Better drug therapy for the children of Africa: current impediments to success and potential strategies for improvement

Analyzing the operational barriers of government-supported healthcare supply chain

Purpose

The purpose of this study is to develop a methodology for the identification, categorization and prioritization of operational government-supported healthcare supply chain barriers (GHSCBs).

Design/methodology/approach

This study develops a theoretical background for identifying and segregating relevant GHSCBs and proposes a 5W2H (a Toyota production system) with fuzzy DEcision MAking Trial and Evaluation Laboratory (DEMATEL) embedded approach to quantify the causal–effect relationships among the identified operational GHSCBs.

Findings

Seven GHSCBs (i.e. uncertainty of demand management, lack of continuous improvement and learning, lack of deadline management, lack of social audit, warehousing equipment unavailability, human resource shortage and inadequate top level monitoring) were identified as significant cause group where the government, top management and decision-makers of government-supported healthcare supply chain (GHSC) have to put efforts.

Research limitations/implications

The results obtained are specific to the GHSC of Indian perspective, which could be extended to global context. However, the proposed approach can be a base and provide a platform to understand and analyze the interactions among GHSCBs.

Practical implications

The proposed methodology will show the appropriate areas for allocating efforts and resources to mitigate the impact of GHSCBs for successful implementation of healthcare supply chain.

Originality/value

According to best of the authors' knowledge, this is the first study of operational barrier for GHSC in India in specific. The use of 5W2H embedded fuzzy DEMATEL approach for the development and analysis of the theoretical framework of Indian GHSCBs is unique in barrier literature.

'Better medicines for children' within the Integrated Management of Childhood Illness framework: a qualitative inquiry in Uganda

Background

The Integrated Management of Childhood Illnesses is the main approach for treating children in more than 100 low income countries worldwide. In 2007, the World Health Assembly urged countries to integrate ‘better medicines for children’ into their essential medicines lists and treatment guidelines. WHO regularly provides generic algorithms for IMCI and publishes the Model Essential Medicines List with child-friendly medicines based on new evidence for member countries to adopt. However, the status of ‘better medicines for children’ within the Integrated Management of Childhood Illnesses approach in Uganda has not been studied.

Methods

Qualitative interviews were conducted with: two officials from the ministry of health; two district health officials and, 22 health workers from public health facilities. Interview transcripts were manually analyzed for manifest and latent content.

Results

Child-appropriate dosage formulations were not included in the package for the Integrated Management of Childhood Illnesses and ministry officials attributed this to resource constraints and lack of initial guidance from the World Health Organization. Underfunding reportedly undercut efforts to: orient health workers; do support supervision and update treatment guidelines to reflect ‘better medicines for children’. Health workers reported difficulties in administering tablets and capsules to under-five children and that’s why they preferred liquid oral dosage formulations, suppositories and injections.

Conclusions

The IMCI strategy in Uganda was not revised to reflect child-appropriate dosage formulations – a missed opportunity for improving the quality of management of childhood illnesses. Funding was an obstacle to the integration of child-appropriate dosage formulations. Ministry of health should prioritize funding for the Integrated Management of Childhood Illnesses and revising the Essential Medicines and Health Supplies List of Uganda, the Uganda Clinical Guidelines and, the Treatment Charts for the Integrated Management of Childhood Illnesses to reflect child-appropriate dosage formulations.

A demonstration of mobile phone deployment to support the treatment of acutely ill children under five in Bushenyi district, Uganda

BACKGROUND

Benefits of mobile phone deployment for children <5 in low-resource settings remain unproven. The target population of the current demonstration study in Bushenyi District, Uganda, presented with acute fever, pneumonia, or diarrhoea and were treated by community health workers (CHWs) providing integrated community case management (iCCM).

METHODS

An observational study was conducted in five parishes (47 villages) served by CHWs well versed in iCCM with supplemental training in mobile phone use. Impact was assessed by quantitative measures and qualitative evaluation through household surveys, focus group discussions, and key informant interviews.

RESULTS

CHWs in targeted sites improved child healthcare through mobile phone use coupled with iCCM. Of acutely ill children, 92.6% were correctly managed. Significant improvements in clinical outcomes compared to those obtained by CHWs with enhanced iCCM training alone were unproven in this limited demonstration. Nonetheless, qualitative evaluation showed gains in treatment planning, supply management, and logistical efficiency. Provider confidence and communications were enhanced as was ease and accuracy of record keeping.

CONCLUSION

Mobile phones appear synergistic with iCCM to bolster basic supportive care for acutely ill children provided by CHWs. The full impact of expanded mobile phone deployment warrants further evaluation prior to scaling up in low-resource settings.