Drug Supply Management in Health Care Institutions in Sri Lanka: A Case Study

Abstract

National Health Policy, Primary Health Care Package and National Medicinal Drug Policy have emphasized the importance of adequate supply of safe & effective drugs of acceptable quality in health care institutions. The Medical Supplies Division (MSD) of Ministry of Health is responsible for ensuring an optimum drug supply management, by strategically managing the key steps of Drug management cycle; Selection, Estimate, Ordering, Procuring, Storing, Distribution, Prescribing, and Use by patients. There are strategies followed at different levels.
 Objective of the study is to analyze the strategies to improve drug supply management in health care institutions in Sri Lanka. Data collection was carried out using KII, Inspection visits, Review manuals & guidelines, Participation in discussion meetings and Review of secondary data. Prioritization was carried out using nominal group discussion and it was decided to select “Institutional level strategies” for in depth analysis to make recommendations.
 The strategies identified were categorized under; Policy; Finance; Process; Facilities & Medicine; Human Resource and Public. Even though a large number of strategies are implemented, there are deficiencies in almost every strategy which leads to stock out of medicine. Root causes for “Deficiencies of Institutional Strategies” were identified using fish born diagram. 
 Lack of terms of reference for Drug Therapeutic Committees; lack of rational prescribing and prescription audits; high demand for non-formulary drugs; unrealistic estimates, inadequate buffer stocks, delays in redistribution & delays in local purchase; limited stores capacity and suboptimal store management and limited transport availability were found as root causes. Recommendations were made accordingly.