1. Congratulations Atu! You have done it, Glory be unto God! BUT: 2.

Your cover page needs to be attended accordingly, check out the guidelines and make it more attractive 3. Your abstract should be adjusted a bit to make it more sound and sweet 4. Your chapter titles should be at the centre 5. Your subsections like introduction in chapter 4 should be in title-case 6. Observe thoroughly the font size, space, etc making your report more calling and palatable 7. The words marked in blue needs your attention using the suggestive corrections in given brackets; you can check this with Sweet Ally Chanz if not scared NB: Currently, I am so busy but I can spare very few minutes for your abstract reparation

PREPARED BY: ATUPELE .A.MWANYANGALA REGISTRATION NUMBER: B0861010

RESEARCH TITLE MANAGEMENT SKILLS PERTAINING SUPPLY OF MEDICINE IN PUBLIC HEALTH FACILITIES: A CASE OF MBEYA CITY. SUPERVISOR NAME: Mr. MAHALLAH, E, R.
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RESEARCH REPORT SUBMITTED TO MBEYA INSTITUTE OF SCIENCE AND TECHNOLOGY AS A PARTIAL FULFILMENT FOR THE AWARD OF BACHELOR DEGREE IN BUSINESS ADMINISTRATION (BBA)

JULY, 2011
Certification The undersigned person certifies that he has read and truly recommends WHAT for acceptance by the Mbeya Institute of Science and Technology the research paper titled MANAGEMENT SKILLS PARTAINING SUPPLY OF MEDICINE IN PUBLIC HEALTH FACILITIES; A CASE OF MBEYA CITY in partial fulfillment of the requirement for the award of Bachelor Degree in Business administration at Mbeya Institute of Science and Technology- Tanzania.

.. Mr. MAHALLAH.E, R (Supervisor)

July, 2011

Declaration I, Atupele A Mwanyangala, declare that this is my own original work and has not been presented to any other UNIVERSITY or INSTITUTE for similar award. SIGNATURE DATE.

Copyright statement Mbeya Institute of Science and Technology, July, 2011 This research is a copyright protected, it may not be reproduced by any means, in full or in partial, except for short extracts, for research or private study, critical scholarly review or discourse with acknowledgement, without the written permission of the science and business management department on behalf of the authors and Mbeya Institute of Science and Technology.

2011 ATUPELE .A. MWANYANGALA All Rights Received.

ACKNOWLEDGEMENT Thanks (check out grammar- thanks to) God for his creation and protection, thanks to all people who supported me morale (grammar-morally) and in any way or another during the whole time of my studies, thanks to the Department of Science and Business Management for provision of unique knowledge to my mind (to me) It is not easy to mention all people from whom I received during the whole period of research work; however I will mention few who are frequently sought for their help (check out grammar- Actually, many people have contributed a lot to the success of this study, however it is not easy to mention all but their contributions are appreciated and acknowledged) I am deeply grateful for the loving concern, moral and material support of Mr and Mrs Lazaro Mwambole (G-UNIT FAMILY) during my study life time. However, I am very grateful to my supervisor, Mr Mahallah, E, R, for his tolerance and tireless efforts in providing constructive criticisms as well as pertinent guidance for my study. I declare that his guidance has been very valuable such that it led to successful production of this dissertation. I owe my special thanks to Mr Charles Raphael (CRN) for killing much of his time not only advising but also encouragement during the whole period of research study that made

this work simpler than expected. ( grammar- I heartedly thank Mr. CRN, Raphael for his closest advice and encouragement for the whole period of this study.) I also owe my heartfelt thanks to all lectures (spelling) from the Department of science of business and management for three years of my studies at Mbeya Institute of Science and Technology. I express my thanks to my parents Mr and Mrs Angetile Mwanyangala for their encouragement during my study life time. (Repetitions) Also (logic- use finally instead of also) I would like to express my sincere thanks to my fellow graduate students, Anitha Mwambete, Venance Mwakosya, Sweet Ally Chanz and Nicholaus Kayombo for their advice from the initial to the final stage of the study.

Dedication This work is dedicated to the lovely family of Mr and Mrs LAZARO MWAMBOLE (GUNIT) whose assistance is the result of successful completion of this research work and was always tirelessly struggling to make sure I successfully complete the degree in BUSINESS ADMINISTRATION, may the King of heaven remember them always (usemay the Almighty God bless them abundantly exceedingly) .

