Evaluation of the implementation of the redesigned logistics system: a case of health facilities and medical stores department in Mwanza region: a process evaluation

Abstract

ABSTRACT Background: The availability of medicines at service delivery points in many African countries including Tanzania remains uncertain. The global funding of diseases like Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome, malaria and Tuberculosis has resulted in increased volumes of commodities that have exacerbated the limitations of an already existing inadequate supply chain infrastructures. The redesigned logistics system was one of the initiatives employed to address the supply chain bottlenecks. The effective implementation of the redesign is crucial in ensuring the constant availability of health commodities at service delivery points. However, the fidelity in the implementation of the redesign logistics system in Tanzania conterxt was unclear.Therefore, this study aimed to assess the implementation of the Redesigned Logistics System by health facilities and Medical Stores Department in MTHwanza region. Materials and Methods: This study was conducted at 47 health facilities in Magu district council including 1 hospital, 6 health centres and 40 dispensaries. Utilizing a sequential explanatory mixed method study design, the study involved both quantitative and qualitative cross section surveys. Quantitative data were collected on the electronic logistics Management information system, Epicor-10 and Facility Financial Accounting And Reporting System databases using a checklist. Qualitative data were gathered through interview with 15 key informants consisting of 7 health facilities personnel and 8 Medical Stores Department personnel. The quantitative data were analyzed by SPSS statistical package while NVivo version 14 was used for qualitative data analysis. Findings: Over six cycles, the redesigned Integrated logistics system increased the timely submission of bimonthly reports from 57.4% to 100%. However, Medical Stores Department struggled with timely delivery, with only 40.8% of supplies delivered on time and 59.2% falling out of timeframe. Magu district utilised only 11.1% of the total health expenditures for purchasing heath commodities below the 50% indicated in the national guidelines. The council hospital had a slightly higher proportion of total expenditure for health commodities as a (23.7%),while health centres (12.1%) and dispensaries (2.5%). The health sector basket fund was the highest source (43.5%) followed by user fees (28.9%) and National Health Insurance Fund (27.4%). Conclusion The implementation of redesigned logistic system has significantly improved the timely submission of health facilities bimonthly reports to Medical Stores Department. However, Medical Stores Department struggled with timely delivery of health commodities to health facilities due to frequent stock shortages, disrupted distribution cycles, infrastructure and human resource challenges. Despite, increased health facility’s fund visibility, there was lower uptake of complementary funds for health commodities procurement that was below the guideline. The funds were lowest allocated for dispensaries with health sector basket funding being the main source fund. Staff motivation, internal and external pressure, and regular communication with stakeholders were among the factors that contributed to successful implementation. These findings underscores the need for policy intervention to address both systematic and operational challenges within the health supply chain, optimize resource allocation, and strengthen infrastructure and human resource capacities within the health system. Recommendations Health facilities should strengthen communication with Medical Stores Department in order to streamline logistical operations and ensure timely distribution of health commodities and seek mentorship support from Regional Health Management Team/Council Health Management Team during supervisory visits to increase reporting accuracy and reduce emergence orders. On the other hand, Medical Stores Department should address human resource challenges especially for areas with high work load, seek support from authorities to improve road infrastructures, improve monitoring and evaluation framework that will help in improving operational efficiencies and prepare a flexible budget for unforeseen circumstances.