1. Congratulations Atu! You have done it, Glory be unto God! BUT: 2. Your cover page needs to be attended accordingly, check out the guidelines and make it more attractive 3. Your abstract should be adjusted a bit to make it more sound and sweet 4. Your chapter titles should be at the centre 5. Your subsections like introduction in chapter 4 should be in title-case 6. Observe thoroughly the font size, space, etc making your report more calling and palatable 7. The words marked in blue needs your attention using the suggestive corrections in given brackets; you can check this with Sweet Ally Chanz if not scared NB: Currently, I am so busy but I can spare very few minutes for your abstract reparation 1
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1. Congratulations Atu! You have done it, Glory be unto God! BUT:
2. Your cover page needs to be attended accordingly, check out the guidelines
and make it more attractive
3. Your abstract should be adjusted a bit to make it more sound and sweet
4. Your chapter titles should be at the centre
5. Your subsections like introduction in chapter 4 should be in title-case
6. Observe thoroughly the font size, space, etc making your report more calling
and palatable
7. The words marked in blue needs your attention using the suggestive
corrections in given brackets; you can check this with Sweet Ally Chanz if
not scared
NB: Currently, I am so busy but I can spare very few minutes for your abstract
reparation
1
PREPARED BY: ATUPELE .A.MWANYANGALA
REGISTRATION NUMBER: B0861010
RESEARCH TITLE
MANAGEMENT SKILLS PERTAINING SUPPLY OF MEDICINE IN PUBLIC HEALTH FACILITIES: A CASE OF MBEYA CITY.
SUPERVISOR’ NAME: Mr. MAHALLAH, E, R.
2
RESEARCH REPORT SUBMITTED TO MBEYA INSTITUTE OF SCIENCE AND TECHNOLOGY AS A PARTIAL FULFILMENT FOR THE AWARD OF BACHELOR DEGREE IN BUSINESS ADMINISTRATION(BBA)
JULY, 2011
Certification
The undersigned person certifies that he has read and truly recommends WHAT for
acceptance by the Mbeya Institute of Science and Technology the research paper titled
“MANAGEMENT SKILLS PARTAINING SUPPLY OF MEDICINE IN PUBLIC
HEALTH FACILITIES; A CASE OF MBEYA CITY” in partial fulfillment of the
requirement for the award of Bachelor Degree in Business administration at Mbeya
Institute of Science and Technology- Tanzania.
………………………………………………………………………..
Mr. MAHALLAH.E, R
(Supervisor)
July, 2011
3
Declaration
I, Atupele A Mwanyangala, declare that this is my own original work and has not been
presented to any other UNIVERSITY or INSTITUTE for similar award.
Controlling the available stock of medicine in public health facilities to check the
progress against the plans.
iv. Doctors and Nurses
Reports to medical store department officers kinds of medicines that are not
available and needed for treatment of the patients at that time.
Figure 4.3 below shows Supply chain of medicine from headquarter to Mbeya
public health facilities.
Medicines from outside the country and local manufacturers;
Medicine reaches to MSD headquarter (Dar es Salaam);
Medicines received to Mbeya MSD;
End user (Patients).
Medicine received to other public health facilities;
35
The figure above shows the supply chain of medicine from outside the country and local
manufacturers, then medicine sent to headquarter MSD, there after medicines are
distributed to other MSD’S in regions to easy purchasing of public health facilities.
The researcher found that medicine supplied to public health facilities, eighty percent
(80%) of medicines are imported from outside the country while the rest twenty percent
(20%) are manufactured locally
4.3 Programs used to manage of medicine in public health facilities.
The researcher through interview and questionnaire found that in National wise, there are
specific programs used to manage medicine in public health facilities, these are; extended
program for immunization (EPI) this deals with immunization especially for the pregnant
mothers and children, the program is under World Health Organization (WHO). Another
program is National Aids Control Program (NACP) used to manage all medicine for HIV
i.e.Ant-RetriViral (ARV). Moreover program used to control malaria, and the program
used to control Tuberculosis .The program were formed to make sure that there is
availability of medicine for such diseases. The programs are there but the supply and
management of medicine remains to be a problem in public health facilities. According to
the study the researcher found that there is negligence among these programs which fail
to manage medicine in public health facilities so as to reduce the problem of medicine
shortage at those facilities. There are number of processes of managing medicine in
public health facilities but people who used to manage medicines are working under these
programs.
