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Improving availability of medicines and supplies at the health facility level in the Lake Zone, Tanzania
Over the past three years, the Tibu Homa Project (THP) has been implementing an intervention to improve case management of children under five with fever in the Lake Zone (Kagera, Mara, Mwanza, Geita, Shinyanga, and Simiyu regions) of Tanzania through health facility system strengthening. The Lake Zone was identified by the Ministry of Health and Social Welfare (MOHSW) and the United States Agency for International Development (USAID) because of its high under-five mortality rate, above the national average, and a high prevalence of malaria.
The Tibu Homa Project is implemented by the University Research Co., LLC (URC) in collaboration with Management Sciences for Health (MSH) and Amref Health Africa. The goal of Tibu Homa is to reduce morbidity and mortality of children under five years of age in the Lake Zone of Tanzania by improving proper diagnosis and treatment of severe febrile illness. The project’s supply chain management (SCM) team contributes to improving case management by ensuring increased availability of medicines and supplies at the facility level.
At the beginning of the project there were rampant stock-outs of essential medicines and supplies at the facility level leading to inappropriate diagnosis and treatment of under-fives. The major cause of stock-outs was poor quantification and forecasting caused by problems in documentation of information at the facility level needed for proper quantification and correct forecasting of medicines and supplies.
To address the gaps identified Tibu Homa and the Regional and Council Health Management Teams (RHMTs/CHMTs) trained facility staff using the classroom method and carried out on-the-job training using logistic mentors. Specifically, logistic mentorship focused on:
- Documentation of information needed to quantify and forecast
- Correct use of consumption data for reporting and requesting
- Managing inventory and tracking consumption of medicines and supplies
- Improved communication between facilities and the District Medical Officers
- Timely submission of reporting and requesting forms
- Re-distribution of medicines and supplies between facilities and within facilities.
Results from these interventions show a tremendous improvement in the availability of commodities in Tibu Homa supported facilities. For instance, on average, 93% of the reporting facilities (170) had more than 10 of the 22 tracer items in April-June 2014 compared to 42% at baseline in January 2012.
The R/CHMTs are expected to maintain these gains through regular supportive supervision and mentorship, an intervention shown to work well. It is recommended that health managers adopt this approach mainly by diversifying sources of funding instead of waiting for disbursement from the central government.
Training and consistent supportive supervision and mentorship give quicker results than embarking into classroom training alone. It is recommended that the R/CHMTs institute a culture of supervising and mentoring the health facilities under their jurisdiction and advocate for the health facilities to have their internal mechanism of self-supervision and assessment.