Abstract
There is a need for efficient medical commodity supply chains in Ghana and in Sub-Saharan Africa (SSA), to be capable of delivering vaccines, medicines and other commodities, critical to delivering quality health care services, especially to last-mile patients. Irrespective of this necessity, medical commodity supply chains in Ghana and across SSA, are generally weak and dysfunctional, resulting in the poor delivery of commodities, continuous pilferage of these commodities, inadequate cold chain facilities and infrastructure, poor commodity security at storage facilities, poor transportation facilities for the delivery of commodities to last mile patients, among others. Despite these known commodity supply chain challenges in Ghana and in SSA over the years, no existing study has compared the private and public medical commodity supply chains in Ghana. In addressing this research gap, the overall objective of the study was to compare the factors influencing the efficiency of the private and public medical commodity supply chains in the Upper East Region (UER) of Ghana, using a mixed method research design. Other specific objectives of the study were to (i) compare the perceptions of senior management staff of the factors affecting the medical commodity supply chains in the UER, (ii) determine if statistically significant differences existed in the factors affecting the commodity deliveries between private and public health care facilities in the UER, (iii) determine if statistically significant differences existed in the factors affecting the commodity delivery per facility in the UER, (iv) compare the perceptions of patients of private and public health care facilities of the factors affecting commodity availability in health care facilities in the UER, (v) determine if statistically significant differences existed in patients’ perceptions of the factors affecting the availability of commodities between private and public supply chains in the UER and, lastly (vi) determine if statistically significant differences existed in patients’ perceptions of the factors affecting the availability of commodities per facility in the UER. Adopting a concurrent mixed method strategy for the study, both quantitative and qualitative data were collected simultaneously. The quantitative data were collected from 172 purposively selected senior management staff of selected private and public health care facilities in the UER of Ghana. These respondents included medical officers, pharmacists, dispensary technicians, accountants, auditors, finance officers, hospitals or facility administrators,
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procurement officers, senior nurses, community health nurses, heads of clinics and health centres or Community health planning services (CHPS). Additionally, 1500 randomly selected patients from private and public health care facilities in the region completed an interviewer-administered questionnaire of the factors affecting the availability of commodities at facilities in the UER. The qualitative data were obtained from six key-informants. The six participants included the acting manager and a senior supply officer at the central medical stores (CMS) in Accra; the Regional Director of the Ghana health service (GHS) and the manager of the regional medical stores (RMS), both in Bolgatanga; the administrator and the procurement officer at the Christian health association of Ghana (CHAG) national office in Accra. These participants, who were purposively selected, occupied senior positions in these facilities, making them critical sources of useful information for this study. The quantitative data were analysed using both descriptive and inferential statistics. The descriptive statistics computed, comprised of means, custom tables and standard deviation whilst a t-test, a one-way ANOVA, post hoc analysis and effect sizes were the inferential statistics used. The study compared the perceptions of senior management on the factors influencing the efficiency of the private and public medical commodities supply chains in the UER. It was established that private health care facilities had better commodity availability than public facilities, there was availability of basic cold chain facilities in both private and public commodity chains, there was a general deficiency in terms of functionality of these facilities across the health care facilities in the region. In addition, the public cold chain was comparatively better equipped than the private cold chain. The study also found that public commodity chains had staff with a supply chain management training compared to the private commodity chains. Regarding inventory replenishment methods, both commodity chains relied on subjective strategies such as re-order level calculations, facilities previous month’s consumption and ‘as and when necessary’. In terms of inventory management methods, First-in first-out (FIFO) and the first-expired first-out (FEFO), were the two most widely used stock control techniques for dispensing medical commodities in both the private and public commodity chains. Security arrangements for commodity storage facilities in both the private and public health care facilities, were low. However, pilferage of commodities was found to be higher in the public compared to private commodity supply chains. The study found significant
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differences existed between private and public health care facilities in the UER in terms of the availability of commodities. Private health care facilities in the region had better availability of medical facilities compared to the public health facilities. However, no significant differences existed between private and public health care facilities in terms of in-vehicle security, cold chain facilities, pilferage of commodities, communication on stock-out information, transport availability and vehicle maintenance practices. The study also established that significant statistical differences existed per health care facility for cold chain facilities, availability of commodities, and transport availability and maintenance practice but none for in-vehicle security, pilferage and communication on stock-out information. The study found that the private medical commodity chain was relatively more efficient than the public chain. From the patients’ survey, the results established that significant differences existed between the patients of private and public sector facilities regarding the availability of medical commodities, incidence of non-availability of commodities, seasonality of non-available commodities, reaction to commodity non-availability and communication of commodity non-availability to patients.