An analysis of credit line model of distributing essential medicines in Public Health Facilities in Nebbi district

Abstract

The Ugandan government has experimented with various supply chain models for distribution of essential drugs and supplies since 1985. In 2010, the credit-line model of distributing essential medicines in public health facilities was adopted. In this study, it was discovered that, the credit-line model operates a dual push-pull system of drug supply and distribution to government health facilities. Under the model, all the lower level health facilities (HC11s and HC111s) passively received essential medicines through a push system whereby NMS determined the types and quantities of medicines delivered to lower level facilities using a standardized supply kits distributed according to a delivery plan made at the beginning of each financial year. Meanwhile, the Hospital and Health Center Four (HCV) operated a pull system whereby, each facility determined the types and quantities of medicines needed and placed orders with the National Medical Stores although the list from which they made order was reported to be so rigid.Consequently,drug stock outs remains a common occurrence in most of the lower level health facilities in Nebbi district. This study therefore, analyzed how the credit-line model of drugs distribution works and how it has affected availability of essential medicines. The structural strengths and weaknesses of the model were also analyzed.

A cross-sectional descriptive study design was used comprising of both qualitative and quantitative data collection methods. The qualitative data were collected by the use of semi-structured interviews, Focus Group Discussionheld with 6 Health Units Management Committees (HUMCs)totaling to 48 FGD members and In-depth interviews with Key Informants comprising of the administrators of the health services in the district namely;In-Charges of the public health facilities, Members of the District Health Team and top district leaders, District Medicine Store Keeper and private medicine transporters, while the quantitative data was collected through structured questionnaires administered to 165 primary respondents who were the users of health services in Nebbi District.The study discovered that, there were limited responsiveness of the current credit-line model to the local and context-specific facility needs of especially the lower level health facilities with exception of the hospitals and HC1Vs that had the leverage of requisitioning for medicines based on facility needs. Procurement and distribution of essential drugs were done without involvement of the frontline managers of HC11s and HC111s. All the HC11s and 111s were reportedly supplied with predetermined kit by the NMS and thereby leading to supply of wrong drugs, insufficient supply and drug stock-outs in most of the lower level health facilities in District.The study concluded that the push aspect (kit based method) of the credit-line model of distributing essential drugs to especially the lower level health facilities was in a top-down nature and has contradicted the aim of decentralization by limiting participation of the managers and local leadership of the lower level health facilities and has thereby, turned them into passive recipients of medicines from higher levels except the hospitals and HC1Vs that maketheir own orders.