Effect of moving from public to state-owned private health supply chain system on the availability of essential medicines in Rwanda

Abstract

Introduction: a strong health system relies on the existence of a robust health supply chain management system that ensures an uninterrupted supply of essential and affordable health products. In Rwanda, the National Supply Chain Assessment of 2017 (NSCA) and previous studies revealed low performance of the supply chain system and low availability of health products. In 2020, Rwanda created Rwanda Medical Supply Limited (RMS Ltd), a state-owned private entity, to improve the procurement system and increase availability of the health products. From then, we have not yet been able to find results about the effectiveness of the new procurement system. This study assesses the effect of RMS Ltd ’processes on the availability of essential medicines.

The objective: this research aimed to assess the effect of switching from a public to a state owned private health supply chain system on the availability of key medications, vaccines, and technology as compared to the prior system.

Method: this study used descriptive design with quantitative approach. Data on procurement, inventory management, data records quality and human resource management influence on the availability of essential medicines were collected using a questionnaire. The purposive sampling was used to recruit 41 respondents from RMS HQ, 30 RMS branches and 7 referral hospitals based on their roles and functions. The data were analyzed using SPSS version 24

Results: findings revealed that the branches of RMS, a state-owned entity, make direct purchase whereas various procurement methods including open tender, restricted method, request for quotation and others could be leveraged before RMS. The use of direct purchase resulted in a decrease of the lead time at all levels concerned. The stock levels are based on order, and the products stocked according to plan increased from 10-30 % in 2017 to 72-94 % in 2022 contrary to what used to happen with the previous system. The availability of some essential medicines such as amoxicillin and captopril increased respectively from less than 30 % and 80 % in 2020 to 89.9 % and 87 % in 2022. In contrast to the results of 2017’s NCSA, the e-LMIS data are being used for decision-making by RMS branches, RMS HQ and Referral hospitals. Over 70 % of the respondents claimed that they are motivated by their responsibilities and the salary was increased between 10 % -20 % by a score of 73 % of the respondents

Conclusion: the study shows that, in contrast to the former public procurement system, the creation of RMS Ltd increased the availability of essential medicines through improvement of processes of supply chain components of the present study.