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American Journal of Public Health Research. 2015, 3(3), 106-112
DOI: 10.12691/AJPHR-3-3-5
Original Research

Challenges Facing the Push and Pull Hybrid System in the Supply of Essential Medicines in Gulu, Northern Uganda

Okello Tom Richard1, Mshilla Maghanga2, and Olido Kenneth3

1Department of Surgery, Lacor Hospital, Senior Honorary lecturer Faculty of Medicine, Gulu University, P. O. Box 166 Gulu, Uganda

2Faculty of Business and Development Studies, Gulu University, P. O. Box 166 Gulu, Uganda

3Department of Marketing & Entrepreneurship, Faculty of Business and Development Studies, Gulu University

Pub. Date: May 07, 2015
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Cite this paper

Okello Tom Richard, Mshilla Maghanga and Olido Kenneth. Challenges Facing the Push and Pull Hybrid System in the Supply of Essential Medicines in Gulu, Northern Uganda. American Journal of Public Health Research. 2015; 3(3):106-112. doi: 10.12691/AJPHR-3-3-5

Abstract

Essential medicines are supplied to the public health facilities using the pull and push system. In many countries the decision to use the pull, push or combination of both is a policy decision, but Uganda has used each of the supply system individually in past and currently is using a hybrid despite the rampant out-cry of essential medicines stock out. Challenges facing the hybrid supply system need to be examined to advise policy makers on the how efficient the system supplies medicines. A cross-sectional study was carried out in the public health facilities in Gulu to examine the major challenges affecting the hybrid system of medicines supply. A sample of 131 health workers filled a pretested coded questionnaire as respondents and the data were then entered and analysed using SPSS version 15. Approximately 27.7% (n=131) of the respondents reported that the store management in the hybrid system is unsatisfactory and inadequate. Quality of essential medicines supplied in the hybrid system to the public health facilities is unsatisfactory and inadequate as reported by 46.5% of the respondents. Collaborative linkages with the National Medical Stores (NMS) the mandated supplier of essential medicines in the country, is weak (42.9%) and quantification of essential medicines by health workers under the hybrid system is poor (33.3%). Furthermore support supervision in weak and inadequate under the hybrid system (37.6%); and personnel who dispense essential medicines are inadequate (44.3%). Approximately 30.3% patients have poor access to essential medicines. The current hybrid system is riddled with a number of challenges which requires re-dressed in order improve access and availability of essential medicines to the public.

Keywords

essential medicines, push and pull system, public health facilities, Gulu, northern Uganda

Copyright

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]  Quick J. D. Hogerzeil, H. V. Germán Velásquez & Lembit Rägo. (2002). Twenty-five years of essential medicines. Bulletin World Health organization vol. 80 (11).
 
[2]  Kotwani A (2011) Transparently and Accountability in Public procurement of Essential Medicine in developing countries, http//www.igiglobal.com (Retrieved 10th August 2013).
 
[3]  Hogerzeil V Hans. (2006). Essential medicines and human rights: what can they learn from each Other? Bull World Health Organ vol.84 (5) Genebra, ISSN 0042-9686.
 
[4]  Laing, R. Waning, B. Gray, A. Ford, N. Hoen, E. (2003). 25 years of the WHO essential medicines list: progress and challenges. The Lancet. Vol. 361 pp 1723-1729.
 
[5]  MOH, (2007b). Essential Medicines List for Uganda. Retrieved October 14th, 2013 form www.health.go.ug.
 
[6]  WHO, (2003). Assessment of the pharmaceutical Sector in Ethiopia, Retrieved September 15th, 2013, from www.who.int/medicines.
 
[7]  Jahre, M. Dumoulin, L. Greenhalgh, L. B. Hudspeth, C. Limlim, P. Anna, S. (2012). Improving health in developing countries: reducing complexity of drug supply chains. Journal of Humanitarian Logistics and Supply Chain Management, Vol. 2 (1) pp. 54.
 
[8]  Okiror, B. (2009). Drug shortage Hits Uganda. Retrieved September 15th, 2013, from http://www.newvision.co.ug.
 
[9]  JSI/Nepal Family Health Program. (2007). Logistic Pull system in Nepal, Nepal Family Health Program (367-00-02-00017-00).
 
[10]  MOH, (2011). Assessment of the Uganda Essential Medicines Kit-Based Supply System in Uganda. Retrieved September 27th, 2013, from www.api.ning.com.
 
[11]  Bukuluki, P. Byansi, P.K. Sengendo, J. Nyanzi, I. Banoba, P. and Kaawa-Mafigiri, D. (2013). Changing from the pull to push system of distributing essential medicines and Health supplies in Uganda: implication for efficient Allocation of medicines and Meeting the local needs of the Health Facilities. Gobal Health Governance, Vol. VI (2).
 
