National Joint Supportive Supervision Report on Pharmaceuticals Supply Chain Management and Pharmacy Services

Abstract

Abdulkedir Gelgelo Boru and Degefa Uma Banti*

Background: Ethiopia, the second most populous country in Africa with a projected population of 121 million by 2025, has made significant strides in health sector development. The country's healthcare system is decentralized, with the Federal Ministry of Health (MoH) overseeing policymaking, strategic planning, and coordination. The Ethiopian Pharmaceuticals Supply Service (EPSS), a semi-autonomous public institution, is responsible for providing qualityassured and affordable pharmaceuticals to public health facilities. The nation's commitment to improving healthcare is reflected in the Pharmaceuticals Supply Transformation Plan II (PSTP II) and the Health Sector Transformation Plan II (HSTP II), which prioritize the availability and accessibility of essential medicines. The World Health Organization (WHO) recommends regular supportive supervision to strengthen human resource capacity and improve logistics systems in low- and middle-income countries. The Joint Supportive Supervision (JSS) report is a crucial tool for providing evidence-based recommendations to improve the pharmaceutical supply chain. The 2nd JSS was conducted at a time when new initiatives, such as the EPSS reestablishment proclamation and a new pharmaceutical procurement directive, were being introduced to address national pharmaceutical availability issues.

Objective: The primary objective of the 2nd JSS was to evaluate the performance of the national supply chain management and pharmacy services to ensure the continuous availability of essential medicines and health commodities across Ethiopia. This supervision aimed to identify challenges, best practices, and lessons learned at all levels of the health supply chain.

Methodology: A nationwide joint supportive supervision was conducted from November 12 to December 12, 2024. The assessment included 157 public health facilities, covering all regions and city administrations. The sample comprised 14 health posts, 39 health centers, 49 hospitals, 11 Woreda Health Offices (WoHO), 16 Zonal Health Departments (ZHD), 16 Regional Health Bureaus (RHB), and 14 EPSS Hubs. Data collection focused on key areas, including supply chain performance, human resource capacity, budget allocation, logistics management information systems (LMIS), and pharmacy services. Both quantitative and qualitative data were collected using standardized tools and a digital platform (KOBO Toolbox) to ensure data quality. Data was analyzed using SPSS Version 27, employing descriptive statistics and frequency distributions, while qualitative data was analyzed by supply chain experts to identify themes and patterns.

Results: The supervision of 14 health posts revealed varied availability of essential health commodity reporting formats. While 57.1% had Health Post Monthly Reporting and Requisition (HPMRR) forms and 50.0% had Bin Cards, only 21.4% had Vaccine Request Forms (VRF). Pharmaceuticals were generally well-organized, but there was a need for more training on the Integrated Pharmaceutical Logistics System (IPLS). The assessment highlighted strong compliance (93.2%) with healthcare financing reforms, although challenges were noted in conflict-affected areas. Significant unpaid credits were observed in General Hospitals. The report identified a high staff turnover rate, insufficient support, and budget limitations as major challenges. Training participation varied significantly by region, with a need for targeted interventions to address these gaps. The study found generally sound governance, with variations among different facility types. Effective governance was linked to stable membership, clear guidelines, and active participation. The assessment revealed that while a substantial proportion of facilities reported on key performance indicators (KPIs) regularly, the utilization of M&E results for timely decision-making was weak, with a national average of only 52.3%. The implementation of Auditable Pharmacy Transactions and Services (APTS) varied significantly, with tertiary/specialized hospitals showing a higher rate of implementation (93.8%) compared to health centers (25.6%). Similarly, the provision of Drug Information Services (DIS) was more prevalent in specialized hospitals (75%) than in health centers and primary hospitals (15.4%).

Conclusion and Recommendations: The 2nd JSS report provides a comprehensive overview of the strengths and weaknesses of Ethiopia's pharmaceutical supply chain and pharmacy services. Key challenges identified include inconsistencies in LMIS tool availability and utilization, gaps in human resource capacity, financial management issues, and regional disparities in the implementation of pharmacy service initiatives. The report recommends a multifaceted approach to address these challenges, including strengthening administrative support, improving financial planning and audit protocols, and implementing targeted interventions to address regional disparities. The findings serve as a crucial starting point for informed action, with the goal of building a more resilient and equitable healthcare system for all citizens.

HTML PDF