Working 'Miracles' for Drug Supply Advances Reproductive Health in Gulu, Uganda
Located in northern Uganda, Reproductive Health Uganda’s (RHU) Gulu Branch Health Center (Gulu) is one of the busiest clinics in the country—serving over 25,000 clients with sexual and reproductive health (SRH) services per month. When demand for SRH services outpaced Gulu’s supply of sexually transmitted infection (STI) drugs and other essential medicines, the clinic could not continue offering essential SRH services to many who needed them, threatening the equitable access to health care in the community.
Clients became less satisfied with their treatment at Gulu and stopped attending services. Additionally, Gulu was no longer on track to meet their annual service delivery target for 2014. Anicia Filda, the manager at Gulu explains:
There was a problem of continuous stock out of drugs -- especially antibiotics [for STIs and other ailments] -- to the clinic and outreaches. We had no issues with the clientele; the problem was drugs. [We were] sending away clients without drugs.
RHU, the leading NGO-provider of family planning services in the country, is affiliated with the International Planned Parenthood Foundation (IPPF), a consortium partner in the USAID-funded Leadership, Management & Governance (LMG) Project, led by Management Sciences for Health (MSH).
In May 2014, a team of RHU facilitators trained to deliver MSH’s Leadership Development Program Plus (LDP+) visited Gulu to train the team and launch the LDP+ process. Developed by MSH, the LDP+ is a facilitated program that supports health workers to learn and practice key leadership, management, and governance (L+M+G) skills for organizational performance improvement. During the program, teams of health workers learned these practical skills over a six-month process where they worked in teams to develop shared visions, analyze inhibiting factors, think collaboratively, and identify innovative solutions to overcome challenges.
The Gulu team identified decreasing stock-outs as their major challenge, while also naming weak logistics and supply chain management as factors. To tackle their challenge, the team focused on two areas to work on: getting more drugs from the RHU head office in Kampala and strategically advocating for drug supply provision from the district government.
We went to the District Health Officer and he recommended we go to Health Center IV for drugs. So we are now ordering drugs from Awaci Health Centre IV, which gives us these drugs and other supplies.
The Gulu LDP+ team took a holistic approach to the issue and made other adjustments, as well, including: revising budgets, increasing coordination with the MOH and RHU central office to increase drug allocation, adapting logistics to speed up the transport of drugs, training service providers in logistics management, and systematizing regular staff meetings to monitor progress.
As a result of their efforts, the RHU Gulu drug store is now well stocked with all of the supplies that the clinic needs. Says LDP+ facilitator Demeter Margaret Namuyobo, RHU medical coordinator at Gulu:
I am just excited, the LDP+ has worked miracles. I recall the last time I came [to Gulu], these shelves were almost empty. But now almost everywhere is full!
Photo credit: Anicia Filda/RHU Gulu
Filda notes that the increased drug supply has produced ripple effects for the clinic:
The LDP+ training has worked not only to improve the supply of the drugs themselves, but also has improved the client load. [As we give] more quality services to clients, they come back and they also recommend others to come.
Gulu’s clientele load has steadily increased—from approximately 25,000 monthly SRH clients in 2013 to an average of more than 36,000 per month in 2014.
Following the LDP+, participants reported improved team work among clinic staff; improved management of drug stocks at the clinic and the ability to analyze and report drug shortages; improved client satisfaction due to adequate drug supply and provision of quality services; and improved statistical data compilation and field reporting by the clinic staff.
According to Namuyobo:
The people and teams within the Gulu clinic were empowered to lead, manage, and govern progress toward their goal of improving their supply system.
Bridging the gap between need and supply, Gulu is now serving more clients in the community with quality SRH services.