See me so that we remake you abstract, it is not some how sweet

Abstract The study was conducted at Mbeya City Council; the aim (use- the main objective was) was to investigate the key cause behind to (use-the instead of to) shortage of medicine in public health facilities at Mbeya City. ( I advise that you ponder something else (another paragraph) to put here instead; this is like a repition in the consequent paragraphs, we can discuss 2gether here) The overall objective of the study was to assess management skills pertaining supply of medicine in public health facilities in Mbeya City; The specific objectives was; To determine supply nature of medicine in public health facilities, to identify medicine supply and distribution system in public health facilities and to determine the stock management at public health facilities in Mbeya City.

The primary data were obtained through interviews and observations. While secondary data were obtained by consulting various literatures. A sample of some officers and Storekeepers from medical store department, nurses and doctors from Referral hospital, Regional hospital, META Reproductive Health and some selected health centers. Data collected were analyzed using both qualitative and quantitative methods. The findings show that there is shortage of medicine in Mbeya City due to; poor management skill, supply and distribution systems of medicine from Medical Store Department (MSD) from headquarter in Dar es Salaam, poor knowledge of staffs in timing of ordering medicines, low fund in health facilities and unethical behavior of some officers who steel (steal) some medicine and sell to their pharmacies and dispensaries illegally and poverty in the country. The research paper is divided into five chapters. Chapter one provides introduction and background of the research, Chapter two gives review of literature, Chapter three gives a research methodology procedures used, Chapter four discusses findings, data analysis and interpretation and the last chapter gives recommendation and conclusion. Procurement of drugs is quite expensive. The proper supply management would ensure the judicious use of limited financial resources. The economic implications of increasing medicine prices in poor economic settings have made it vital to deal extensively with supply and financial management issues coupled with medicine revolving funds. This study aimed at identifying and examining the problems associated with medicine supply management in the public sector. The research design for the study followed a pattern of personal observation, informal interview with key informants and some officials, followed by semi structured questionnaire. This study found out that there are several problems militating against effective and efficient management of medicine supply. These range from delay in approval of logistics, lack of interest in funding the system, inadequate financial resources, poor salary of personnel, and financial mismanagement which resulted in some of the major constraints. Besides, weak management system, incompetent staffing, lack of up-to-date knowledge and training of personnel involved, all presented a real challenge of finding lasting solution to the situation at stake. Funding of medicine supply by government alone is inadequate to ensure availability with sustainability. New trends in

the managing of medicine supply that will provide effective and efficient set of practices aimed at ensuring the timely availability and appropriate use of safe, quality medicines and services must come into play.

LIST OF ABBREVIATIONS

MSD NEDL WHO NACP EPI

Medical Store Department National Essential Drugs List World Health Organization National AIDS Control Program Extended Programs for Immunization

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ARV LDCS META HIV

Ant-Retri Viral Least Developed Countries Medicine Transparency Alliance Human Immunodeficiency Virus

AIDS Acquired Immune Deficiency Syndrome RHD REFF.H Reproductive Health Department Referral Hospital

CHAPTER ONE BACKGROUND TO THE PROBLEM 1.0 INTRODUCTION This chapter forms the background of the study on management skills pertaining supply of medicine in public health facilities. The chapter examines the profile of Mbeya City, number of wards with their respective health facilities and the population of the City. It further explains the problem of insufficient of medicine in public health facilities and its

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effects to the people. The chapter also gives the statement of the problem, objectives, significance of the study, scope of the study and research questions. The chapter ends by giving the organization of the study. 1.1 Background to the problem Mbeya city is the capital city of Mbeya region located in Southern Highlands Zone of Tanzania. It lies between latitudes 8 50-8 57 East of Greenwich and longitude 33 30`-35 3535` .It is almost surrounded by Mbeya District council in all directions. The city covers an area of 214 sq km, is situated at an elevated land to an altitude of 1700ft above the sea level. The climate is influenced by its altitude receives mean annual of 1200mm (November May) accompanied with mean temperatures ranging between 11c-25c. (http//tzonline.org/pdf/mbeyareg.pdf/ pg 1) According to Mr Mwaikinda, the environment officer, Mbeya City is composed of thirty six (36) Wards, namely:- Iyunga, Iwambi, Igawilo, Itezi, Isanga, Ilemi, Itiji, Iziwa, Isyesye, Iganzo, Iduda, Itende, Tembele, Mwansanga, Kalobe, Mwansekwa, Ntagano, Nsoho, Nonde, Iyela, Uyole, Nzovwe, Iganjo, Nsalaga, Mabatini, Ruanda, Sinde, Manga, Majengo, Ghana, Ilomba, Mwakibete, Mbalizi-Road, Forest, Maendeleo and Sisimba. Out of the number of wards given, eight (8) wards have public health facilities and twenty eight (28) do not have those services. Even the wards with health facilities, there is a problem of insufficient medicine. The question of inadequate medicine in the health facilities has got negative impact on the health of the people at their localities something implying the loss of peoples lives if not tackled accordingly. According to the National Census of the year 2002, the city had a population of 266,422 people; 126,679(48%) were males and 139,743(52%) were females with a population growth rate of 4.0%. The current population is estimated to be 325, 409 people of which 156,196(48%) are males and 169,213(52%) are females. Table 1: Population distributions in Mbeya City

