Evaluation of Procurement & Storage of Medicine at Rural Health Centers in District Chiniot

Abstract

Objective: To assess the process of procurement and storage of medicines at rural health
centres (RHCs) in District Chiniot.
Material & Methods: A cross-sectional study was conducted. All 5 RHCs in the District were
included in the study and in charge of the RHCs were interviewed on a prescribed questionnaire
to assess the procurement of medicines. The condition of stores was assessed by a separate
structured check list.
Results: Eighty percent of the officers in charge were Senior Medical Officers, 40% had post
graduation qualification and majority had 15-20 years experience. 20% had less than 1 year
experience in purchase. Forty percent had Pull and Push both drug procurement systems and
100% calculated their demand on the basis of average monthly consumption, buffer stock and
review period basis. All procured major chunk of medicine through District Medical Store but
purchase from local market and petty purchases were also made to meet the demand of the
patients. Tender was called, and the rate contract was done by District Health Authority and all in
charges submitted their demands and supply orders. Majority (80%) of them accepted the drug
having more than 75% shelf life. Eighty percent had more than 1 drug store at their health facility
and only 40% had got the store white washed annually. 100% maintained their stock by following
FIFO and FEFO methods. Despite only 40% received budget in time, 80% utilized the budget
100% and only 60% faced some sort of audit paras. Custodian of RHCs were dispensers at 100%
RHCs. 60% in charges had got logistics management training for less than 2 weeks whereas non
of the store keeper had got any such training. None of the store had adequate space i.e. 250 sq. ft.
20% stores had leaking roofs. 60% stores had pellets, shelves and racks. Space between stacks
and wall was not present in any of these stores. In majority 80% stores the cartons were placed on
the floor instead of on the racks. To maintain the cold chain and storage temperature of controlled
items, functional refrigerator was present in 80% stores, whereas deep freezer was present in
only 20% stores. Tripping and power supply failure is very important issue especially in rural
areas. Generators were present in 40% RHCs out of which 20% were not functional.Cleanliness
was satisfactory in 100% stores. None of the store was white washed. Exhaust fans were not
present in any of these stores. Direct sunlight was not coming into 80% stores. Cross ventilation
was ensured in only 60% stores and 80% stores had separate cool place for temperature
controlled items. At 100% RHCs stock registers were maintained but stock was physically present
as per record at only 20% RHCs. Physical verification of stock by in charge, DOH or EDOH was
conducted at 80% RHCs during the year. Major issues / constraints at RHCs were: delay in
budget provision and rate contract, insufficient store space and difficulty in unloading the stock.
Conclusion: These results indicate that although the in charges had successfully completed
the process of procurement, yet there is need for logistics management training. As the store
space is insufficient at all RHCs, there is need to build new medicine stores according to the
international standards at all RHCs. Timely provision of efficient drugs at RHCs will decrease the
morbidity and mortality in the rural community and will help reduce the poverty.