From the study 88.46 responses shows that there is poor management of medicine in
public health facilities, this causes shortage of medicine in public health facilities as
explained below:-
I. Mis-management of medicines/ drugs at public health facility due to
Insufficient of qualified staffs at public health facilities.
II. Irrational use of medicine by doctors and nurses. For stance they supposed to
give out medicines which they received early and store those which come later
to avoid spoilage of medicine, but they usually give out medicine which come
36
later leaving other medicine expire and become not good for treatment to
human being.
III. Negligence of medical storekeepers in timing of ordering medicine. They
press order to MSD while medicine are totally finished at their facilities.
Therefore during the process of ordering and purchase of medicine causes the
particular facility to have shortage of medicine.
IV. Unethical behavior of some medical storekeepers together with doctors and
nurses who still medicine at public health facilities and send them to their
private pharmacies or sell them illegally.
4.4 The nature of supply and distribution of medicine in public health facilities
Observed actions revealed that, supply of medicine starts from headquarter in Dar es
salaam MSD after medicine have been purchased from outside the country or bought
locally. During the study it was observes that, 80% of Medicines bought by the country
under the minister of health and social affairs (MSD headquarter) are imported from
abroad while the rest 20% are manufactured locally. Medicines are transported to other
regional MSD’S ready for distribution to public health facilities It involves a lot of
processes from the top downward to public health facilities. Poor supply is one among
factors contributing to shortage of medicine in public health facilities. Therefore the
supply of medicines in public health facilities is poor as it is associated with bureaucratic
processes. In addition to that medicine supplied are not enough compared to the demand
(order placed). The shortage of medicine in Mbeya city is sometimes beyond the Region
(MSD) capacity because they used to take medicine to headquarter (Dar es Salaam) so if
they miss specifications requested by public health facilities from Mbeya City it means
the problem of shortage of medicine continues.
Moreover the findings showed that supply of medicine is poor due to the fact that the
country itself is poor. The poverty causes medicine not to deliver at the public health
facility in time and those which are delivered are not enough compared to the societies
demand.
37
The supply of medicine in public health facilities is poor due to negligence of top leaders
who fail to take measures and other alternatives to rectify the situation.
Poor supply of medicine in the country is the major reason which causes patients to be
always instructed to buy medicine in private pharmacies rather than being given at the
particular health facility.
As 77.78% of respondents argued that there is poor supply of medicine in the country
from headquarter to Regional MSD’S and lastly to public health facilities, this by
implication means that supply of medicine is the accelerates shortage of medicine in
public health facilities.
Supply and distribution of medicine in Mbeya city.
Source: Survey data, 2011
Figure 4.2 above shows that there is poor supply of medicine in Mbeya City. As 92.30
percent of responses shows that large number of population in Mbeya City are not
satisfied by medicine supplied in public health facilities. Nurses and doctors who works
38
in public health facilities faces the problems during purchases of medicine as most of
times they don’t find medicine at MSD. Patients also complained that most of times when
they went to the public health facilities for treatment they just instructed to buy medicine
at private pharmacies (after check-up) where cost of medicine is very high compared to
their income.
Bureaucratic processes from headquarter to other MSDS and public health facilities is the
major cause of poor supply and distribution of medicine. Sometimes head officers make
unnecessary delay to sign documents, inspect and then dispatch medicine to public health
facilities. Moreover supply of medicine is poor due to the fact that the country itself is
poor. The poverty causes medicine not to deliver at the public health facility in time and
those which are delivered are not enough compared to the societies demand. Also supply
of medicine in public health facilities is poor due to negligence of top leaders who fail to
take measures and other alternatives to rectify the situation.
