Performance of integrated logistic system in health facilities: a case of Singida region

Abstract

Background: The Integrated Logistics System (ILS), a system for reporting about use of drugs and related medical supplies and for requesting resupply, designed to move beyond the previous supply system by integrating the drugs and supplies for numerous vertical programs. Unsatisfactory performance of ILS fail to fulfill the six right of logistic system of ensuring that the right medicines, in the right quantities, in the right condition are delivered to the right place, at the right time for the right cost. However the performance of ILS in Singida region, Tanzania is unknown. Objective: To assess the performance of integrated logistic system in health facilities in Singida region, Tanzania Methods: The study was a cross sectional survey using logistic indicator assessment tools, developed by JSI DELIVER PROJECT for assessing the performance of logistic system in health facilities. It was conducted between April and May 2013. For this study a total of 55 health facilities were included of which 15 health centers were selected by convenient and 40 dispensaries selected randomly. The central zone Medical Stores Department (MSD – Dodoma) was included as the sole government agency for medicines and medical supplies in public health facilities and makes a samples size of 56 Results: Stockout duration was observed to be high for oxytocin injection, artemether/lumefantrine tablets and amoxycillin capsules and low for dizepam injection in all districts. The average supply gap ranged from 28.9% in Singida Municipal to 45.6% in Singida District. The average order fulfillment rate ranged from 54.4% in Singida District to 71.1% in Singida Municipal. Over supply of tracer medicines was found in Singida Municipal and delivery of unordered was observed in Singida Municipal, Iramba and Manyoni Districts. The average delivery time of medicines consignment in districts ranged from 16.5 to 48 hours in Singida Municipal and Singida district respectively and it was found to be independent on the distance from the zonal MSD. Availability of LMIS register ranged from 85.5% for injection and 98.2% for patient registers, filling accuracy ranged from 68.1% for injection to 93% for dispensing registers. Majority of health facilities in Singida Municipal adhered to prescribed storage standards while in Manyoni district 60% health facilities scored in unacceptable range storage condition. Generally 27% of health facilities visited had good storage conditions, 29% scored in acceptable range vi and 44% scored in unacceptable range as per JSI DELIVER/WHO 2003 storage standard. Conclusion: The performance of ILS in the region varies within the districts. The overall availability of medicines in the region is still low. The stock-out duration of essential medicines is still high in the region, some key medicines were stocked out for more than 3 months. Order fulfillment rate by MSD is low and varies between districts in the region. The average delivery time of medicines from the zonal MSD to the health facilities is still high and it was found not depending on the distance from the zonal medical stores. Availability and completeness of LMIS tools in health facilities is still a problem and a number of health facilities were not adhering to prescribed storage standards.