The use of Public-Private Partnerships in Health Supply Chain Management in Rwanda

BackgroundThe Government of Rwanda considers the private sector to play an important role in supporting provision of strategic national investments through Public-Private Partnerships (PPPs).ObjectiveThis study aims to describe the various aspects of PPPs in Health Supply Chain Management (HSCM) in Rwanda.MethodsA questionnaire was used to collect data from health professionals and individuals familiar with HSCM Public-Private Partnerships for this descriptive, cross-sectional and quantitative study.ResultsThe PPP interventional areas used in HSCM in Rwanda were namely supply of commodities (99%), delivered health Information Technology (IT) supplies and equipment (operate) (53%), finance (52%), and maintenance area (40%). The main challenges were limited conversation and absence of formal platforms for public and private engagement (83.7%) and complex procurement requirements for medical products and equipment by public institutions (73.3%). The strategies to improve the PPPs in HSCM were effective coordination of PPPs (93.3%) and improved dialogue and formal platforms (90.6%)ConclusionThese findings indicated that private sector through PPPs plays an important role in HSCM in Rwanda. The engagement of the private sector can increase the financial support in terms of financing HSCM activities like supply of health commodities and equipment. Rwanda J Med Health Sci 2021;4(2): 237-25

Effect of Universal Health Coverage on the Availability of Medicines in Public Health Facilities in Kisumu County, in Kenya

BackgroundStock outs of medicines and unaffordable cost are two major barriers of access to healthcare. Universal Health Coverage (UHC) seeks to ensure that all people have access to quality essential health services without suffering financial hardship.ObjectiveThe main objective of the study was to determine the effect and challenges of UHC program on the availability of medicines in public health facilities in Kisumu County.MethodologyThe study used a Pretest - posttest research design. The study was carried out in twenty-nine health facilities that were selected using stratified random sampling. Data was collected using key informant interviews with a health worker in each facility. Participants also involved four hundred and forty-four patients selected from the chosen facilities using consecutive sampling. Data from patients was collected using researcher administered questionnaires.ResultsThe availability of medicines improved by 3.4% for 20 tracer medicines since the introduction of the pilot UHC in Kisumu County. This was also supported from the patient’s perspective (n= 444; 79.5%). conclusion In spite of this, health workers experienced challenges which included inadequate supply, delays and stock out of some medicines. Other challenges were overworking, shortage of qualified staff and inconsistent supplies. Rwanda J Med Health Sci 2021;4(2): 269-28

Assessment of Factors Contributing to Medicine Expiry in Rwanda: Case of the Medical Procurement and Production Division

BackgroundRegardless of the significant efforts used and put in place to enhance supply chain performance in Rwanda, there is still poor inventory management and big loss due to expiry of medicines at Medical Procurement and Production Division (MPPD).ObjectiveTo assess the factors that contributes to expiry of medicines at MPPD and formulate recommendations for the improvement of the current situation.MethodsThis is a descriptive cross-sectional study used for 25 respondents. A questionnaire containing closed-ended questions was used focusing on factors contributing to expiries of medicines for each product category managed by MPPD from 2014-2018. Additionally, the researcher reviewed all inventory reports, including expiries for the same period under study. The study focused on targeting respondents working at MPPD as pharmacists both technical and administrative, also other non-pharmacist working in the warehouse were considered as respondents. The hard copy of questionnaire was handed over to 26 respondents and requested to provide filled questionnaire within seven days. Twenty-five respondents were able to return the filled questionnaire on time, giving 96% response rate.ResultsThe study found that in MPPD, medicines are still expiring. During five years (from 2014 up to 2018) the total expired products were valued at RWF 6,046,778,655 for all program categories: HIV commodities had the largest share 53.3%, Essential Medicines 22.5%, Malaria 13%, Maternal Child Health commodities 5.7%, Products used for Community health workers 4.5%, TB products 1% and 0.1% for Family Planning products. The study found that major contributing factors for expiry of health commodities at MPPD, are ranked as follows: Supply chain management 90%, other factors 73%, Poor storage management 68% and Excessive drug supply 67%. ConclusionConsidering the study results, it looks like no significant effect of excessive drug supply and inventory management on the expiration of medicines at MPPD. However, the Supply Chain Management components are the most vulnerable to contribute to the expiration of medicines at MPPD. There are many changes to be done inside the institution to remedy the issue of expiration like working according to the standard operating procedures, improving the Skills of personnel in supply chain management, empowering the procurement unit with skilled personnel and improving the communication with stakeholders to facilitate the smooth and quick replenishment and distribution of the stock. Rwanda J Med Health Sci 2021;4(2): 281-29