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Source: URT, 2002 Population and Housing Census The study will concentrate much on children and pregnant mothers who are most affected by the shortage of medicine. Medicine for children and pregnant mothers are frequently Age groups(Years) Males Females Total 0- 5 25,366 27,182 52,548 6- 18 52,101 63,079 115,180 18- Above 80,182 90,238 170,420 Grand total 157,679 180,499 338,148 unavailable, impractical to administer and unaffordable. Children and pregnant mothers are affected, but the impact is most acute and the needs most urgent in poor countries where promotion in population is highest and the services are weakest. Action is needed to ensure pregnant mothers and childrens medicine meet the standard expected for medicines. (Wilkinson, M, M. 2000) Mercurio B. 2007 argues that, insufficient of medicine remain to be the biggest challenge in many countries especially third word countries.Over the last decade, public health and development issues have become topics of great international concern. Public health in many parts of the world has reached crisis level. Over 14 million people are killed by infectious diseases each year. 90% of which are in the developing world, over 40 million people are infected globally with HIV/AIDS, 90% of which are in the developing world and the disease kills over three million people annually. Over 500 million people are infected with malaria each year and the disease kills upwards of two million people annually while over eight million people develop active tuberculosis (TB) each year and the disease kills over two million people annually. About 99% of deaths resulting from TB are found in the developing countries. 1.2 Problem statement In real life, the community daily activities whether in the private or public organizations, mainly aim at getting success or reach the desired goal. Availability of medicine in public health facilities should be effective and efficient inorder to achieve such success. Since

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diseases are inevitable, medicine should be available and afforded by all types of income earners especially in public health facilities. There are some irregularities related to management, distribution and supply of medicine in public health facilities which hinder a number of sick people to get medicine after checkup. The Government of Tanzania together with Regional Medical Store Department of Mbeya are trying to eradicate the problem of insufficient of medicine. Supports from donors like Mission for Essential Medical Supplies (MEMS), National Health Insurance Fund (NHIF) and Pharmaceutical Supplies Unit (PSU) improve support, supervision and training to see whether drug utilization in rural hospitals can be improved. Mbeya city is among the regions in Tanzania suffering from medicine shortage especially in public healthy facilities. When the number of patients arrives to the healthy facilities for treatment, after check-up they are just given the name of medicine and being told to go and buy at private pharmacies rather than being given at the particular facility. Therefore, this study aims at investigating the nature of Supply and distribution of medicine in Mbeya at public health facilities, like Referral hospital, Regional hospital, META reproductive health department and Ruanda health centre at Mwanjelwa. 1.3 Objectives of the study 1.3.1 Main Objective The main objective of the research is to assess the management skills pertaining supply of medicine in public health facilities in Mbeya city; this main objective was supported by the following specific objectives. 1. 3.2 Specific Objectives 1.3.2.1 To determine supply nature of medicine in public health facilities; 1.3.2.2 To identify medicine supply and distribution system in public health facilities and 1.3.2.3 To determine the stock management. 1.4 Justification of the study The study was conducted in Mbeya city specifically at Mbeya Referral Hospital; Mbeya Regional Hospital, META Reproductive Healthy Department and one selected healthy centre such as Mwanjelwa Healthy Centre so as to get accurate and reliable information

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concerning management and supply of medicine in public healthy facilities. The study was conducted on the said areas due to limited time; financial constrains, the objective of the research, and the selected areas are anticipated to give the useful representation of the management skills pertaining supply of medicine in public healthy facilities. Significance of the study The study will be useful mostly for the researcher in academic issues in partial fulfilment of requirement for the award of Bachelor degree of Business Administration (BBA). Although the study is conducted for the purpose of academic pursuance, it will catalyse the government and NGOs to think of solving the problem hence having positive impacts to the pregnant mothers and children who suffer much from insufficient of medicine in public healthy facilities. It will be of great value to future researchers as they (researchers) may decide to conduct the research on the causes of medicine shortage in public healthy facilities; The study will be helpful and relevant to the needs of the society living in Mbeya City and the country at large since it will serve their lives by reducing unnecessary deaths due to availability, efficacy and minimum price of medicine; To the medical store department management staffs, it will help them to manage available quantity against demand, and planning for the right time for ordering. This in turn will reduce or eliminate the problem of stock out of medicine in public healthy facilities, and MIST as an organization will reduce unnecessary costs incurred because of referring its students and workers to other public healthy facilities caused by stock out of medicine in its Dispensary. 1.6 Research questions

