Better Storage and Inventory Practices Improving Access to Quality Medicines in Kenya
“Medicine can be poisonous if it is contaminated. It can poison my clients, who will keep returning to the facility. To prevent contamination of the medicines we receive, our facility has invested in proper storage facilities,” says Mr. Andrew Mabele, a clinical officer responsible for screening outpatients, reviewing lab results, and providing HIV and tuberculosis patient follow-up treatment in the Kabichbich Health Centre.
The Kabichbich Health Centre, a level 3 health center in West Pokot County, attends to approximately 1000 outpatient clients each month. Common ailments treated at the hospital include malaria, upper respiratory tract infections (URTIs), and various skin diseases.
Mr. Mabele is just one of the participants who benefitted from an orientation on inventory management, organized by the USAID Kenya-funded Health Commodities and Services Management (HCSM) Program, led by Management Sciences for Health (MSH).
In March 2012, the district health management team conducted a supervisory visit at Kabichbich Health Centre with a checklist of standards for the various commodity management activities performed in the facilities. This list included standards for inventory management and use of job aids and reporting tools. At Kabichbich Health Centre, the storage of medicines emerged as a key challenge.
“Our store had not been arranged for the past ten years,” says Mr. Mabele.
According to Dr. Enoch Nyakundi, the district pharmacist for West Pokot, the poor arrangement of the stores led to inaccurate physical counts of commodities, causing frequent adjustments of data in monthly consumption and request reports. Wrong data from the facility can lead to over- or under procurement, leading to expiries or shortages at the central medical stores and facility levels. Dr. Nyakundi explains:
“The quantities of commodities available on site did not correspond with those captured in monthly commodity consumption and request reports that I had received. Additionally, laboratory commodities such as vacutainers, HIV test kits, and malaria rapid diagnostic test kits (RDTS), were stored at the dispensing pharmacy instead of the laboratory, thus contributing to space constraints."
“Although the facility had stock control cards, they hardly used them, due to lack of skills on how to use them,” Dr. Nyakundi adds.
“We were using exercise books as stock cards, and stock cards for dispensing medication to patients,” says Mr. Mabele.
Local Solutions to Local Problems
Mr. Mabele describes how they addressed the challenges:
“With the district health management team, the first thing we did after identifying the gaps in our facility was rearrange the stores so that we could see the available medicines. While arranging the stores, we found some expired amitriptyline tablets. Some other medicines were almost [ready to expire] and were redistributed to facilities with high consumption rates.
The second challenge addressed was getting pallets. When it rained, water would leak into the store. With no pallets in the store, we improvised and used some doormats. … but, the mats would still [soak up] water and eventually the packaging would get wet. An opportunity to solve this presented itself later when the facility was constructing a kitchen for the maternity ward. We asked whether we could use the leftover wood to make pallets, and the facility committee approved. We now have pallets.”
“We received on the job training on proper storage, calculation of quantities of commodities required, use of reporting tools, and proper dispensing of medication. This has led to improvement in the quality of service to our patients.” says Mr. Mabele.
Dr. Nyakundi confirms Mr. Mabele’s observations.
“We went to the facility two months after the supervisory visit, and there was a difference. Besides an organized store, the facility now makes use of the stock control cards, which are displayed and routinely updated. As a result, the facility is also submitting better reports. We were all smiles.”
This change has not only occurred in this facility but in other facilities that have received training and supportive supervision within the district. The supervision and training at the facility level is facilitated through the collaborative efforts of HCSM.
“There is a reduction in stock outs and an increased availability of commodities in hospitals. Earlier, some facilities would be having expired products while some facilities were experiencing stock outs. This was caused by poor quantification and inaccurate reports,” says Chris Kipkulei, District Medical Lab Technologist (DMLT).
“We now have improved reporting rates for health commodities. For example, for laboratory reports, the reporting rate has improved from 48 percent in October 2011 to 92 percent in August 2012. Interventions included provision of tools and regular feedback to the facilities."
Improved record keeping and proper storage practices in facilities such as Kabichbich Health Centre help avert potential wastage of public resources (e.g., expired medications). Improved documentation at facilities also helps enhance accountability in public hospitals that receive procured commodities. This helps Kenyans move toward achievement of the Millennium Development Goals and enjoy access to quality health care.
Mr. Mabele credits the improvement in his facility to the leadership of Mr. Fredrick Chebet, the clincial officer in charge of the facility, support from the district health management team, teamwork, and shared responsibility among his colleagues to improve the facility.
“Everyone took ownership to improve practices in our facility,” says Mr. Mabele.
Yvonne Otieno is a communications specialist with HCSM Kenya.