Availability of drugs and medical supplies for emergency obstetric care: Experience of health facility managers in a rural District of Tanzania

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Study Justification:
– The study aimed to describe the experience of rural health facility managers in ensuring the timely availability of drugs and medical supplies for emergency obstetric care (EmOC).
– The provision of quality EmOC relies on the presence of skilled health attendants working in an environment where drugs and medical supplies are available when needed and in adequate quantity and of assured quality.
– The study aimed to identify the challenges and barriers faced by health facility managers in obtaining drugs and medical supplies for EmOC.
Highlights:
– Participants reported on the unreliability of obtaining drugs and medical supplies for EmOC.
– The absence of essential items was observed during the facility survey, indicating a lack of availability.
– The unreliability of obtaining drugs and medical supplies resulted in the provision of untimely and suboptimal EmOC services.
– Insufficient budget for drugs from the central government, lack of accountability within the supply system, and a bureaucratic process of accessing the locally mobilized drug fund were reported as contributing factors.
Recommendations:
– Multiple approaches should be used to address challenges within the health system that prevent access to essential drugs and supplies for maternal health.
– There should be a special focus on improving the governance of the drug delivery system, promoting accountability of key players, transparency in the handling of information and drug funds, and the participation of key stakeholders in decision making over the allocation of locally collected drug funds.
Key Role Players:
– Health facility managers
– Council Health Management Team (CHMT) members
– Council Health Service Board (CHSB) members
– District Medical Officer (DMO)
– District Pharmacist
– Chairperson of the CHSB
Cost Items for Planning Recommendations:
– Budget for drugs and medical supplies
– Funding for improving the governance of the drug delivery system
– Resources for promoting accountability and transparency in the handling of information and drug funds
– Resources for involving key stakeholders in decision making over the allocation of locally collected drug funds

The strength of evidence for this abstract is 8 out of 10.
The evidence in the abstract is based on in-depth interviews with health facility managers, a survey of health facilities, and a qualitative thematic analysis approach. The study provides specific examples and quotes from participants to support the findings. However, the abstract does not mention the sample size or selection process, which could affect the generalizability of the results. To improve the evidence, the abstract could include more details about the methodology, such as the criteria for selecting participants and the data analysis process.

Background: Provision of quality emergency obstetric care relies upon the presence of skilled health attendants working in an environment where drugs and medical supplies are available when needed and in adequate quantity and of assured quality. This study aimed to describe the experience of rural health facility managers in ensuring the timely availability of drugs and medical supplies for emergency obstetric care (EmOC).Methods: In-depth interviews were conducted with a total of 17 health facility managers: 14 from dispensaries and three from health centers. Two members of the Council Health Management Team and one member of the Council Health Service Board were also interviewed. A survey of health facilities was conducted to supplement the data. All the materials were analysed using a qualitative thematic analysis approach.Results: Participants reported on the unreliability of obtaining drugs and medical supplies for EmOC; this was supported by the absence of essential items observed during the facility survey. The unreliability of obtaining drugs and medical supplies was reported to result in the provision of untimely and suboptimal EmOC services. An insufficient budget for drugs from central government, lack of accountability within the supply system and a bureaucratic process of accessing the locally mobilized drug fund were reported to contribute to the current situation.Conclusion: The unreliability of obtaining drugs and medical supplies compromises the timely provision of quality EmOC. Multiple approaches should be used to address challenges within the health system that prevent access to essential drugs and supplies for maternal health. There should be a special focus on improving the governance of the drug delivery system so that it promotes the accountability of key players, transparency in the handling of information and drug funds, and the participation of key stakeholders in decision making over the allocation of locally collected drug funds. © 2014 Mkoka et al.; licensee BioMed Central Ltd.