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This study shall be guided by the following interview questions so as to get desirable informations: i. ii. iii. iv. v. vi. Can you explain supply and distribution nature of medicine in public health facilities? How does medicine managed in public health facilities? Do you think there is poor supply and distribution system of medicine from Head quarter to Regional medical store department? May you give the factors which influence the shortage of medicine in public health facilities? Are the current supply and distribution system of medicine satisfying the population of Mbeya City? Despite the measures taken by the government of Tanzania and NGOS to reduce or eradicate medicine shortage in public health facilities, can you suggest other measures?

CHAPTER TWO: LITERATURE REVIEW 2.0 INTRODUCTION This chapter gives a brief review on various concepts used in the study and their applicability; those are medicines, health facility, a child and pregnant mothers, management skills of medicine and supply of medicine

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2.1 Theories related to the current study 2.1.1: Medicines Medicines are crucial health care products in the primary care system. An important function of any health care system is to deliver appropriate health products and services in an equitable, reliable and efficient manner. The quality of primary health care system is usually judged by patients on the basis of appropriate medical staff and availability of needed medicines Medicine is defined as that which satisfies the priority health care needs of the society. They are selected with due regard to public heath relevance, evidence, on efficacy and safety and comparative cost-effectiveness. Medicines are intended to be available within the context of functioning health systems at all times in adequate amounts, in the appropriate dosage forms, with assured quality and adequate information and at a price that the individual and the community can afford. 2.1.2: Health facility (Department of Health, 2011)Health facilities are places that provide health care/services. They include hospitals, clinics, outpatient care centers and specialized care centers, such as birthing centers and psychiatric care centers. When you choose a health facility, you might want to consider i. ii. iii. iv. How close it is; Whether your health insurance will pay for services there; Whether your health care provider can treat you there and The quality of the facility.

The facility conveys a message to patients, visitors, volunteers, and staff. The facility also communicates a torrent of clues about the organization and the medical care being provided there. The clues start at the approach to the facility, the drop-off area, the parking lots and the street signs. Ideally, that message is one that conveys welcoming, caring, comfort and comparison. Commitment to patient well-being and safety, where stress is relieved, refuge is provided, respect is reciprocated, competence is symbolized, way-finding is facilitated and families are accommodated. 17

2.1.3: A child In most international and national institution, children are defined as boys and girls up to the age of eighteen (18) years. The age of eighteen years relates primarily to the generally accepted age of majority, though in all countries there are legal expectations. For example, the ages at which a child may be married, make a will, or consent to medical treatment. (UNCEF) 2.1.4: Pregnant mothers Are matured women having a baby developing in the womb. Pregnancy is the term used to describe when a woman has a growing fetus inside. Because pregnant women are prone to diseases they need medicine to be available in adequate amount and minimum price inorder to access them all the time. (World Health Organization. 1999) 2.1.5: management

According to Drunker P. Management is Organization and coordination of the activities of an enterprise in accordance with certain policies and in achievement of clearly defined objectives. Management is often included as a factor of production along with machines, materials, and money. (Wikipedia.org/wiki/peter drunker)

2.1.6: Management skills Are skills used by managers to make work done well. Management Skills

Technical: used for specialized knowledge required for work. Human: refers to the ability to understand, work with, lead and control the behavior of other people. Conceptual: used to analyze complex situations.

2.1.7 Basic management Functions

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According to Henri Fayol Management operates through various functions, often classified as planning, organizing, staffing, leading/directing, and controlling/monitoring.

Planning: Deciding what needs to happen in the future (today, next week, next month, next year, over the next 5 years, etc.) and generating plans for action. Organizing: (Implementation) making optimum use of the resources required to enable the successful carrying out of plans. Staffing: Job analyzing, recruitment, and hiring individuals for appropriate jobs. Leading/Directing: Determining what needs to be done in a situation and getting people to do it. Controlling/Monitoring: Checking progress against plans. Motivation: Motivation is also a kind of basic function of management, because without motivation, employees cannot work effectively. If motivation doesn't take place in an organization, then employees may not contribute to the other functions (which are usually set by top level management). (Wikipedia.org/wiki/henri-Fayor)

2.1.8: Basic managerial Roles

Interpersonal: roles that involve coordination and interaction with employees. Informational: roles that involve handling, sharing, and analyzing information. Decisional: roles that require decision-making.