As 92.30 percent of the results shows that there is poor supply of medicine in the country
from headquarter to Regional MSD’S and lastly to public health facilities. This by
simplification mean that medicine supply in the country is poor then this causes supply to
be poor in Mbeya City also, this by the case imply that demand is higher that supply of
medicine in the Mbeya City.
4.5 Reasons to why patients are instructed to buy medicine in private pharmacies after
check-up in public health facilities
From the study, 86.47 percent of responses show that medicine is not available in public
health facilities because of poor management and supply. This proves that communities
of Mbeya are aware of medicine shortage in public health facilities. This is the major
problem affects their health and then daily activities as when they are sick they fail to get
treatment in such a case the situation causes poverty among the society of Mbeya City
since the workforce cannot work properly.
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Source: Survey data, 2011
IV.6 Factors influence shortages of medicine in public health facilities.
4.6.1 The study found number of factors which causes shortage of medicine in public
health facilities. In addition to those factors many respondents complained about National
Essential Drugs List (NEDL). This is the tool which is used by the nation to procure
medicine. The tool is used for procurering uniform medicine in the whole country. The
problem of this tool is that since it has created no changes have been made to it. There are
new diseases erupting daily, because medicines to treat such diseases are not in the list it
causes death of the patients who face particular diseases. There was a case on July 2010,
one patient brought at Referral hospital suffering from the disease known as Gangling,
the disease was new to such hospital because there was no medicine to treat him the
patient died with ought any help.
4.6.2 Other factors other than NEDL which causes shortage of medicine in public
health facilities are the follows:-
i. Low fund given to public health facilities for buying medicine either at MSD or at
private pharmacies.
40
ii. Mis-management of medicines/ drugs at public health facility due to Insufficient
of qualified staffs at public health facilities.
iii. Irrational use of medicine by doctors and nurses. For stance they supposed to
give out medicines which they received early and store those which come later to
avoid spoilage of medicine, but they usually give out medicine which come later
leaving other medicine expire and become not good for treatment to human being.
iv. Negligence of medical storekeepers in timing of ordering medicine. They press
order to MSD while medicine are totally finished at their facilities. Therefore
during the process of ordering and purchase of medicine causes the particular
facility to have shortage of medicine.
v. Unethical behavior of some medical storekeepers together with doctors and nurses
who still medicine at public health facilities and send them to their private
pharmacies or sell them illegally.
vi. There are some medicines which are used by pregnant women only therefore its
order is usually small. When particular medicines are out of stock and not
available at MSD then it creates the problem of insufficient of medicine at that
facility. Examples of such medicines are Quinine, Folic Acid, (iron sulphide) Fe
so4, Ant-worms, TT-Injection.
vii. Medicines for children and pregnant mothers are given free to the patients (no
cost sharing) while the facility is not given free from MSD, this creates the
problem of ordering other medicine in time because of financial problems.
viii. Low fund by the government to health sector, they give low salaries to the doctors
and nurses that is why they still some medicine and sell so that they can survival.
ix. Also bureaucratic in the process of supplying medicine. It was found that 80% of
medicines are imported from outside the country and the rest 20% are
manufactured in the country. Therefore when medicine are finished at headquarter
in Dar es salaam (MSD) , it means all MSD’S and all public health facilities are in
trouble as they must wait until medicine brought in the country, inspected, send to
MSD headquarter then distributed to other MSD’S and lastly to the health
facilities.
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x. There is also a serious lack of coordination and transparency in donor assistance.
In many cases, it is even difficult to estimate the total amount of funding going to
support medicines. The lack of transparency and multitude of donors create
significant transaction costs for Tanzania, which must devote scarce staff of
managing the morass (confusing situation) of reporting requirements.
The study found that about 84.62 percent of the respondents had been are aware of other
factors and National Essential Drugs List (NEDL) used by the country to procure and
manufacture medicine used by in the public health facilities. The other 7.69 percent of
respondents knows other factors only, while the remaining 7.69 percent they don’t know
exactly answer.
