Managing disposal of unwanted pharmaceuticals at health facilities in Tanzania: a case of Dar es salaam region public health facilities

Abstract

ABSTRACT Background: In the public sector medicines are the property of the state, for which strict accounting procedures to write-off the unwanted pharmaceutical stock are necessary (Public Finance Act & Regulations, 2004). This applies both to medicines that are procured through the normal channels and to donated medicines. For quite a long time, disposal of unwanted medicines e.g. especially expired pharmaceuticals in the country has not been done systematically and professionally due to a number of factors that are yet to be clearly explained. This has resulted to accumulation of unwanted medicines in health facilities and medicines outlets in the country. Objectives: The study examined current pharmaceutical disposal practices and identified challenges encountered in the safe disposal of unwanted pharmaceuticals in Tanzania. Methodology: The study was a descriptive cross sectional survey. Data were collected through interview of medicines store in-charges/pharmacists from a sample of 63 selected health facilities on relevant issues with regard to safe disposal of unwanted pharmaceuticals. Furthermore the investigator reviewed records of previously disposed pharmaceuticals and those of unwanted medicines stock that is awaiting disposal. Results: Most of the public health facilities’ pharmacy stores personnel (73.4%) were nonpharmaceutical professionals hence have inadequate essential pharmaceutical management skills and low knowledge (34%) hence leading to poor handling of unwanted medicines. Since medicines in public health facilities are public properties thus are treated just like other properties like vehicles in their write –off and disposal procedures as per Public Finance Act & Regulations, 2004. Main disposal methods for unwanted drugs from the surveyed health facilities comprised of crushing and burying (72.4%) at the Dar es Salaam dumpsite open burning (31.0%) at the dumpsite, though not advisable under TFDA Guidelines for safe disposal, and incineration (37.9%); this is attributable to inadequate enforcement by TFDA. Conclusions and Recommendations: Managing disposal of unwanted medicines at public health facilities is highly associated with a number daunting challenges such as inadequate enforcement by TFDA, legal constraints (public Finance Act & Regulations, 2004); long procurement procedures at MSD, donation medicines (with short expiries) prescribing patterns (brand names prescriptions) and inadequate number of pharmaceutical staff. It is recommended that TFDA should now increase efforts such as frequent inspections at public facilities; facilities should only receive donations having 6 months shelf life remaining upon arrival in the country; and the MOHSW should enforces generic drugs prescribing as well as strengthen its efforts of ensuring that staffs of pharmaceutical cadre increase with the demand of service provisions.