Assessment of medicines cold chain storage conformity with the requirements of the World Health Organization in health facilities in the Eastern province- Rwanda

Abstract

Background: Health actors who manage pharmaceutical supply chain systems must follow established global regulations to handle properly, store, and distribute temperature-sensitive products. These requirements highlight cold chain temperature devices usability and storage facilities to ensure that the products mentioned above are stored accordingly throughout the supply chain. Various studies have shown that the storage and transport of products in the cold chain are inefficient, leading to poor product quality and thus public health problems. Therefore, it was worth identifying how Rwanda has developed its cold chain supply systems from central medical stores to the end-users of Eastern Province that register high temperatures. Methodology: This study was carried out in selected health facilities in Eastern Province (public, faith-based and private). Prospective, cross-sectional, and observational design with quantitative and qualitative approaches were adopted, and forty-four health facilities were selected using convenience, stratified and purposive sampling techniques. The respondents were the cold chain technicians managing vaccines and other cold chain products in the selected health facilities. The researcher created a checklist and questionnaire for data collection, and temperature data loggers were mounted in refrigerators to measure MKT. The University of Rwanda provided ethical approval, and health facilities were permitted to conduct a study in their premises voluntarily. Key informants consented to participate in the study voluntarily as well. Results: In vaccination programs in public and faith-based facilities, the recorded MKT conformed to the WHO standards. Nevertheless, at public, faith-based, and private pharmacy storage, the cold chain storage conformity deviated from the required temperature of 2–8 °C. The performance of cold chain storage conformity of refrigerators used in pharmacy stock of public health facilities was 18(56%), in faith-based facilities was 4(57%), and in private retail pharmacies was 7(70%). WHO pre-qualified refrigerators were available at 62(97%). Factors affecting storage conformity were the lack of a contingency plan in the power outage (54,5%) and limited calibration of cold chain equipment (42%). This study also pointed out insufficient knowledge of cold chain technicians and a distribution gap of products from central medical stores to service delivery points. Conclusion: The study found cold chain equipment status, temperature monitoring system, quality management system, and transportation management to be the significant factors that affect the WHO storage temperature conformity in health facilities in the study area. Hence, there is a need to harmonize the supply chain of both vaccines and other temperature-sensitive medicines.

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