2.1.9: Supply of medicine Is a quantity of drugs that is available for use when it is needed to the society. The supply of medicine remains to be the challenge in the third world countries. It causes a lot of deaths especially the children and pregnant mothers who are more prone to such medicine. The supply of medicine from Tanzania medical store department to other places of the country is very poor which cause deaths of people to grow up as time going. (Kumarian, 1997).

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Considering that the number of infants in the developing world dying in their first month of life equals the total number born in the United States in a year, it's fair to say that maternal and infant mortality rates are some of global health's most dramatic indicators. In addition, a woman in sub-Saharan Africa has a 1 in 16 chance of dying in childbirth, while a woman in North America has only a 1 in 3,700 chance of facing the same fate. Similarly dismal comparisons abound for low birth weight infants, mortality in children under 5, and children who are under weight and height for their age. The majority of maternal and infant deaths occur in the poorest, most disadvantaged places, where health services are inaccessible or nonexistent, food and transportation are scarce, and other structural determinants work against population health. Representative of the imbalance between countries is the fact that almost 99% of all neonatal deaths occur in low- and middle-income countries, yet the majority of research focuses on the 1% of these deaths occurring in rich countries. (Westport (CT), 2006) Women and young people are increasingly affected by HIV/AIDS. Globally, almost half of all adults living with HIV/AIDS are women, and young people ages 15-24 accounted for 40% of new HIV infections in 2006. Although East and Central Asia and Eastern Europe accounted for the largest increase (21%) in new infections between 2004 and 2006, every region in the world recorded increases during the same two-year period. (WHO, 2004)

2.2 Empirical review (Various researches done in relation to the current study) The general idea of supply of medicine in developing world continues to suffer without adequate supply of the needed medicines. Begging the question what are the primary causes of, or more appropriately, what are the barriers to resolving, the continuing crises and lack of access to life-saving medicines in the developing world. Timely, supply of drugs of good quality which involves procurement as well as logistics management is of critical importance in any health system. To decentralize the procurement activities and build capacity for this purpose, WHO emphasized setting up State Procurement Systems and Distribution Networks for improved Supplies and distribution. (Kumarian, 1997) 20

All medical graduates must understand the various approaches to the organization financing and delivery of health care. They must recognize threats to their own professionalism as posed by conflicts of interest inherent in financial and organizational arrangements. They must have the ability and vision to use new developments in technology and information systems to manage, problem-solve and make decisions that are relevant to the efficient and effective medical care of individuals and populations. They must learn to understand the context in which they practice and the interdependence between the patient care that they provide, that is provided by others and that is provided to the society at large. They will learn how to apply their knowledge to improve the care of individual patients and groups of patients as well as others in the health care system. They will learn to apply systematic and cost-effective strategies to prevent, diagnose and treat in a manner that never compromises quality of care. They must learn how to collaborate with other members of the team and their patients and families to coordinate care, to assist patients in dealing effectively with a complex system, and to improve systematic processes of care in an effort to improve outcomes. Whatever constraints are placed on the healthcare system, they will demonstrate their ability to remain a consummate advocate for the quality of care of their patients. They will learn how to use their leadership style, organizational chain of command, multi-tasking skills, and due process to best effect change that will lead to improved patient or practice environment outcomes. (Berkman LF, Kawachi, 2005) The World Health Organization (WHO) reported that 30 percent of the world's population, some 1.725 billion people, lacked regular access to essential medicines. By 1999, the 15 percent of the population who lived in high-income countries purchased and consumed 90 percent of all medicines, by value. Recently WHO report estimates that 30 percent of the world's population, including 47 percent of Africans, 65 percent of people in India, 29 percent of people in the Eastern Mediterranean, and 26 percent of Southeast Asians (excluding those from India), had no access to essential medicines . So although access has significantly improved in a number of countries, a large fraction of the world's population still has no effective access to modern medicines or vaccines. The majority of

