Abstract
Improving laboratory service delivery requires a functioning logistics and supply system. Uganda's Ministry of Health uses the credit-line approach to provide laboratory supplies including commodities for CD4 test equipment. We examined the effectiveness of the credit-line approach in improving laboratory service delivery by using the functionality of CD4 test equipment as a proxy indicator. A cross-sectional survey was conducted at 7 level-three health centres (HC IIIs), 18 level-four health centres (HC IVs), and 10 hospitals in 15 districts of mid-northern Uganda, including the Lango (17 facilities) and Acholi sub-regions (18 facilities), between July 2013 and August 2013. Functionality, was determined through self- and interviewer-administered questionnaires. The chi-squared test was used to assess differences in functionality by sub-region, facility type, and equipment type. A total of 38 CD4 test analysers were assessed. Of these, 26 (68%) were functional. In hospitals, 85% of CD4 analysers were functional, in HC IVs, 67% were functional and in HC IIIs, 43% were functional. The differences did not reach statistical significance. In the Lango sub-region, 72% of analysers were functional; in the Acholi sub-region, 65% were functional. Non-functionality was mainly due to lack of reagents and cartridges, as well as low staffing levels of laboratory technicians with the skills necessary to operate the equipment. The credit-line approach supported the functionality of CD4 equipment in the surveyed facilities. However, there is a need to address issues of staffing and availability of reagents to enhance the functionality of CD4 equipment and improve patient care, especially at HC IIIs.
Highlights
There is a need to address issues of staffing and availability of reagents to enhance the functionality of CD4 equipment and improve patient care, especially at HC IIIs
Until 2003, the Ministry of Health (MoH) of Uganda used a ‘push’ system to guarantee supply of medical commodities, especially in areas affected by natural disasters or areas such as northern Uganda, which was affected by a 20-year-long civil war
PIMA was a predominant type of CD4 equipment and the majority of CD4 analysers were in HC IV facilities (18 of 38; 48%)
Summary
Until 2003, the Ministry of Health (MoH) of Uganda used a ‘push’ system to guarantee supply of medical commodities, especially in areas affected by natural disasters or areas such as northern Uganda, which was affected by a 20-year-long civil war. The authorised supplier determines the types and quantities of supplies to be issued to health facilities.[1] Inconsistencies remained between the needs of the user areas and the medical items supplied. The MoH introduced a ‘pull’ system in 2003 to overcome the challenges of frequent stock outs and expired items This system required health facilities to determine the types and quantities of medical items that they needed.[3,4] An assessment of the performance of the pull system to improve the availability of equipment and reduce expiration of medical supplies showed that the pull system improved the availability of medical supplies, but did not address challenges such as inadequate training of staff, lack of transport and inadequate funding.[5]. Uganda’s Ministry of Health uses the credit-line approach to provide laboratory supplies including commodities for CD4 test equipment
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