Evaluation of medication adherence methods in the treatment of malaria in Rwandan infants

Objectives: To compare three methods for evaluating treatment adherence in a 7-day controlled treatment period for malaria in children in Rwanda. Methods: Fifty-six children (< 5 years) with malaria were recruited at the University Hospital of Butare, Rwanda. Patients were treated with quinine sulfate, taste-masked, pellets during seven days: three days in hospital (in-patient) followed by a four-day out-patient period. Three methods to evaluate medication adherence among patients were compared: manual pill count of returned tablets, patient self-report and electronic pill-box monitoring. These pill-boxes were equipped with a microchip registering date and time of every opening. Medication adherence was defined as the proportion of prescribed doses taken. The inter-dose intervals were analysed as well. Results: Medication adherence data were available for 54 of the 56 patients. Manual pill count and patient self-report yielded a medication adherence of 100% for the in-and out-patient treatment periods. Based on electronic pill-box monitoring, medication adherence during the seven-day treatment period was 90.5 +/- 8.3%. Based on electronic pillbox monitoring inpatient medication adherence (99.3 +/- 2.7%) was markedly higher (p < 0.03) than out-patient adherence (82.7 +/- 14.7%), showing a clear difference between health workers' and consumers' medication adherence. Conclusion: Health workers' medication adherence was good. However, a significant lower medication adherence was observed for consumers' adherence in the outpatient setting. This was only detected by electronic pill-box monitoring. Therefore, this latter method is more accurate than the two other methods used in this study

Synchronization of patient data among health facilities through electronic medical records system: a case study of Kabgayi District Hospital

Background: The use of modern technology in healthcare system aims to increase the reliability, accessibility and productivity of delivered services. In most developing countries, particularly in sub-Saharan Africa, Electronic Medical Records (EMRs) has been dominated by paper-based system. In Rwanda, EMRs started in 2011 with a baseline of 8% and reached 50% in 2017 within 516 health facilities, but patient data synchronization among health facilities is still a problem. The aim of this research was to identify factors hindering EMRs implementation and propose applied solutions.Methods: A cross-sectional descriptive study design with qualitative and quantitative approach was used. A purposive method to select the research participants among the target population was also used.Results: It was found that, despite the improvement of hospitals’ management and healthcare efficiency via EMRs system, factors affecting synchronization of patients’ data among health facilities still persist. The study also revealed the need for the interoperability in the integration of EMRs system among health facilities.Conclusion: The OpenMRS EMR-based data synchronization can reduce gaps in HIV care. It avoids a duplication of patient identification number (PID) at the same health facility for more than one visit and missing data among health facilities. As part of implementable solutions for effective service delivery, cloud-based server and patient identification were suggested as solutions for much more success in Open MRS EMRs system.Keywords: Electronic Medical Record, Data synchronization, Cloud computing technolog

Prices, availability and affordability of medicines in Rwanda.

BackgroundAccess to affordable and good quality medicines is a key to meeting Sustainable Development Goal No. 3 by the year 2030. Prices, availability and affordability of essential medicines have been studied in many developing countries, but no such information has been published about Rwanda yet. This study aimed at providing data on prices, availability and affordability of medicines in different health facilities of Rwanda.MethodsA survey was carried out on availability, prices and affordability of 18 medicines in Kigali City and five districts of Rwanda. 44 health facilities were surveyed, including public and faith-based hospitals, public and faith-based health centers and private pharmacies. The standardized methodology developed by WHO and Health Action International (HAI) was used to collect and analyze the data.FindingsPrices for generic medicines in public and faith-based health facilities were remarkably low, with median price ratios (MPRs) of 1.0 in comparison to the international procurement prices published by Management Sciences for Health. In private pharmacies, prices were twice as high (MPR = 1.99 for generics). Availability of medicines fell short of the of 80% target set by WHO, but was better than reported from many other developing countries. Availability of medicines was highest in the private sector (71.3%) and slightly lower in the faith-based (62.8%) and public (59.6%) sectors. The government procurement agency was found to work efficiently, achieving prices 30% below the international procurement price given in the International Medical Product Price Guide. Affordability of medicines was better in the public and faith-based sectors than in the private sector.ConclusionIn Rwanda, medicines are affordable but poorly available in both the public and the faith-based sectors. Further improvements of the availability of medicines in the public and the faith-based health facilities represent the most important key to increase accessibility and affordability of medicines in Rwanda