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these people are either extremely poor or are living in remote rural areas where the supply of drugs is limited or nonexistent or both. (WHO, 2004). Medicine Supply Management -is a problem common to most public health institutions in the Nigerian health sector which is attributable to negative impact in the economy Medicines promote trust and participation in health services and are a major determinant of health services utilization. Realistic improvements in managing supply and use of drugs are possible when due attention is focused on the prevailing issues of management. Appropriate use of financial resources is achieved through the purchasing of medicines in the right quantities through competitive pricing, and appropriate selection to achieve adequate coverage of the most prevalent diseases (WHO, 1997). The benefits of good medicine management encompasses: avoiding wastage, ensuring availability of medicines at all times and avoiding dangers associated with improper usage (IDA, 2005). Political, economic, financial and traditional considerations could contribute to appropriate financial expenditure, avoidance of wastage, increase access and ensuring that medicines are properly used. (Twiter, K, 2011) Werner, D 1985 argues that, the politics of health and health care are fraught with contradictions. Just as an example, look at smoking. The governments of overdeveloped countries now warn their people that "cigarette smoking is dangerous to your health". Yet these same governments, while cutting back on health benefits to the poor, continue to subsidize the tobacco industry with millions of dollars. And since fewer people in the rich countries now smoke, the big tobacco companies have bolstered their sales campaigns in the Third World, where the growing epidemic of smoking now contributes to more deaths than do most tropical diseases. Supply of medicines is needed in forms that are appropriate for use in household and clinical settings. Also medicine must be available and affordable. Pediatric medicines must be palatable and acceptable to the children and pregnant mothers. Moreover it must be stable and practical to use in difficulty conditions, packed appropriately and accompanied by information that can be understood during usage. Many currently medicines are unpleasant to taste, difficulty to administer and costly. In some diseases several drugs have

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to be taken, making fixed-dose combinations a practical solution. Impractical dosage forms result in inefficiencies in busy clinical settings, waste money and have poor health outcomes. Zambian Friday Daily News of 08 January 2010 reported that, Most of African countries suffer from the problem of not having enough medicine as it was reported by the Friday news Nearly two thirds of people in Zambia do not have regular and affordable access to essential medicines. It is recognized fact by Governments throughout the world including Zambia that access to health care is a fundamental human right. Without equitable access to essential medicines, this fundamental human right can not be fulfilled. Further the importance of access to essential medicines is also recognized in the millennium Development Goals. On January. 26. 2011 at TBC News, Minister of health and social affairs reported that, Tanzania is among the countries that face this problem of shortage of medicine in public health facilities especially MSETO which cause deaths of many people especial children and pregnant women he said that they are on process of requesting medicine from outside the country about five hundred thousand (500,000) packets with ten (10) tablets each while people still suffering at the period when the process is going on. Despite existing treatments for diseases and conditions such as malaria, measles, tetanus, and child diarrheas, an estimated one-third of the world population lacks regular access to essential drugs, with this figure rising to over 50% in the poorest parts of Africa and Asia. And even where drugs are available, weak regulations may mean that they are substandard or counterfeit. Each year, tens of millions of children do not receive basic immunizations, and more than two million people die of vaccine-preventable diseases. Moreover while most illnesses - especially infectious diseases - are preventable or treatable with existing medicines, the World Health Organization (WHO) estimates that over 1.7 billion people - nearly one-third of the world's population - have inadequate or no access to these essential medicines.

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Moreover, another study recently found that 10 million children a year die from preventable diseases and conditions, with almost all these deaths occurring in poor nations. (Northwestern university Journal of International Human Rights, 2011) Another study found that prompt diagnosis and treatment of health problems in Africa and Southeast Asia alone could save approximately 4 million lives each year. In addition, resistance to existing treatments due to improper use or over-exposure plays a significant role in increasing the severity of the public health crises in many nations. Other studies link health with the economic prosperity of nations and persuasively demonstrate the dramatic role the HIV/AIDS epidemic has played in the declining economic growth in sub-Saharan Africa. The consequences of the vicious cycle between poverty and illness are clear and the situation will become even more untenable unless the world comes together to resolve the public health crisis engulfing much of the developing world. (2007, Northwestern university school of law, Northwestern university Journal of International Human Rights) (Berkman LF, Kawachi, 2005) Relatively few of the worlds resources for health research are allocated for solving the health problems of developing countries; the latest estimate from the Global Forum for Health Research puts total health research investment at US$105.9 billion. But there is still massive under-investment in health research relevant to the needs of low-and middle-income countries, with a mere 10% of this worldwide expenditure on health research and development devoted to the problems that primarily affect 90% of the world's population. Crises such as HIV/AIDS, tuberculosis and others gripping much of the developing world are very real and escalating problem in many developing nations. But the fact is that if patient regulations did not exist, much of the developing world would still lack access to medicines. Importantly, 95% of the pharmaceutical products on the WHO Essential Drug List (such as medicines to treat AIDS, tuberculosis, and malaria) are off-patent and, due to flexibilities contained in TRIPS and extended by paragraph 7 of the Declaration and waivers granted in 2002 by the council for TRIPS, the grace period for LDCs delaying implementation of section 5 (patents) and 7 (confidential information) in relation to