The study was conducted in Kongwa, a typical rural district in Dodoma region which had a total population of about 309,973 people in 2012 [30]. The two main ethnic groups found in this district are Gogo and Kaguru. Common occupations include subsistence farming and small scale trading. The district has one hospital, four rural health centers and 32 dispensaries that conduct delivery services. Many health facilities are accessed by unpaved rural roads, which are not easily passable during the rainy seasons. All these facilities provide antenatal care (ANC) and offer delivery services. Caesarean sections are provided at one rural health center and at the district hospital. Different methods were used to collect data for this study. These included in-depth interviews with facility health managers, a survey of selected heath facilities and a desk review of existing/available documents. In depth interviews guides were designed to collect the views of facility managers on their experience of ensuring the timely availability of drugs and medical supplies for EmOC. In April and May 2012 a total of 17 health facility managers were interviewed: 14 from the dispensaries and three from health centers. Furthermore, two members of the CHMT and one member of the CHSB were also interviewed on their experiences of the drug funding mechanism for the health facilities. The facilities where respondents came from were purposively selected from three wards (Mkoka, Mlali, Ugogoni) to reflect the geographical diversity of the study. Respondents were also selected purposively to include those involved in drug ordering and reporting using ILS. The two CHMT members, the District Medical Officer and District Pharmacist and a chairperson of the CHSB were interviewed because of their involvement in the approval of funds for drug procurement at the district level. The first author together with the research assistant collected data and all interviews were audio-taped; field notes and memos were written up both during and immediately after the interviews. The interviews followed a semi-structured format, and the following aspects were explored: availability of drugs and medical supplies and its effect on care, focusing on EmOC; the accessibility of complementary drug funds; and community and staff reactions to drug shortages. During April 2012, 18 government-owned facilities were surveyed by the first author with the aim of understanding the existing situation with regard to the availability of drugs and supplies needed for EmOC. At each visited facility, observation and assessment were conducted by interviewing facility managers using a facility survey guide. The researcher interviewed facility managers about aspects of human resources, infrastructure, availability of drugs and medical supplies, and their experience of deliveries. The data collected during the interviews were validated by observation of the facility drug storage rooms and informal discussion with facility managers, staffs and user representatives at some of the facilities. In particular, the observation during the facility survey was focused on the presence or absence of essential drugs and medical supplies for EmOC. Audio-taped interviews were transcribed by the first author and translated from Swahili into English. The transcripts together with the expanded field notes were the main data used for analysis. To ensure familiarization with the data, multiple readings of the transcript and expanded notes were conducted and data were analyzed using thematic analysis [31]. Thematic questions were preselected and the parts of the text that referred to those questions were marked and coded. Similar codes considered pertinent to the preset research question were grouped to form subthemes and similar subthemes formed a theme. The emerged themes were then shared among other authors and a consensus was reached about the various themes and how they fitted together. Data from document reviews and health facility surveys were used as supporting information in clarifying the concepts that emerged during thematic analysis. This study was approved by the review body of Muhimbili University of Health and Allied Sciences (MUHAS). Permission to conduct the study in Kongwa district was given by Dodoma Regional Administrative Secretary (RAS). Written consent to visit facilities was obtained from the District Medical Officer’s (DMO) office, the District Executive Director’s (DED) office and the District Administrative Secretary’s (DAS) office. Informed consent to participate was obtained from the participants after assurances of anonymity and confidentiality were given.

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The study recommends several innovations to improve access to maternal health by addressing challenges within the health system that prevent access to essential drugs and supplies. These innovations include:

1. Improving governance of the drug delivery system: The study suggests promoting the accountability of key players involved in drug delivery, ensuring transparency in the handling of information and drug funds, and involving key stakeholders in decision-making processes related to the allocation of locally collected drug funds.

2. Enhancing budget allocation for drugs: The study highlights the need for an increased budget for drugs from the central government to ensure an adequate supply of essential drugs and medical supplies for emergency obstetric care.

3. Streamlining the drug procurement process: The study recommends addressing bureaucratic processes that hinder the timely procurement of drugs and medical supplies, which can lead to shortages and delays in providing quality emergency obstetric care.

4. Strengthening the supply chain management system: The study emphasizes the importance of improving the overall supply chain management system to ensure the reliable and timely availability of drugs and medical supplies for maternal health services.

By implementing these innovations, it is expected that the timely availability of drugs and medical supplies for emergency obstetric care will be improved, leading to better quality maternal health services.
AI Innovations Description
The recommendation from the study to improve access to maternal health is to address the challenges within the health system that prevent access to essential drugs and supplies. Specifically, the study suggests improving the governance of the drug delivery system by promoting the accountability of key players, transparency in the handling of information and drug funds, and the participation of key stakeholders in decision making over the allocation of locally collected drug funds. This would help ensure the timely availability of drugs and medical supplies for emergency obstetric care (EmOC), thereby improving the quality of maternal health services.
AI Innovations Methodology
To simulate the impact of the main recommendations of this abstract on improving access to maternal health, a possible methodology could involve the following steps:

1. Identify key stakeholders: Identify the key stakeholders involved in the drug delivery system for maternal health in the study area. This may include health facility managers, members of the Council Health Management Team (CHMT), members of the Council Health Service Board (CHSB), and other relevant decision-makers.

2. Conduct baseline assessment: Conduct a baseline assessment to understand the current state of drug availability and access to maternal health services in the study area. This can involve surveys, interviews, and observations similar to the methods used in the original study.

3. Develop intervention strategies: Based on the recommendations from the study, develop intervention strategies to address the challenges within the health system. This may include promoting accountability, transparency, and stakeholder participation in the drug delivery system. Consult with key stakeholders to ensure their input and buy-in.

4. Implement interventions: Implement the identified intervention strategies in collaboration with relevant stakeholders. This may involve implementing changes in governance structures, improving information systems, and strengthening accountability mechanisms. Monitor the implementation process closely to ensure adherence to the recommended strategies.

5. Measure impact: Measure the impact of the interventions on improving access to maternal health services. This can be done through follow-up surveys, interviews, and observations to assess changes in drug availability, timeliness of care, and overall quality of maternal health services.

6. Analyze and interpret data: Analyze the data collected during the impact assessment to evaluate the effectiveness of the interventions. Compare the results with the baseline assessment to determine the extent of improvement in access to maternal health services.

7. Disseminate findings: Share the findings of the simulation study with relevant stakeholders, policymakers, and the broader healthcare community. This can be done through reports, presentations, and publications to raise awareness and promote further action to improve access to maternal health.

It is important to note that the methodology may vary depending on the specific context and resources available. The above steps provide a general framework for simulating the impact of the recommendations on improving access to maternal health.

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