Process evaluation of essential drug supply management: The case of three public health centers in Jimma town special zone, Southwest Ethiopia

Abstract

Background: A well functioning drug supply management (DSM) is the corner stone for any meaningful health service. However, Pharmaceutical supply systems in many developing countries have severe problems, including inefficient selection, procurement and use of drugs. The magnitude and extent of the problem is huge and chronic in the Ethiopian health care system for a long time. Objective: The objective was to evaluate the drug supply management process in three public health centers (HCs) in Jimma town special zone. Evaluation Methodology: The focus of the evaluation was the process of the program with formative approach. The evaluation design was facility based cross sectional study with both quantitative and qualitative methods. The evaluation dimensions included assessment of availability of resources, compliance of the services provided with the standard manuals\guidelines and accommodation. Totally 23 indicators were used. For determination of prescription pattern, simple random sampling was used to select the minimum 600 prescriptions recommended by World Health Organization (WHO) for facility based cross sectional studies, form the past six months of July 8, 2010 to January 8, 2011 to consider seasonal variations. For Patient care practice, 418 (calculated 380 and 38 added for 10% compensation for non response rate) outpatients were selected conveniently for exit interview by using Epi Info Version 6 at 50% prevalence, 95% confidence interval and 5% margin of error based on past six month‘s 31,579 patient flow in the three health centers. For observation of consulting and dispensing time the calculated 380 samples (for each) were selected from the three health centers, respectively. Quantitative descriptive data analysis that generates frequency and calculated mean and median of the indicators as per the matrix of analysis and judgment was made using SPSS version 16.0 software and MS excel. The qualitative data was analyzed component by component thematically and the result was presented in narrative form to explain quantitative results. Results: In the special zone, percentage availability of the 13 selected essential drugs was 10.7(82.0%) and there were no expired drugs found on their shelves. The availability of 15 of the required 16(93.3%) professionals was adequate according the Business Process Reengineering (BPR). The average lead time was found to be less than five days and adequacy of conservation conditions and handling of drugs was 6.8 of 10 criteria (67.5%). The average consultation time and dispensing time were 5:43 minutes and 1:17 minutes, respectively. The average number of drugs per prescription was 2.0. The high percentage of patients prescribed antibiotics 394(65.7%) may indicate the overuse of these drugs, whereas the 59(9.8%) prescribed injections showed rational use. The 1154(97.9%) of drugs prescribed by generic name and 1175(99.7%) of prescribed drugs on Essential Drug List indicates prescribers‘ adherence to Essential Drug List. Conclusion: This evaluation revealed that (based on the pre-set judgment criteria) the achievement of the selected essential drug supply management in Jimma town special zone was medium 70.3% (achieved 211 of 300 weight given), i.e. were not yet at optimal level and needs improvement. Areas for improvement identified were: the Standard Treatment Guidelines (STGs) and Essential Drug List (EDL) should be available in all health centers. Pre- and in-service training for all health workers involved in drug supply management to improve on the medium consultation time, poor record keeping and the extremely poor labeling of drugs.