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pharmaceutical products and the marketing rights thereof have been extended until 2016; meaning LDCs do not currently have to provide patent protection for pharmaceuticals. To illustrate, as of 2003, of the fifteen antiretroviral (ARV) drugs used for treating AIDS, patent coverage is below 20%, with 172 patents out of 759 that could theoretically apply. Moreover, of the 52 African nations, only South Africa has patient protection for more than half of its AIDS drugs, with 15 patents out of possible 16. Importantly, 25% of the countries provide no patients and the rest have an average of 4 patented drugs, with no patents on more than a dozen different triple-therapy cocktails used to combat HIV/AIDS. Thus, while the majority of African countries do not patent most ARV drugs used to treat AIDS and the majority of countries of sub-Saharan Africa do not have any patent protection for any of the drugs, the AIDS epidemic continues to infect and kill millions of people per year in the continent. (Attaran, A. 2011) Many authors on supply and distribution system of medicine in public health facilities agree that there is evidence in poor supply and distribution system of medicine and the problem is increasing in different African countries and the causes have been classified in different ways as explained above. Within Mbeya City Council there is also a creeping notion that poor supply and distribution system of medicine is caused by poverty within a country which cause failure to purchase medicine in time. This cause shortage of medicine to the region as all medicine comes from headquarter (Dar es salaam) so when there is insufficient of medicine in headquarter it means all regions suffer from the problem.

CHAPTER THREE: RESEARCH METHODOLOGY 3.0 INTRODUCTION This chapter discusses the methodology which will be used in the study. In a nutshell, the paper will employ field data gathering tools including interview, participatory observation and documentary review depending on the nature of data.

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3.1 Research design A research design is the arrangement of conditions for collection and analysis of data in a manner that aims to combine relevance to the research purpose with economy in procedure. (Kothary, 2004) The study will adopt simple random sampling. In this study a combination of both qualitative and quantitative research methods was adopted. A qualitative research design was chosen because the study intended to gain an insight in depth of the information about the management skills pertaining supply of medicine in public healthy facilities. Quantitative method was partially used especially during the analysis of the collected data for example, presenting the distribution of the characteristics of respondents. 3.2 Area of the Study The study covered areas and facilities located in Mbeya city including Referral Hospital, META Reproductive Health Department, Regional Hospital and one selected health centre which is Ruanda Health Centre at Mwanjelwa 3.3 Study Population The study population involved pharmacists, medical storekeepers, doctors, nurses and patients at the study area mentioned above. In short, the total population will be twenty seven (27) people. 3.4 Methods of Data Collection The methods used in collecting data for the study were interview, observation, and documentary review. 3.4.1 Interview Is the method of collecting data involves presentation of oral-verbal stimuli and reply in terms of oral-verbal responses. (Kothary, 2004) This is the face to face conversation between interviewer and interviewees. In this study the interview was used to Medical Store Department staffs, pharmacists, doctors and nurses and some of the patients. Interview was used to the foresaid respondents due to the nature of their business job i.e. they are busy and very occupied all the time in their working places. The other reasons were because of limited time, fear of misplacing the questionnaires by the respondents and

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the intention of the researcher to understand the respondents inner feelings about how medicine is being managed in terms of skills, distributed and supplied in Mbeya City. 3.4.2 Observation Also, the study used observation method whereby the researcher observed patients who always go to health facilities for check-up and treatment. In so doing, these patients are just given a name of medicine and instructed to go and buy the given medicine from private pharmacies as there is no required medicine in those particular public health facilities. 3.4.3 Documentary Review Documentary review is the source of secondary data whereby various reports, speeches, journals and other relevant materials related to the topic were consulted. The data documentary reviews were collected from Zonal Reproductive department known as META, Referral hospital, Regional hospital and Medical Store Department office. (Kothary C, R) 3.5 Sample size of respondents Sample size in any research does not come from a vacuum or air but some forces (criteria) push a researcher to select a certain sample size which in this case refers to the number of respondents. The table below shows the number of respondents in each health facility attended by the researcher. That number of respondents was concluded due to the following criteria:

Table 2: Number of Respondents Attended during the study S/N 1 2 3 4 5 Name of health facility Expected Percent % Attended 11.11 14.81 11.11 18.52 18.52 Respondents 03 04 03 04 05 Percent (%) 11.54 15.38 11.54 15.38 19.23

Sample size Medical Store Department 03 META Reproductive Health 04 Referral Hospital 03 Regional Hospital 05 Ruanda Health Centre 05 (Mwanjelwa) 27

