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. 2021 Mar 21;11(1):5-11.
doi: 10.5588/pha.20.0033.

Evaluating the availability of essential drugs for hypertension, diabetes and asthma in rural Rwanda, 2018

F Mbonyinshuti  1   2   3 , K C Takarinda  4   5 , S Ade  4   6 , M Manzi  7 , P G Iradukunda  8   9 , J Kabatende  8   10 , T Habiyaremye  1   11 , P C Kayumba  2
Affiliations

Evaluating the availability of essential drugs for hypertension, diabetes and asthma in rural Rwanda, 2018

F Mbonyinshuti et al. Public Health Action. .

Abstract
in English, French

Setting: Hypertension, diabetes mellitus and asthma are on the rise in developing countries, including Rwanda; there is thus a need to ensure uninterrupted drug availability.

Objectives: To assess 1) the frequency and duration of drug stock-outs; 2) lead time duration 3) monthly stock levels; and 4) drug quantities requested vs. quantity delivered for captopril, metformin and inhaled salbutamol between January and December 2018 Kirehe District, Rwanda.

Design: This was a cross-sectional study using secondary programme data.

Results: The median annual stock-outs for captopril, metformin and inhaled salbutamol were respectively 4 (IQR 3-4), 3 (IQR 2-3) and 4 (IQR 4-5) at rural health facilities (RHCs); no stock-outs occurred at the district hospital. For all three drugs, the median lead time was 7.5 days (IQR 5.5-11.5) at the hospital vs. 5 days (IQR 3-6) in RHCs. Stock status for captopril was below the 4-week minimum stock level for 2/12 months at the hospital vs. 7/12 months at the RHCs, while metformin and inhaled salbutamol were below the 4-week minimum stock levels for respectively 1/12 and 4/12 months at both hospital and RHCs. Total drug quantities delivered were less than the combined total quantities requested in respectively 8/12, 5/12 and 8/12 months for captopril, metformin and inhaled salbutamol.

Conclusion: There is a need to regularly and effectively monitor drug stock levels and ensure timely and sufficient stock replenishment to avert stock-outs.

Contexte: L’hypertension, le diabète sucré et l’asthme augmentent progressivement dans les pays en développement, y compris le Rwanda ; il est donc nécessaire d’assurer une disponibilité ininterrompue des médicaments.

Objectifs: Évaluer 1) la fréquence et la durée des ruptures de stock de médicaments ; 2) durée du délai d’approvisionnement ; 3) niveaux de stock mensuels ; et 4) quantités de médicaments demandées par rapport aux quantités livrées pour le captopril, la metformine et le salbutamol inhalé ; entre janvier et décembre 2018 dans le district rural de Kirehe, au Rwanda.

Methode: Il s’agissait d’une étude transversale utilisant des données secondaires de programme.

Résultats: Les ruptures de stock annuelles médianes pour le captopril, la metformine et le salbutamol inhalé étaient respectivement de 4 (intervalle interquartile [IQR] 3–4), 3 (IQR 2–3) et 4 (IQR 4–5) dans les Centre de Santé ruraux et aucune rupture de stock n’est survenue à l’hôpital de district. Pour les trois médicaments, le délai d’approvisionnement médian était de 7,5 jours (IQR 5,5–11,5) à l’hôpital contre 5 jours (IQR 3–6) dans les services sanitaires ruraux. L’état des stocks de captopril était inférieur au niveau de stock minimum de 4 semaines pendant 2/12 mois à l’hôpital contre 7/12 mois aux services sanitaires ruraux, tandis que pour la metformine et le salbutamol inhalé ils étaient inférieurs aux niveaux de stock minimum de 4 semaines pour 1/12 et 4/12 mois à l’hôpital et dans les Centre de Santé ruraux, respectivement. Les quantités totales de médicaments livrées étaient inférieures aux quantités totales combinées et demandées en 8/12, 5/12 et 8/12 mois pour le captopril, la metformine et le salbutamol inhalé, respectivement.

Conclusion: Il est indispensable de surveiller régulièrement et convenablement les niveaux des stocks de médicaments et d’assurer un réapprovisionnement en temps propice et en quantité appropriée pour éviter les ruptures de stock.

Keywords: Rwanda; SORT IT; non-communicable diseases; operational research; supply chain.

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Conflict of interest statement

Conflicts of interest: none declared.

Figures

FIGURE 1
FIGURE 1
Annual frequency of non-communicable disease drug stock-outs stratified health facility in Kirehe District, Rwanda, January–December 2018.
FIGURE 2
FIGURE 2
Average weeks of drug stock levels of three NCD drugs in comparison to maximum-, minimum- and emergency- stock level thresholds, stratified by type of health facility in Kirehe District, Rwanda, January–December 2018. NCD = non-communicable diseases.
FIGURE 3
FIGURE 3
Monthly trends for quantity of drugs requested by health facilities vs. total quantities of drugs delivered from the district pharmacy and the percentage net stock supplies stratified by type of NCD drug in Kirehe District, Rwanda, January–December 2018. The proportion of net stock supplies is the percentage difference between the total quantities of drugs delivered minus the total quantity requested divided by the total quantity requested on a monthly basis. NCD = non-communicable diseases.
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