Date Published: February 27, 2019
Publisher: Public Library of Science
Author(s): Desmond Kuupiel, Boikhutso Tlou, Vitalis Bawontuo, Paul K. Drain, Tivani P. Mashamba-Thompson, Nei-yuan Hsiao.
Several supply chain components are important to sustain point-of-care (POC) testing services in rural settings. To evaluate the availability of POC diagnostic tests in rural Ghana’s primary healthcare (PHC) clinics, we conducted an audit of the supply chain management for POC diagnostic services in rural Upper East Region’s (UER) PHC clinics, Ghana to determine the reasons/causes of POC tests deficiencies.
We conducted a review of accessible POC diagnostics in 100 PHC clinics in UER, Ghana from February to March 2018. We used a monitoring audit tool adopted from the World Health Organization and Management Science for Health guidelines for supply chain management of diagnostics for compliance. We determined a clinic’s compliance with the stipulated guidelines, and a composite compliant score was defined as a percentage rating of 90 to 100%. We used univariate logistic regression analysis in Stata 14 to determine the level of association between supply chain management and the audit variables.
Overall, the composite compliant score of supply chain management for existing POC tests was at 81% (95%CI: 79%–82%). The mean compliance with distribution guidelines was at 93.8% (95%CI: 91.9%–95.6%) the highest score, whilst inventory management scored the lowest, at 53.5% (95%CI: 49.5%–57.5%) compliance. Of the 13 districts in the region, the results showed complete stock-out of blood glucose test in all selected PHC clinics in seven (53.8%) districts, haemoglobin and hepatitis B virus test in three (23.1%), and urine protein test in two (15.4%) districts. Based on our univariate logistics regression models, stock-out of tests at the Regional Medical and District Health Directorates stores in the region, high clinic attendance, lack of documentation of expiry date/expired tests, poor documentation of inventory level, poor monitoring of monthly consumption level, and failure to document unexplained losses of the various POC tests were significant predictors of complete test stock-out in most of the clinics in the Upper East Region.
There is poor supply chain management of POC diagnostic tests in UER’s PHC clinics. Improvement in inventory management and human resource capacity for POC testing is critical to ensure accessibility and sustainability of POC diagnostic services in resource-limited settings PHC clinics.
Diagnostics are an essential component to advance universal health coverage, address health emergencies, and promote healthier populations . However, several primary healthcare (PHC) facilities lack sophisticated laboratory infrastructure and do not have the resources to transport clinical specimens to central laboratories, where available, and point-of-care (POC) diagnostics can provide a solution to this challenge [2–4]. The World Health Organization (WHO) has pre-qualified some POC diagnostic technologies for use in resource-limited settings to facilitate POC testing, disease management and prevention . However, supply chain management challenges may hamper the accessibility of these essential POC diagnostics and possibly result in stock-outs, especially in low- and middle-income countries (LMIC) rural clinics such as Ghana [5, 6]. For instance, nearly 50% of clients did not have access to HIV and syphilis testing in Guatemala partially due to test stock-outs ; almost half of the rapid syphilis test (RST) implementation pilot sites and a third of rollout sites in Zambia reported test stock-outs . In addition, stock-outs of RSTs were reported at various stages in Zambia in a study aimed at assessing the impact of RSTs and treatment in pregnant women . It is also evident that stock-outs of various POC tests have been reported in primary healthcare facilities in Mozambique , Uganda , and South Africa . In Ghana, a study aimed at assessing the accessibility of POC diagnostic services for antenatal care in rural primary PHC clinics, revealed poor availability of POC tests , which is similar to what has been reported in rural South Africa .
We audited the supply chain management of POC diagnostics in rural PHC clinics in the UER of Ghana. In this study, inadequate supply chain management of POC diagnostics was high, and the combined compliance score was strong on distribution and selection of POC diagnostics. POC diagnostics inventory management was revealed to be weak, followed by human resource capacity for POC testing in the region. This audit also demonstrated stock-outs of haemoglobin, blood glucose, syphilis, hepatitis B, and urine protein/albumin POC test kits in the majority of the rural clinics. Lack of POC tests at the Regional/District Health Directorate stores, inadequate inventory management, and high clinic attendance demonstrated significant association with test stock-out in the PHC clinics.
There is poor supply chain management of POC diagnostics in the Upper East Region’s rural PHC clinics. The audit results have shown higher deficiencies in inventory management and human resource capacity for POC diagnostic services in audited PHC clinics in rural UER. Improving inventory management, training of healthcare workers, and provision of standard operating procedures, alongside increased procurement of POC diagnostics is highly recommended strengthening rural healthcare delivery and outcomes. Finally, supply chain management strategies for POC diagnostics need to be well planned to ensure accessibility of POC diagnostic services in rural resource-limited settings, which could ultimately lead to universal health coverage.