainable Development Goals (SDGs).

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Title: Strengthening the Supply Chain for Essential Medications and Equipment in Bombali District, Sierra Leone
Description: This recommendation focuses on improving access to maternal health services in Bombali District by strengthening the supply chain for essential medications and equipment. The research conducted in Bombali District identified gaps in access to basic emergency obstetric and neonatal care (BEmONC) services, highlighting the need for improvements in procurement, distribution, storage, inventory management, monitoring, and collaboration with stakeholders. By implementing these recommendations, the supply chain for essential medications and equipment can be strengthened, leading to improved access to maternal health services and contributing to the reduction of maternal mortality and the achievement of the Sustainable Development Goals (SDGs). This research was published in the World Medical and Health Policy journal in 2019.
AI Innovations Description
Recommendation: Strengthening the Supply Chain for Essential Medications and Equipment

To improve access to maternal health in Bombali District, Sierra Leone, it is recommended to focus on strengthening the supply chain for essential medications and equipment. This recommendation is based on the findings from the research conducted in Bombali District, which highlighted gaps in access to basic emergency obstetric and neonatal care (BEmONC) services.

1. Improve procurement and distribution: Enhance the procurement process to ensure a reliable supply of essential medications and equipment. This includes establishing partnerships with reliable suppliers, implementing effective inventory management systems, and ensuring timely distribution to primary health-care facilities in Bombali District.

2. Enhance storage and inventory management: Provide training and support to health-care facility staff on proper storage and inventory management practices. This includes ensuring medications are stored in appropriate conditions to maintain their efficacy and safety. Regular monitoring and supervision can help identify and address any issues related to storage and inventory management.

3. Strengthen monitoring and reporting systems: Implement a robust monitoring and reporting system to track the availability and utilization of essential medications and equipment. This can help identify gaps and bottlenecks in the supply chain, enabling timely interventions to ensure consistent access to maternal health services.

4. Collaborate with stakeholders: Engage with relevant stakeholders, including government agencies, non-governmental organizations, and community leaders, to foster collaboration and support for improving the supply chain. This can involve sharing best practices, coordinating efforts, and mobilizing resources to address the challenges faced in accessing maternal health services.

By implementing these recommendations, the supply chain for essential medications and equipment can be strengthened, leading to improved access to maternal health services in Bombali District. This, in turn, can contribute to reducing maternal mortality, increasing neonatal survival rates, and achieving the targets set by the Sustainable Development Goals (SDGs).
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health in Bombali District, Sierra Leone, the following methodology can be used:

1. Baseline data collection: Collect data on the current state of the supply chain for essential medications and equipment in Bombali District. This includes information on procurement processes, inventory management, storage conditions, distribution, and availability of medications and equipment in primary health-care facilities.

2. Define indicators: Identify key indicators that will be used to measure the impact of the recommendations. These indicators can include the availability of essential medications and equipment, stockouts, storage conditions, distribution timelines, and utilization rates of maternal health services.

3. Intervention implementation: Implement the recommended interventions, such as improving procurement and distribution processes, enhancing storage and inventory management practices, strengthening monitoring and reporting systems, and collaborating with stakeholders. Ensure that appropriate training and support are provided to health-care facility staff.

4. Data collection post-intervention: Collect data on the indicators identified in step 2 after the implementation of the interventions. This can be done through surveys, interviews, and record reviews at primary health-care facilities in Bombali District.

5. Data analysis: Analyze the collected data to assess the impact of the interventions on the supply chain for essential medications and equipment. Compare the post-intervention data with the baseline data to identify any improvements or changes in the indicators.

6. Interpretation of results: Interpret the findings of the data analysis to determine the effectiveness of the interventions in improving access to maternal health services. Assess whether the recommendations have led to increased availability of essential medications and equipment, reduced stockouts, improved storage conditions, and enhanced utilization rates of maternal health services.

7. Recommendations and next steps: Based on the results of the analysis, provide recommendations for further improvements in the supply chain for essential medications and equipment. Identify any additional interventions or adjustments that may be needed to sustain and enhance the impact of the recommendations.

By following this methodology, researchers and policymakers can assess the impact of the recommended interventions on improving access to maternal health in Bombali District, Sierra Leone. This information can guide future efforts to strengthen the supply chain and ultimately contribute to reducing maternal mortality and improving neonatal survival rates.

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