Factors affecting the availability of HIV medical supplies and health workers’ strategies used to address shortages in two Rwandan public hospitals

Abstract

Background Availability, accessibility and rapid scale up of antiretroviral therapy (ART) has changed what was a fatal disease to a manageable condition resulting in remarkable reduction in the worldwide rates of AIDS associated deaths and new infections. Regardless of global efforts to make ART treatment accessible worldwide, ART coverage differs among countries and regions of the world substantially. The estimated antiretroviral therapy coverage rate in Rwanda is 79%. The expansion of ARVs drugs to reach all patients who meet the eligibility criteria is one of the priorities of the Rwandan ministry of health; however, the achieve this it is still a great challenge and there are many structural bottlenecks. In 2013, one important issue has been the serious shortage of medicines and laboratory supplies in public hospitals of Rwanda especially in those which are in Kigali city and southern province. Aim of study Using the WHO Health systems framework, this cross-sectional, observational study aimed to investigate factors affecting the availability of HIV medical supplies at two hospitals in Rwanda and the coping strategies used by health workers to address the issue of shortages of these supplies. The specific objectives of this study were toidentify factors contributing to HIV medical product shortages in two Rwandan public sector hospitals; and to explore 6 decision-making process and coping strategies used to manage HIV medical product shortages in the two hospitals. Methodology The study adopted a cross-sectional, observational design using qualitative methods to investigate health workers’ views of the factors influencing availability of HIV-related medical supplies and their strategies to manage these shortages. The primary data collection method involved semi-structured interviews with health workers at two public hospitals in Gasabo district, Kigali city of Rwanda: Kibagabaga and Muhima hospitals. In Kibagabaga Hospital, eight health workers were interviewed, in Muhima Hospital, eight health workers were interviewed. Health workers interviewed included: Doctors and nurses who work in ART clinics, laboratory technicians, pharmacists and procurement officers. Interviews covered the frequency of the stock outs of HIV medical products, factors that contributing to these shortages, impact of these shortages on patient and strategies use to manage the scarcity of HIV medical products. They were conducted in Kinyarwanda, recorded, translated and transcribed by the researcher. The researcher coded and arranged the data into descriptive and analytical themes and subthemes by hand. Finally, the result of this analysis was further interpreted and discussed in order to be able to contribute with main identified challenges and call for further action. Findings Findings and emergent themes were organised and presented in three areas: firstly, the broader context of medical product shortages in the Rwandan health system; secondly, the specific factors influencing HIV-related product shortages in the two hospitals, and thirdly, the management and coping strategies used to mitigate HIV medical products shortages. Firstly, in the broader context: negative attitudes of health workers towards ARVs, the misuse of ARVs drugs by feeding them to animals were mention to have a great contribution to the HIV medical products shortages.Secondly, limited financial resources and lack of leadership skills were cited as the main causes of stock outs of HIV medical product shortages. Lack of trainings in store management and procurement practices, shortage of qualified health workers in the procurement and supply management system as well as the ART clinics were mentioned as the main barriers which result in HIV-related product shortages. Inaccurate ARVs drugs consumption records to the Central Medical Store and poor transportation were also reported as the factors that influenced the delays in deliveries of these products. All of these factors were found to have a great impact on the patients’ lives including: drug resistance, poor adherence to treatments and negative treatment outcomes. Finally, strategies used to manage the stock outs of ARVs were acknowledged. Significance of study The study adds to a limited evidence base about what influences medicines stock outs and how health systems and health workers manage these challenges. The study results highlighted that numerous factors interrelate to influence the stock-outs of antiretroviral 8 drugs and other HIV-associated commodities. To ensure the effectivity and sustainability of whole health system; all the factors in the six WHO building blocks need to be strengthened.