Effect of COVID-19 on essential medicines order quantities and prices for Mulago national referral hospital; a mixed methods study

Abstract

Background: Mulago national referral hospital (NRH) housed Uganda’s largest COVID-19 treatment unit, and managed patients with moderate, severe and critical disease severities. Clinical management of these patients required a considerable amount of essential medicines (EM) whose demand surged with patient numbers. EM orders were adjusted including, through emergency orders, to procure COVID-19-leaning EM. EM prices too increased with demand. Increase of COVID-19-leaning EM order quantities was curtailed by budget constraints.

General objective: This study assessed the effect of COVID-19 on EM order quantities and prices at Mulago NRH.

Methods: A concurrent mixed methods study was conducted at Mulago NRH. The study included 142 EM and 9 key informants (KIs). EM selected for the study were those listed in Mulago’s orders of March 2018 to March 2022 and within the essential medicines and health supplies list of Uganda 2016. KIs were purposively selected. Pre-tested data collection tools (EpiData Manager V4.6 and key informant guide) were used to collect data on EM order quantities and prices, and coping mechanisms deployed by Mulago. Data was analysed using SPSS v22.0 and ATLAS.ti v8

Results: Out of the 237 medicines ordered during the study period, 142 (59.9%) were EM. Of these, 89 (62.7%) were COVID-19-leaning. In response to EM needs, emergency order numbers increased 10-fold, over the first two years of the pandemic from the two years just before. COVID-19-leaning and non-COVID-19-leaning EM order quantities are correlated to severity and patient numbers, with correlation coefficients of 0.45 and -0.02 respectively. COVID-19-leaning and non-COVID-19-leaning EM prices are correlated to severity and patient numbers, with correlation coefficients of 0.13 and 0.23 respectively. KIIs revealed that Mulago NRH coped with EM demands through emergency ordering, order quantity adjustments, inter-institutional redistribution of EM, procurement of donations and cost sharing with patients

Conclusion: There was a moderate positive a very weak negative correlation between COVID-19-leaning EM order quantities and non-COVID-19-leaning EM respectively, and COVID-19 patient numbers. There was a very weak positive and a weak positive correlation between COVID-19-leaning and non-COVID-19-leaning EM prices respectively and vii COVID-19 patient numbers. Mulago NRH applied a multipronged approach of coping mechanisms to meet the emerged EM demands that arose due to COVID-19