Examining the inventory management of antiretroviral drugs at community health centres in the cape metropole, Western Cape
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South Africa is faced with a high number of people living with HIV/AIDS, and subsequently a great need to access quality medicines for improving patient therapeutic outcomes. Antiretroviral drugs (ARVs) require rigid, efficient and effective management, due to their valuable efficacy in prolonging the survival of HIV/AIDS patients, and the limited possibility of substitution. Managing their flow is vital to ensure an uninterrupted supply. Problematic inventory management was experienced by some healthcare facilities in South Africa where in recent years it resulted in stock outs and stock losses through thefts. These factors present obstacles to the availability of quality medicines, which ultimately leads to treatment failure and deterioration of the health status of patients. The aim of this study was to characterise the inventory management practices and medicine store maintenance of ARVs in community health centres (CHCs) in the Cape Metropole, Western Cape, in order to identify specific problems associated with ARV stock management. The study used a descriptive, cross-sectional study design to examine ARV records and to highlight associated discrepancies between recorded iii quantities on logistics tools used and physical counts, to assess the store maintenance, to measure the supply rate and identify factors contributing to poor stock management. The sample comprised 15 CHCs under the Western Cape Provincial Government (WCPG) accredited to provide ARV treatment. A checklist developed by Management Sciences for Health was adapted and was used to gather quantitative information (e.g. physical stock count). Some qualitative data was collected from responsible personnel for ARV drug management at each site. 86.7% of CHCs utilised a logistics tool (either manual or electronic) to manage ARVs. The average number of adult ARV drugs with a logistics tool available in all CHCs was 82.7% of which 21.9% met the criteria for accuracy. Only 32.9% of all logistics tools had records that were up to date. The average percentage of total variation between stock records and physical counts for the ARV drugs assessed was 51.6%. No historical data on stock outs and monthly usage (monthly consumption) could be retrieved in any of the CHCs, although there were no actual stock outs on the day of the fieldwork. The order fill rate was 91.9%. Since ordering is done more often that it should, stock availability did not appear to be problematic. Standard appropriate physical dimensions were not met by 20% of the CHCs and only 66.7% of the CHCs had appropriate labeling of the shelves in the dispensary and in the storeroom. This study demonstrated poor inventory management with respect to the general quality of record keeping, space allocation and general organisation of the medicine storeroom. Making timely entries and recording issues on logistics tools are recommended to keep up to date inventory records and management information system. Frequent monitoring of stock status is suggested, to avoid discrepancies and to keep it to adequate levels iv which will minimise multiple ordering. Regular supervision by the district pharmacist is needed to identify training and other needs. A study on general cost and delivery costs associated with poor record keeping should be carried out.