Stock Out Survey -Study to identify facilitators and barriers in procurement and supply chain management and prescribing patterns of providers

Background

In line with the constitution of Nepal (2007) which enshrined health as the basic right of citizens, the Government of Nepal (GoN), Ministry of Health (MoH) provisioned essential health care services to be delivered free of cost at the point of use since 2008. Expansion of free care has led to many other initiatives i.e. Aama and Newborn Surakshya Program, Uterine Prolapse etc. To provide access to health care beyond the free care and to reduce out of pocket expenditure which currently stands at more than 50% of the total health expenditure, since 2015 the GoN has rolled out a Social Health Insurance scheme throughout the country in a phase wise manner. In 2017/2018 the program is slated to cover 25 districts. The Nepal Health Sector Strategy (NHSS) 2016-2021 guides priority activities in the health sector. It has set improving the efficiency, economy and transparency of procurement and supply chain of essential medicines and equipment as one of the outcome objectives.

With Financial support from USAID, HERD International is implementing this study to identify facilitators and barriers in procurement and supply chain management and prescribing patterns of providers. The findings will ultimately help to inform the existing PSM of essential drugs and commodities at all three tiers of the governments: Federal, provincial and local, and suggesting a re-structuring of the functions considering the federal context to ensure the essential drugs are available at the point of care.

Overall purpose of the project:

To examine the factors that associate to the stock out of free essential medicines at government health facilities.

Specific Objectives:

The specific objectives of the study are as follows:

1. To identify the top five factors associating to the stock out.
2. To examine medicine prescription practices by the health provider
3. To examine medicine dispensing practices at health facilities
4. To assess client’s demand for medicines and user- factors that may potentially associate to stock outs.
5. To explore the procurement and supply chain management mechanisms of drugs in the federal context.

Project focal person 

Project’s focal person is Dr. Chandani Kharel 

Methodology

Methodology that we plan to employ is a mixed method study, both qualitative and quantitative approaches to collect and analyze data. A total of 272 health facilities have been selected across 7 provinces to enumerate in this study.  Quantitative research through structured questionnaire aided interviews will be conducted. A total of 420 exit client interview will be conducted in selected 272 health facilities, 168 observation of client-health worker interaction will be conducted and 420 prescription audit will be conducted to help us identify the number and types of medicines and antibiotic prescribed. Qualitative data collection through semi-structured interviews (SSIs) will be conducted. A total of 76 SSI will be conducted, 10 at central level, 14 at provincial level, 27 district level/local level, 7 at PHCC level and 18 at HP level.

Study Coverage

Province 1, Districts – Sunsari, Sankhuwasabha, Ilam 

Province 2, Districts – Siraha, Saptari, Sarlahi

Province 3, Districts – Kavre, Makwanpur, Nuwakot

Province 4, Districts – Mustang, Manang, Baglung

Province 5, Districts – Kapilbastu, Arghakhanchi, Nawalparasi

Province 6, Districts – Mugu, Humla, Dolpa

Province 7, Districts – Doti, Bajura, Dadeldhura