[12]  Buuse, B. B. (2012). Increasing access to health services in a post-conflict space: A study of the Village Health Team strategy program in Gulu, District Uganda. Retrieved March15th, 2014, from http://.www.dare.una.nl/document/468571.
 
[13]  Tumwine, Y. Kutyabami, P. Odoi, R.A. and Kalyango, J. (2010). Availability and Expiry of Essential Medicines and Supplies during the ‘Pull’ and ‘Push’ Drug Acquisition Systems in a Rural Ugandan Hospital. Tropical Journal of Pharmaceutical Research, Vol. 9, (6), pp. 557-564.
 
[14]  Ministry of Medical Services and Ministry of Public Health & Sanitation (2009). Access to Essential Medicines in Kenya; A Health Facility Survey. Retrieved April 20th, 2014, from www.health.go.ke.
 
[15]  MOH, (2009). Final Report Essential Medicines and Health Supplies Tracking Study. Retrieved September 27th, 2013, from www.health.go.ug.
 
[16]  Mueller, D. H., Lungu, D. Acharya, A. and Palmer, N. (2011). Constraints to Implementing the Essential Health Package in Malawi. PLoS One. Vol. 6(6).
 
[17]  MOH/USAID/SURE, (2011). Assessment of the Essential Medicines Kit-Based Supply System in Uganda. Retrieved September 27th, 2013, from www.api.ning.com.
 
[18]  SURE, (2012). "Improving Access to medicines and Health Supplies: Experience and Future Prospects" Retrieved July 17th, 2013, ww.sure.ug/?Success_Stories:District_level.
 
[19]  Oluka, P. N. Ssennoga, F. and Kambaza, S. (2013). Tackling Supply Chain Bottle Neck of Essential drugs: A case of Uganda Local Government Health Units. Retrieved September 15th, 2013 from www.ippa.org.
 
[20]  HEPS (2010). Right to Essential Medicines Tracking Uganda’s Health Sector in Budgeting, Financing and Delivery of Essential Medicines. Retrieved April 14th, 2014 from http://www.tap.resultsfordevelopment.org/sites/tap.resultsfordevelopment.org.
 
[21]  Ministry of Health and Social Welfare, (2008). In-Depth Assessment of the Medicines Supply management System In Tanzania, Dar-essalaam, Tanzania. www.who.int/medicines accessed 26/September/2013).
 
[22]  SURE, (2010). Annual Progress Report. Retrieved July 17th, 2014, from www.sure.ug.
 
[23]  NMS Pharmacy Division, (2013). National Performance Report on Medicines Management, Issue no. 3, November 27, 2013, Retrieved April 17th, 2014 from http://www.sure.ug.
 
[24]  HEPS and UNHCO, (2012). Funding Essential Medicines. Retrieved April, 14th, 2014 from www.unhco.or.ug/wp content/plugins/download.../download.php?id.
 
[25]  WHO, (2004). Access to essential medicines. Retrieved August 4th, 2014, from http://apps.who.int/ medicinedocs/en/d/Js6160e/9.html.
 
[26]  Watal, J, ( 2000). Access to Essential Medicines in Developing Countries: Does the WTO TRIPS Agreement Hinder It? Science, Technology and Innovation Discussion Paper No. 8, Center for International Development, Harvard, Cambridge, MA, USA.)
 
[27]  Vera, M. V. P. Anaclaudia, G. F. Maria de Fátima, S. M. Marlos, R. D. and Andréa, D. B. (2010). Measuring access to medicines: a review of quantitative methods used in household surveys. BMC Health Services Research, Vol.10 (146).
 
[28]  Quick J. D. Hogerzeil, H. V. Germán Velásquez & Lembit Rägo. (2002). Twenty-five years of essential medicines. Bulletin World Health organization vol. 80 (11).
 
[29]  Kotwani A (2011) Transparently and Accountability in Public procurement of Essential Medicine in developing countries, http//www.igiglobal.com (Retrieved 10th August 2013).
 
[30]  Hogerzeil V Hans. (2006). Essential medicines and human rights: what can they learn from each Other? Bull World Health Organ vol.84 (5) Genebra.
 
[31]  Laing, R. Waning, B. Gray, A. Ford, N. Hoen, E. (2003). 25 years of the WHO essential medicines list: progress and challenges. The Lancet. Vol.361 pp1723-1729.
 
[32]  MOH, (2007b). Essential Medicines List for Uganda. Retrieved October 14th, 2013 form www.health.go.ug.
 
[33]  WHO, (2003). Assessment of the pharmaceutical Sector in Ethiopia Retrieved September 15th, 2013, from www.who.int/medicines.
 
