Menu
Menu
Menu
Menu
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.
This study was approved by the Navrongo Health Research Centre Institutional Review Board/Ghana Health Service (approval number: NHRCIRB291) and the University of KwaZulu-Natal Biomedical Research Ethics Committee (approval number: BE565/17). Permission was obtained from the Upper East Regional Health Directorate prior to the conduct of this study. All study participants also signed an informed consent prior to participating in the study. This is a cross-sectional study, which involved an audit of the role of supply chain management of POC diagnostic test accessibility in rural PHC clinics in the UER of Ghana. This current study is a follow-up on a prior study involving 100 rural PHC clinics from all 13 districts aimed at assessing the accessibility of POC diagnostic services for maternal health in rural PHC clinics in the UER [13]. The findings of the previous study demonstrated low availability of POC test (less than 5 tests for most of the clinics. Supply chain management was found to be a major barrier hence; informing our decision to conduct this follow-up study to audit the supply chain management for POC diagnostic tests to determine the reasons for POC tests deficiencies. This study was conducted in the UER of Ghana. The region was chosen because it is the least (21%) urbanized in Ghana with a maternal mortality ratio of 108/100000 live births [20]. It is located in the north-eastern corner of Ghana, bordered by Burkina Faso to the north, Togo and the Upper West Region to the east and west respectively, and the Northern Region to the south. The region had 1188800 people in 2016 and is considered largely (79%) rural and scattered in dispersed settlements [20]. The main source of income for the majority of the population is farming. The region is divided into 13 administrative districts (Fig 1) and all were used in this study. This was a follow-up study to a prior study aimed at assessing the accessibility of POC diagnostic services for maternal healthcare in rural health facilities in the UER, Ghana [13]. The previous study used a multistage sampling strategy comprising stratified sampling, probability proportionate to size and simple random sampling to select 100 rural PHC clinics with representation from all the thirteen districts in the UER. All 100 PHC clinics were surveyed in this current study. This study was conducted from February to April 2018, using an audit tool adopted from Management Science for Health (MSH) laboratory diagnostic supply chain management [17] and WHO guidelines for selection of POC tests for rural PHC clinics [18]. The audit tool (S1 Table) was pre-tested in ten non-participating rural PHC clinics in the UER and adjusted to suit the local context based on feedback from respondents. The audit tool consisted of a set of questions, each aimed to assess the selection, inventory management, distribution, and human resource capacity for POC testing in the selected PHC clinics. In order to ensure the accuracy of the audit, the PHC clinics managers/supervisors were informed about the purpose of the audit and the procedures that would be followed. Data on the selection of POC diagnostics was obtained based on the WHO quality-ASSURED criteria for POC diagnostic selection for rural PHC clinics [18]. Data on the distribution of POC diagnostics, POC diagnostics storage and inventory management, and human resource capacity for POC testing were obtained using the audit tool in order to investigate the supply chain management of POC diagnostic tests of the selected rural PHC clinics. We also obtained data on stock levels of eight (8) POC tests: HIV, malaria, syphilis, haemoglobin, urine protein/albumin, urine pregnancy, blood glucose, and hepatitis B, in order to investigate deficiency and determine its relationship with the supply chain management. These tests were the top eight POC tests in the majority of the PHC clinics. These POC tests are also included in the first WHO essential list of diagnostics for resource-limited settings [1]. Finally, we took data on the average clinic attendance per month to facilitate the determination of the relationship between clinic attendance and POC test stock-out. The primary outcome of this study included supply chain management and stock levels of POC tests in all selected PHC clinics in the UER of Ghana. For supply chain management, one point (100%) was allotted to each question if all the requirements for the question were fulfilled for each of the components. A sum of the scores for each component was obtained to provide the overall percentage score. A score of 90 to 100% was considered “compliant” supply chain management, indicating strong, reliable, and satisfactory compliance with the stipulated guidelines. A rating of less than 90% was considered “non-compliant” supply chain management, indicating unsatisfactory compliance of the clinic to the stipulated MSH and the WHO guidelines. POC test stock-out was measured as either “Yes” or “No” of HIV test, malaria test, syphilis test, haemoglobin test, urine protein/albumin test, urine pregnancy test, blood glucose test, and hepatitis B test. That is, Yes = availability of test, and No = complete stock-out of test. Clinic attendance was measured as: 0–100 patients/clients per month = low attendance and > 100/month = high attendance. Data were analysed using Stata version 14. Frequencies, means, standard deviation as well as 95% confidence intervals (CI) were calculated for all eight POC tests audited. We used Univariate logistic regression to associate the independent (reasons for test stock-outs) variables with the dependent variable (POC tests for HIV, malaria, syphilis, haemoglobin, urine protein/albumin, urine pregnancy, blood glucose, and hepatitis B test) and p<0.05 was reported. Data from this study are the property of the University of KwaZulu-Natal and can be made publicly available. All interested researchers/readers/persons who meet the criteria for access to confidential data can access the dataset via Dr Tivani Mashamba-Thompson, the project supervisor and the Academic Leader (Research) for the School of Nursing and Public Health via this email address: az.ca.nzku@nospmohT-abmahsaM. Data access may also be requested from the University of KwaZulu-Natal Biomedical Research Ethics Committee (BREC) from the following contacts: The Chairperson BIOMEDICAL RESEARCH ETHICS ADMINISTRATION Research Office, Westville Campus, Govan Mbeki Building University of KwaZulu-Natal P/Bag {"type":"entrez-nucleotide","attrs":{"text":"X54001","term_id":"2135","term_text":"X54001"}}X54001, Durban, 4000 KwaZulu-Natal, South Africa Tel.: +27 31 260 4769 Fax: +27 31 260 4609 Email: az.ca.nzku@CERB.