The figure below shows 84.62 percent of respondents are aware with NEDL and other
factors which causes shortage of medicine in public health facilities. 7.69 percent are
those who aware with other factors only and the remaining 7.69 percent do not know
exactly answer.
42
4.7 Measures suggested to be taken by the government and NG’OS to reduce medicine
shortage in public health facilities.
The following were measures suggested by number of workers from different health
facilities and patients so as to overcome the problem of medicine shortage in public
health facilities. These were the follows:-
I. MSD should send medicines directly to the public health facilities so as to make
sure that all medicines bought by a particular facility reached real destination (at
public healthy facility) and not otherwise.
II. There should be close supervision to supplies officers, doctors, nurses and
medical storekeepers to make sure there is no negligence which can lead to expire
of some medicine and un ethical behavior of steeling medicine should be reduced
or stop if possible. (from high level to low level)
III. National Essential Drugs List (NEDL) should be changing regularly due to
eruption of new diseases so as to avoid the problem of insufficient of particular
medicine.
IV. To provide health education to the society so that preventive should be taken
rather than wait until disease becomes critical while medicine are not available all
the time.
V. Storage capacity should be increased in size so as medicine should be taken in
large amount to avoid the problem of insufficient especially at the time when
there is stock out at headquarter. As the population increases always which cause
demand of medicine to be higher than supply.
VI. Training of staffs especially management skill of medicine, this could reduce the
problem of irrational use of medicine at public healthy facilities and could reduce
the problem of medicine expire while the demand is high.
VII. Government should make sure that medicines for women and children are
available all the time by purchasing large number compared to other groups of
people. Women and children are more prone to diseases medicine should be
available at all time to reduce the number of deaths of women and children.
VIII. There should be close supervision to supplies officers, doctors, nurses and
medical storekeepers to make sure there is no negligence which can lead to expire
43
of some medicine and un ethical behavior of steeling medicine should be reduced
or stop if possible.
IX. To give strong punishment to health officers who steel medicine and sell it
illegally or send to their private health facility.
X. To increase salaries to doctors, nurses, medical store keepers which relate to their
job so as they could not be tempted to steel medicine due to difficulty of life.
XI. Doctors and nurses should make sure that medicine is available at their health
facilities so as to serve their lives.
XII. The government of Tanzania should make sure that they allocate enough funds
which could be able to buy medicine in time and enable public healthy facilities to
hold enough funds for purchasing medicine at private pharmacies at the time of
stock-out.
XIII. Also the government should take care with government fund which are allocated
in politics rather than keep for health purposes.
As 96.15 percent of responses seemed to need changes at public health facilities, this by
simplification mean that changes in whole process of supply, management and
distribution of medicine should be taken into consideration so as to reduce the problem of
unnecessary deaths of people especially pregnant mothers and children who cannot afford
to go at private hospitals for treatment.
44
4.8 Changes suggested to be made in the overall system of medicine supply in public
health facilities.
Source: Survey data, 2011
Figure above shows 92.3 percent of responses needs changes in the process of medicine
supply in public health facilities. As most of the societies living in Mbeya city are low
income earners. Most of them depend in agricultural activities and small businesses, this
prohibit them to afford the cost of medicine charged by private pharmacies and private
health facilities. Therefore there is a need for changes in medicine supply so as to serve
their lives especially pregnant mothers and children who are more prone to diseases.
4.9 Things to be done towards supply, management and distribution of medicine in
public health facilities.
From the observation 92.30 percent of responses need changes of medicine supply and
management in public health facilities, the following the changes which can help to solve
the problem medicine shortage in public health facilities.