[34]  Jahre, M. Dumoulin, L. Greenhalgh, L. B. Hudspeth, C. Limlim, P. Anna, S. (2012). Improving health in developing countries: reducing complexity of drug supply chains. Journal of Humanitarian Logistics and Supply Chain Management, Vol. 2 (1) pp. 54.
 
[35]  Okiror, B. (2009). Drug shortage Hits Uganda. Retrieved September 15th, 2013, from http://www.newvision.co.ug
 
[36]  JSI/Nepal Family Health Program. (2007). Logistic Pull system in Nepal, Nepal Family Health Program (367-00-02-00017-00).
 
[37]  MOH, (2011)b. Assessment of the Uganda Essential Medicines Kit-Based Supply System in Uganda. Retrieved September 27th, 2013, from www.api.ning.com.
 
[38]  Bukuluki, P. Byansi, P.K. Sengendo, J. Nyanzi, I. Banoba, P. and Kaawa-Mafigiri, D. (2013). Changing from the pull to push system of distributing essenttial medicines and Health supplies in Uganda: implication for efficient Allocation of medicines and Meeting the local needs of the Health Facilities. Gobal Health Governance, Vol. VI (2).
 
[39]  Buuse, B. B. (2012). Increasing access to health services in a post-conflict space: A study of the Village Health Team strategy program in Gulu, District Uganda. Retrieved March15th, 2014, from http://.www.dare.una.nl/document/468571.
 
[40]  Tumwine, Y. Kutyabami, P. Odoi, R.A. and Kalyango, J. (2010). Availability and Expiry of Essential Medicines and Supplies during the ‘Pull’ and ‘Push’ Drug Acquisition Systems in a Rural Ugandan Hospital. Tropical Journal of Pharmaceutical Research, Vol. 9, (6), pp. 557-564.
 
[41]  Ministry of Medical Services and Ministry of Public Health & Sanitation (2009). Access to Essential Medicines in Kenya; A Health Facility Survey. Retrieved April 20th, 2014, from www.health.go.ke.
 
[42]  MOH, (2009). Final Report Essential Medicines and Health Supplies Tracking Study. Retrieved September 27th, 2013, from www.health.go.ug.
 
[43]  Mueller, D. H., Lungu, D. Acharya, A. and Palmer, N. (2011). Constraints to Implementing the Essential Health Package in Malawi. PLoS One. Vol. 6(6): doi: 10.1371/journal.pone.0020741)
 
[44]  MOH/USAID/SURE, (2011). Assessment of the Essential Medicines Kit-Based Supply System in Uganda. Retrieved September 27th, 2013, from www.api.ning.com.
 
[45]  SURE, (2012). "Improving Access to medicines and Health Supplies: Experience and Future Prospects" Retrieved July 17th, 2013, ww.sure.ug/?Success_Stories:District_level.
 
[46]  Oluka, P. N. Ssennoga, F. and Kambaza, S. (2013). Tackling Supply Chain Bottle Neck of Essential drugs: A case of Uganda Local Government Health Units. Retrieved September 15th, 2013 from www.ippa.org.
 
[47]  HEPS (2010). Right to Essential Medicines Tracking Uganda’s Health Sector in Budgeting, Financing and Delivery of Essential Medicines. Retrieved April 14th, 2014 from http://www.tap.resultsfordevelopment.org/sites/tap.resultsfordevelopment.org.
 
[48]  Ministry of Health and Social Welfare, (2008). In-Depth Assessment of the Medicines Supply management System In Tanzania, Dar essalaam, Tanzania. www.who.int/medicines accessed 26/September/2013).
 
[49]  SURE, (2010). Annual Progress Report. Retrieved July 17th, 2014, from www.sure.ug.
 
[50]  NMS Pharmacy Division, (2013). National Performance Report on Medicines Management, Issue no. 3, November 27, 2013, Retrieved April 17th, 2014 from http://www.sure.ug.
 
[51]  HEPS and UNHCO, (2012). Funding Essential Medicines. Retrieved April, 14th, 2014 from www.unhco.or.ug/wp content/plugins/download.../download.php?id.
 
[52]  WHO, (2004). Access to essential medicines. Retrieved August 4th, 2014, from http://apps.who.int/ medicinedocs/en/d/Js6160e/9.html.
 
[53]  Watal, J, ( 2000). Access to Essential Medicines in Developing Countries: Does the WTO TRIPS Agreement Hinder It? Science, Technology and Innovation Discussion Paper No. 8, Center for International Development, Harvard, Cambridge, MA, USA.).
 
[54]  Vera, M. V. P. Anaclaudia, G. F. Maria de Fátima, S. M. Marlos, R. D. and Andréa, D. B. (2010). Measuring access to medicines: a review of quantitative methods used in household surveys. BMC Health Services Research, Vol.10 (146).