Challenges and Solutions of Shortage of Essential Drugs, Supplies and Equipment at the Emergency Department of CHUK: A mixed method Study

Abstract

Background: Safe emergency care needs include essential drugs and supplies, and functional equipment. However, in low and middle-income countries (LMICs), several significant barriers limit the delivery of safe emergency care, including a lack of medications or physical resources such as supplies and equipment. The capacity of care in the emergency department is directly associated with the availability of drugs and equipment. This mixed-methods study evaluated the availability and shortage of essential drugs, supplies, and equipment; and to identify the challenges and effects of stockouts in the emergency department (ED) of the University Teaching Hospital of Kigali (CHUK) in Kigali, Rwanda. Methods: A qualitative and quantitative assessment was employed in the ED at CHUK from January to April 2021. An evaluation of the availability and inventory of essential drugs, supplies, and equipment in an ED was performed eight times over two months, using a validated checklist created and adapted from: the World Health Organization (WHO) list, the Rwanda Ministry of Health (MOH) list and the other study done previously. Semi-structured interviews and focus groups among key informants in the hospital were conducted to understand the challenges, effects, and solutions to shortages. Transcripts of interviews and focus groups were analyzed using inductive and deductive thematic analysis. Results: The assessment revealed that unavailable of essential drugs and supplies pose a significant challenge in CHUK ED. Overall; the average availability for essential medicines was 57.62% of the time. Participants reported significant challenges to the current procurement process, which caused delays in receive supplies and was seen as closely associated with the local market. Consequences of stock-outs included poor quality of patient care. Key informants reported management solutions for mitigating stock-outs, including new policies and management of the procurement process regulations. Conclusion and Recommendation: The findings suggest a critical issue of drugs, supplies, and equipment within the CHUK ED. There is an urgent need to revise procurement regulations and policies in order to reduce stockouts and mitigate their consequences to patient care. Future research is required to evaluate the implementation and impact of new regulations.