45
i. MSD should send medicines directly to the public healthy facilities so as to make
sure that all medicines bought by a particular facility reached real destination (at
public healthy facility) and not otherwise.
ii. It is the time for the Government to find strategies of increasing medicine
production in the country so as to easy supply of medicine in public health
facilities.
iii. Supervision in the process of supplying medicine to reduce negligence of top
leaders to bottom and increase of medicine production in the country to improve
supply of medicine.
iv. Medicine should be manufactured locally rather than importing from other
countries which increase cost of buying and transportation.
The figure below, 76.92 percent of responses needed changes in supply of medicine in
public health facilities, 15.39 percent of responses do not need any changes while 7.69
percent they do not know what should be done. Since the percentage for those who needs
changes is high i.e. 76.92 percent there is a need of changes in medicine supply for the
development of Mbeya city and the country in general.
46
Source: Survey data, 2011
47
CHAPTER FIVE: CONCLUSIONS AND RECOMMENDATION
5.0 Introduction
Chapter Four concentrated on the analysis of the data collected during the study. This
chapter gives the conclusions of findings and recommendations on what should be done
to rectify the situation. The chapter Starts with the introductory part while section one
gives the main conclusions which were drawn from the findings of the study. Section two
gives the recommendations and section three gives the strategies which should be
implemented in order to reduce the problem of medicine shortage in public health
facilities.
5.1 Conclusions
From the study 92.30 percent of responses needed changes in public health facilities so as
to overcome the problem of medicine shortage. The supply nature of medicine clearly
increases medicine shortage in public health facilities. The supply system involves a lot
of processes and red-tape actions which causes medicine being delivered late to public
health facilities. Another cause of medicine shortage is eighty (80) percent of medicine
are importing from outside the country, a lot of government fund is consumed for
medicine transportation costs and money value of the country is compared to the money
value of other countries. Since a lot of money is used for importation of medicine this
causes public health facilities to be given insufficient fund which are not enough for
buying medicine at the time when they are not available at MSD.
Also the tool for used for medicine procurement in the country is outdated, it needs
frequent changes as new diseases are erupting daily while medicine for treating are not
available in National Essential Drugs List. This causes shortage of medicine in public
health facilities. Sometimes some medicine are not procured because they are not listed in
National Essential Drugs List (NEDL)
The study found that most of communities in Mbeya City does not take any measures to
make sure that the problem of medicine shortage is eliminated. They were just blaming
among themselves something which had no help to them. Most of complaints were
directed to the government, nurses and doctors who not only instructed them to buy
48
medicine in private pharmacies after check-up but also they treated them badly especially
when patients demanded medicine at the particular facility.
Hence, there is a need to take deliberate measures against the procurement, supply,
management and distribution of medicine in public health facilities.
The Government, Civil Societies, Non Government Organizations and other stakeholders
have to initiate, support and extend health programs aimed at manufacturing medicine in
the country. They also have to take measures on changes of management, supply and
distribution of medicine so as to overcome the problem of medicine shortage in public
health facilities in Mbeya City and the country in general
5.2 Recommendations
I. From the results researcher advices to change the supply system of medicine in
public health facilities either by reducing unnecessary processes which cause
medicine fail to reach at the public health facility in time.
II. Also medicine should be manufactured in the country rather than importing from
outside the country which leads to long processes in medicine delivery to public
health facilities. Importation of medicine from outside the country increases the
cost and reduce fund which could be used to other areas in health sector
III. Managing director and senior pharmacist of the particular health facility should
make sure that inspection is regularly made to the medical storekeeper’s records
so as to improve the availability of medicine at public health facilities.
IV. The researcher advises the government to take measures concerning health
services especially to make regular changes to the National Essential Drugs List
(NEDL) and to increase fund to health sector and find ways to reduce red tape
(bureaucratic) for the medicine supply and distribution in public health facilities.
V. Emergency procurement is needed from time to time to handle the fluctuating
demand. MSD should be able to use this method with the appropriate conditions
and controls. MSD would need to negotiate with the government and Ministry of
49
health on how to handle the price of items (medicine) if procured under
emergency conditions.
5.3 Measures to be taken and strategies to be implemented so as to rectify the
situation.
