Management of drug supply chain in a major public sector and private sector hospital in Sri Lanka

Abstract Around eleven percent of the health care budget in Sri Lanka is allocated to drugs. To ensure maximum benefit from such an investment, the drugs should be available at health care institutions whenever they are needed. There are differences in the drug management cycles of public sector and private-sector hospitals. Continuous supply of essential drugs is one of the most important requirements for saving a patient’s life. Proper management of the supply chain is essential to improve the availability of drugs in healthcare institutions. A supply chain consists of all the stages involved in fulfilling a customer request, either directly or indirectly. Therefore, either public or private, proper management of the supply chain is very important for a hospital. There were complaints about shortages of drugs and other medical devices in public sector health care institutions on some occasions. Sometimes, problems associated with drug quality and efficacy are also reported in public sector health institutions. The high cost of drugs in private sector hospitals is a major problem, and they too experienced shortages of drugs. As a result, the purpose of this study is to evaluate drug supply chain management in leading public and private sector hospitals and identify their strengths and weaknesses. Key informant interviews with directors, pharmacists, doctors, and nurses of these hospitals, Direct observation by using a checklist, desk review with available records, Interviews with selected patients using an interview administered guide were used as methods in this descriptive qualitative study. The study was conducted at a district general hospital in the western province and a leading private hospital in Colombo. There was a shortage of some clinic drugs during some periods in the district general hospital. Sometimes, some of the important drugs, including antibiotics, are out of stock. Even in a private sector hospital, they faced shortages of drugs during some periods due to manufacturing and shipping problems. The root causes of the shortage of drugs at the district general hospital were analyzed by using the Ishikawa diagram. An inadequate estimate of drugs was the main reason 4 for the shortage. During estimation, some units didn’t provide the correct requirements, some units couldn’t predict the future enhanced demand, and some units missed some requirements. Even during the preparation phase of the annual requirement, the chief pharmacist couldn’t predict the future rise in demand. The inability to maintain enough buffer stocks for certain drugs was another root cause of shortages of drugs. The condition of the drug store is very poor currently, and it must be upgraded to provide satisfactory service. There is no price regulation of drugs at private hospitals. Therefore, patients had to pay more than the usual value of the drug. This is one major problem in the private sector. This hospital usually maintains drug stock for only two weeks. But it is a somewhat dangerous strategy as our country doesn't produce many drugs. If there is any problem with manufacturing, shipping, or local suppliers, they will have to face a shortage and a serious problem due to this strategy. The drug store at this hospital is also not properly organized. Drugs are not stored according to the new store-keeping methods. Based on this study, it is recommended to organize the drug stores of both hospitals to standard level, prepare a correct annual drug estimate at the district general hospital, maintain several suppliers for the same product at private sector hospitals, introduce a system to price the drugs at private hospitals, improve supervision and test checks at both hospitals, and provide enough information to patients during dispensing of drugs at DGH.