Health Supply Chain Performance in Emergencies in Sierra Leone

Abstract

Background: Public Health emergencies are of serious concern to health systems globally. It is very important that preparedness ahead of time is adequate and capable of addressing urgent needs. As health emergencies are unpredictable, they may occur at any time and with grave consequences. It is therefore of great importance that the supply chain is robust enough and logistically ready to manage commodity movement in an efficient and timely manner. Sierra Leone was affected by the ebola virus in 2014, it was a point of reflection at the health care system and several weak points were identified. Amongst these were weak supply chain management structures. Managing supply chains particularly sourcing, financing, planning, and delivering products in a rapidly changing environment requires agile and flexible approaches and coordination. Objectives: This study was designed to assess the status of the public health supply chain in Sierra Leone and to investigate the performance of the supply chain during the ebola crisis. Lastly to ascertain the level of preparedness of the supply chain in the eventuality of an emergency. Methods: A cross-sectional study design was used to obtain participants' information with a structured questionnaire. The questionnaire was divided into four sub-sections collecting information on personal information of respondents, assessment of storage facilities, experience in the supply chain, and preparedness for future emergencies. Data collection was done for two months to all district-level supply chain staff and selected central level staff. The data was analyzed and results were generated. The presentation of results was done using charts, tables, and figures. Results: The study included 55 respondents at the district and central levels. Most respondents, 44 (80%) work at the district level, whilst 11 (20%) work at central level operations. The study revealed that 11( 20%) of the respondents were District Pharmacists, District Information officers, and District Storekeepers respectively were 8 ( 14.5%) each, and District Hospital Pharmacists that responded had a total of 9(16.4%). Assessment of the current storage conditions showed that 42 (76.4%) of respondents stated that storage space was available but inadequate whilst 13 (23.6%) of respondents stated that storage was available and adequate. The study revealed several limitations for the improvement of supply chain systems in Sierra Leone. They included: Inadequate number of staff: 32(58.2%) of respondents stated that this is a limitation whilst 23(41.8%) did not think this was a limiting factor in supply chain systems. Secondly, 45(81.8%) of respondents noted that lack of handling equipment is a limiting factor whilst, 10(18.2%) noted that this was not a limiting factor. Respondents were asked to indicate factors that represent improvements to supply chain systems at their levels. The following were listed as opportunities: Availability of more qualified staff, 39(70.9%) stated that this was an opportunity whilst 16(29.1%) didn’t hold this view for operations at their level. Forty-four -44 (80%) respondents revealed that the need for integration of supply chain management activities was an opportunity at their level whilst 11(20%) did not hold that view. Based on the data collected, it revealed that 22(40%) respondents had been actively involved in at least one emergency, 12(21.8%) had been actively involved in at least two emergencies whilst 11(20%) have not worked in any emergencies. This section investigated the level of preparedness of supply chain units at district and central levels. Forty eight-48(87.3%) respondents revealed that storage space was available but inadequate in the eventuality of an emergency, 4(7.3%) noted that space was available and adequate whilst 2(3.6%) noted that storage space is not available. To the question, do you currently have an emergency plan at your level: the following data was captured, 30(55.6%) respondents stated that an emergency plan was available at their level whilst 25(44.4%) stated that they were not in possession of an emergency plan. Conclusion: The current supply chain is faced with numerous challenges including inadequate storage infrastructure, non-uniform inventory management systems across health facilities, inadequate staff and training capacity gaps, non-uniform distribution of Emergency protocol documents. However, most respondents stated that the supply chain performance during the ebola crisis was good. The level of preparedness as informed by the research does not reveal a steady progression as expected after the ebola outbreak. Warehouse improvement plans including staff capacity training, wider dissemination, and training on the Emergency protocols are recommended to improve preparedness plans.