5.3.1 Measures should be taken so as to overcome inefficiencies at any stage of the
supply chain which can cause stock-outs like:-
Inadequate funds for procurement of medicines ;
Inaccurate and non-participatory forecasting ;
Inadequate buffer stock of essential medicines at all levels of the supply chain;
Inefficient distribution systems at national and regional levels and
Inadequate record-keeping.
5.3.2 Strategies to be implemented in order eliminate stock-outs of medicine in public
health facilities.
City health management teams should be participatory to encourage transparency
and accountability in the supply chain;
Monitoring of availability of medicines at the health facilities;
Advocacy for 100% availability of medicines and advocacy for increased funding
for medicines.
Adequate data on its safety, and efficacy should be available from clinical
studies.
Choice of medicine manufactured should be made on the basis of relative
efficacy, safety, quality, price and availability.
Cost Benefit Ratio (CBR) remains a major consideration in health services so as
to provide public health facilities with minimum fund which should be used for
emergency purchases of medicine in case there is shortage.
50
The change of National Essential Drugs List (NEDL) should be a continuing
process, regularly updating drug selections in light of new therapeutic options and
changing therapeutic needs.
Religious organizations, in collaboration with the ministry of health and other
development actors should increase assistance of building number of health
facilities with minimum cost sharing which could enable low income earners to
get treatment when they are sick.
Training should be given to health providers and medical storekeepers so that they
could be rational in medicine management so as to increase the availability of
medicine in public health facilities.
Strong punishments should be made to unethical doctors, nurses, medical
storekeepers and health officers at MSDS who still medicine and sell them at their
pharmacies where the cost is very high compared to public pharmacies.
Government should increase fund to health sector which could be used for
emergency purchasing of medicine and paying salaries to health officers on time
so as to they can work comfortable as well as to reduce unethical behavior of
stilling medicine in public health facilities.
51
APPENDICES
Interview Questions
Dear Respondent,
My name is Atupele A Mwanyangala, a student at Mbeya Institute of Science and Technology (MIST) pursuing Bachelor degree of Business Administration (BBA). I am conducting a research on Management Skills Pertaining Supply and Distribution of Medicine in Public Health Facilities. At Medical Store Department (MSD), Referral hospital, Regional hospital, META reproductive health and Ruanda health centre.The purpose of this questionnaire is to seek your views on this study. The information provided will be treated as confidential as possible and be used for the academic purpose.
I request your cooperation in completing and feeling the enclosed questionnaires which will guide me in conducting the study.
(a) Personal particulars
Gender………………………
Department…………………
Experience…………………..
Position………………………
(b) Interview questions
1. How do medicine being managed in public health facilities?
………………………………………………………………………………………………………………………………………………………………………………………………2. Can you give your opinion about supply and distribution system of medicine in public health facilities?……………………………………………………………………………………………………………………………………………………………………………………………..
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3. Are current supply and distribution system of medicine satisfying the population of Mbeya City?………………………………………………………………………………………………………………………………………………………………………………………………4. Why do you think patients are instructed to buy medicine in private pharmacies after check-up in public health facility?………………………………………………………………………………………………………………………………………………………………………………………………
5. May you give factors which influence the shortage of medicine in public health facilities?………………………………………………………………………………………………………………………………………………………………………………………………
6. Despite the measures taken by the government and NGO’S to reduce or eradicate
medicine shortage in public health facilities, can you suggest other measures?
………………………………………………………………………………………………
………………………………………………………………………………………………
7. Are there any changes you would like to see on the overall system of supply and
distribution of medicine in public health facilities? Which are they?
………………………………………………………………………………………………
………………………………………………………………………………………………
Put a tick to the most appropriate answer
8. Can you give your opinion concerning supply nature of medicine in Tanzania from Dar es Salaam to Mbeya region?
Is it poor or effective?(a) Yes(b) No(c) Moderate
(a) If the answer is Yes How? ………………………………………………………………………………………………………………………………………………………………………………………………