The aim of this chapter was to determine whether the ARV drug distribution practices were effective and efficient in the management of ARVs in the QwaQwa district. The participants' biographic data and the practices performed on the ARV distribution are summarised below.
The biographic data was analysed to provide information on the professional qualifications of the employees, their maturity in terms of their age, the dominant gender in the field, and the employees' job experience.
The majority of the staff held lower professional qualifications, they were in the middle age group of 31-40 years, and held less than five years of experience in the field. An analysis of gender did not make a significant contribution to the level of performance. It was used to indicate the gender ratio, and indicated that there were more females employed than males. The question on the period of service was not answered accurately by the majority of the staff, due to the fact that allocation to work in the ARV department was not permanent but was on a rotational bases. The shortage of highly qualified staff and the limited years of service in the field were an indication of an ongoing recruitment and retention battle in the government sector.
The distribution practices that were reviewed were on the ordering, transportation, management of inventory and warehousing and finally, distribution of treatment to the HIV/AIDS patients who are in need of treatment.
The overall practices performed on the ordering of stock from the depot were satisfactory. However, practices that required improvement were the placement of orders using the electronic system instead of the manual system, the ordering of stock using the fixed order quantity model, and the use of e-mails for following up on orders with the depot. The performance that was rated unsatisfactory was the lack of information on the expected delivery dates. This practice should be reviewed and improved on, to facilitate an effective order fulfilment cycle time and order process.
The majority of the practices on transportation of the stock from the depot to the hospitals require improvement. It should, however, be noted that there is a gap between the practice on the ordering of the stock at the depot, and the practice on the transportation of the stock to the hospital. The gap was identified in the practices on the procurement of the stock and the processing of orders at the depot. However, these practices are outside the scope of the study and were not discussed further.
The critical step to a reliable transport system is a well-planned and executable routing and scheduling of deliveries. This factor contributes highly to the timely delivery of the correct quantities, thereby ensuring a consistent availability of the stock. An unreliable transport system could result in stock shortages. Therefore, it should be eliminated.
The overall practices on the management of inventory and warehousing were rated as average (refer to Table 4.8 on page 100). Therefore, these practices should be improved. The practices that require improvement are the use of electronic records instead of the current manual system to facilitate easy retrieval of information when required. The other practices to be improved are the record keeping of stock
discrepancies, and the record keeping of stock levels at the clinics, for better management of the stock.
The last improvement required on the inventory management and warehousing practices are the utilisation of the stores to capacity. This could be managed by having a Warehouse Management System (computer system) in place. The practices that were rated unsatisfactory, and therefore require major intervention, are the incorrect stock quantities delivered from the depot, and the short expiries of medications received. However, it was noted that the reliability of the transport system and the delivery of correct quantities in the correct condition were pre- determinants of good inventory management.
The practices on the distribution of treatment from the hospital to the clinics were satisfactory. However, the distribution practice that should be improved is the method of ordering the stock according to predetermined levels and not according to order dates as currently practiced. It should be noted, however, that the distribution practices are majorly dependent on the ordering, transportation and the management of inventory and warehousing practices. Therefore, improvement of these practices could result in a more effective and efficient distribution system.
The last section of the chapter reviewed the stock shortages and the level of information sharing between the supply chain partners. The hospital experienced a high occurrence of stock shortages and these stock-outs have mostly been experienced for a period of one to three months. A high percentage of the staff did not attend meetings to discuss ARV-related matters such as anticipated stock-outs. These factors raised concerns on the level of communication among the supply chain partners and the continuous availability of ARV treatment to the patients in need of treatment, bearing in mind that if a patient misses more than five days of treatment, compliance and adherence to medication are compromised. This increases the risk of developing resistance to treatment and ultimately to treatment failure.
There should therefore be measures in place to limit the stock shortages such as the procurement of sufficient drug quantities by the depot and the availability of back-up systems in place, to deal effectively with such uncertainties. A working relationship and accurate information sharing amongst all supply chain partners are also of critical importance to a successful management of inventory and in ensuring accurate inventory visibility at all supply chain stages.
It was earlier brought to the attention of the reader that the above practices were inter-related, and that no practice stood alone as they were interwoven. The lack in performance of one practice affects all other practices. Therefore, a coordinated performance of all practices is imperative to an effective and efficient distribution system.
The next chapter describes the limitations of the study, the recommendations and the conclusion.
CHAPTER 5