Influence of Health System Determinants on Availability of Medicines in Public Health Facilities in Bungoma County, kenya

Abstract

Availability of medicines is important in provision of health care. Lack of medicines has been a major challenge in public health facilities in developing countries including Kenya. This research aimed at determining the influence of procurement process, inventory management practices and healthcare financing on availability of medicines in Bungoma County, Kenya. Descriptive cross sectional research design with mixed approach methods was applied. The target population included the county pharmacist, sub county pharmacists, medical superintendents, procurement officers, health administrative officers, the county procurement officer and the chief officer for health and sanitation. All the nine sub county hospitals were sampled and a census method applied to sample four staff from each sub county with one staff being sampled from each cadre of the target population above hence 36 respondents. This was achieved through G- power Priori power analysis. Additionally, the county procurement officer, the chief officer for health and sanitation and the county pharmacist were purposively sampled. The resulting total number of respondents was 39. A semi structured questionnaire, an in-depth interview guide, and a checklist were the study data gathering tools. Data was analyzed qualitatively and quantitatively. Descriptive statistics were employed in quantitative data analysis while Chi-square was used as appropriate. The information was then tabulated. Logistic regression was used to explain relationship between dependent and independent variables. Qualitative data was categorized into specific themes as per the research objectives and reported in narrative form together with quantitative presentation. 81.2% of respondents reiterated that procurement processes were followed as compared to 18.8% where, laid down procurement procedures were not followed. Health administrative officers were a majority of those who reported adherence to these procedures while all the pharmacists and procurement officers said they had full adherence. There was no significant relationship between adherence to procurement procedures and the cadre of the health professional involved (χ2 =2.230: p= 0.534). Inadequate funding, inadequate procurement staff and long procurement process were cited as challenges related to procurement of medicines. Inadequate funding was the main issue leading to stock out of medicines with 43.8% of respondents strongly agreeing to this statement while 46.9% plainly agreed. The influence of budgetary allocation was significant where subjects who said that budgetary allocation influenced availability medicine were included (OR=2.65, 95% CI, 0.737, 3.123), whereas the adherence to procurement procedures seemed to have a greater influence on the availability of medicines (OR=4.194, P=0.002). An average of 72.22 (63.35%) medicines were available, out of 114 that exist in the county’s standard order and reporting form for hospitals. On the other hand, the county averaged 51.30 days of stock outs in a quarter of a year. Absence of a county central store, an unreliable inventory management system, and an insufficient number of pharmaceutical professionals constituted the inventory management problems. The findings of this study will provide a baseline for further research in addition to providing insights on determinants of medicine availability. The government needs to streamline procurement, support inventory management practices and increase funding for medicines to ensure availability of medicines.