Assessment of Monitoring and Evaluation Practices in Management of Laboratory Reagent Stock Outs in Selected Regional Referral Hospitals in Uganda. A Concurrent Mixed Methods Study.

Abstract

Background: Laboratory reagents are essential for accurate diagnosis and efficient healthcare delivery, yet Uganda’s referral hospitals frequently experience stockouts. These shortages delay diagnosis, compromise treatment decisions, increase healthcare costs, and reduce the overall quality of patient care. Aim: This study evaluated monitoring and evaluation(M&E) practices for managing stock out of laboratory reagents, facilitators and barriers to their application at Entebbe and Mbale regional referral hospitals. Methods: This study is a concurrent mixed-methods study. Data on stock out of laboratory reagents was collected from the stock cards and Order /Requisition forms, Electronic afya(E-AFYA) system in the laboratory using a checklist. Additional data was collected through key informant interviews of laboratory staff in Mbale and Entebbe regional referral hospitals. The interviews were audio recorded and data analyzed using thematic manual coding. Quantitative data was summarized in frequencies and inferential analysis was conducted using chi-square tests. Results: A total of 171 reagents experienced 848 stockout episodes from 2023–2025, with Entebbe RRH recording 66 reagents and 369 episodes, and Mbale RRH 105 reagents and 479 episodes. Entebbe had more frequent stockouts, while Mbale had fewer but longer episodes. Stockouts were most common in Immunology/Serology (37.6%) and Biochemistry (26.5%). The overall mean stockout duration was 26.7 days (SD: 39.3); Entebbe averaged 19.5 days (SD: 35.2) and Mbale 35.9 days (SD: 42.2). A Chi-square tests (p < 0.05) showed significant differences in stockouts between the two hospitals for Microbiology/Parasitology and Immunology/Serology, but not for Hematology and Biochemistry. Qualitative findings indicated that stock monitoring tools, electronic inventory systems, supervision, audits, and reporting mechanisms were in place in both hospitals but were applied inconsistently. Mbale achieved full implementation of the Electronic afya (E-AFYA) system in May 2025, with earlier records maintained manually, while Entebbe had relatively more organized documentation; nevertheless, both facilities demonstrated data quality challenges, including incomplete stock cards, missing records, and inconsistent requisition forms. Use of M&E data for decision-making and accountability was limited. Facilitators included leadership support, availability of digital tools, and inter-facility redistribution of reagents, whereas barriers included staff shortages, weak data-use culture, and irregular supervision. Conclusion: Strengthening M&E systems including better data quality, reporting, supervision, staff capacity, and digital tools will enhance stockout management and ensure sustained reagent availability.