Patients Found in Healthy Facilities Regional Hospital _o2 META R. H.D 02 Ruanda H.Centre-01 Referral Hospital-02 Total 07 27 25.93 100% 07 26 25.92 100%

7 6 5 4 3 2 1 3 4 3 55

5 4 3 3 4

MS D ME A T RE F F .H RE .H G R.H .C P atients

Source: Survey data 2011

As figure 3 above0 shows, the number of respondents expected to be attended by the

E xpected s aple s ize Attended researcher and its percentages. It also shows the respondents who were attended by the res pondents researcher during the research study. The Majority of the respondents were workers from
different public health facilities in Mbeya city however some of the patients were among the respondents explained as follows: - About 73.08 percent (%) of the respondents were workers while 26.92 percent (%) were patients from different health facilities. About 11.53 percent (%) of workers were attended from MSD, 15.38 percent of workers were attended from META, 11.53 percent (%) of workers were attended from Referral Hospital, 15.38 percent (%) of workers were attended from Regional Hospital, 19.23 percent of workers were attended from Ruanda Health Centre and the rest 26.92 percent (%) were the patients from different health facilities. The presence of fewer health facilities such as total of eight

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(8) health facilities in thirty six (36) wards of the city crates the sample of twenty seven (27) respondents as a ten percent of all officers in those public health facilities. Criteria of selecting sample Nature of the business, In health facilities workers are usually busy spending most of their time in taking care of the patients. Therefore, it was difficult to find them easily in large number. Being that the case, it was difficult for the doctors or nurses to leave the patients and come to participate in the research interview. Time, the time given for this research was shorter compared to the effective and efficient research that takes normally even years; the time was very short due to other businesses engaged by the researcher like continuous classes; and appointment time made by the respondents caused waiting time for data collection. Therefore, the particular sample of 27 respondents was reasonable to meet the researchers objectives and the deadline allocated. Financial Constraints, the particular sample size was selected in relation to the budgetary constraints in the sense that, the researcher is a private-sponsored student as she had no any external financial source for research and practical fields. For that case therefore, the little money she had was thoroughly calculated only to address and attend the selected sample size. 3.6 Ethical Consideration Permission to carry out the study was obtained from the Area Manager (MSD), Doctor in charge for the facility (Referral Hospital, Regional Hospital, META Reproductive Health Department and Ruanda Health Centre). The permission was asked to the interviewed patients from whom their free consent accepted to be interviewed. The respondents of the study were assured of anonymity and privacy by the researcher even some people seemed to be scared of giving out details. In this study the informed consent from the respondents were obtained orally after describing the aim of the study. 3.7 Data Analysis and Interpretation Method Data were collected, assembled and processed in a sequence and then analyzed in accordance to the research objective and questions. The study employed qualitative and

29

partially quantitative methods of data analysis. Since the nature of many data seemed to base on opinion of the community especially from verbal statements of the Respondents. Due to the nature of the data descriptive analysis were the major means of analysis from which conclusion were drawn. In data processing the researcher read the data collected and divide them into meaningful segments and code them (assigning the data with symbols, descriptive words or category names) by using Statistical methods. The analysis involved calculations, percentages and trends. Presentation involved was in the form of tables and histogram. There after conclusions and recommendations were drawn basing on the findings of the study, the analysis relied on qualitative method. In short, data collected were compiled, edited and their analysis were done by using EXCEL and STATISTICAL METHODS whose details were presented in the following chapter, (chapter four)

CHAPTER FOUR: DATA ANALYSIS 4.0 INTRODUCTION. The study was guided by a set of questionnaires, observation and interview schedules. The questionnaires that were sent for filling and interview were twenty seven (27) and those which come in usable form were twenty six (26), hence the response rate were 2627100 =96.23%. As response exceeded 50% then the researcher was in the position to start the analysis. This part represents the answers to the research questions as actually observed in the normal conducts of the organization of the case study. The current part constitutes the discussion of findings based on the objectives of the research also represents the analysis of research interview questions

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Table 4.1: Number of the responses towards questionnaire and interview

Questionnaires Items Number Percentage (%) Responded 26 96.23 Not responded 1 3.70 Total 27 100

Figure below shows number of responses towards questionnaires and interviews during the study. The researcher surveyed in four (4) public health facilities out of eight (8) available in the City, like Referral hospital, Regional hospital, META reproductive health department, Ruanda health centre together with Mbeya MSD as samples. The respondents found provided the researcher with informations used to conduct a research and draw conclusions and recommendations for the study. F ure.4.1:num of res ig ber pons towards es ques tionnairesand interviews
30 25 20 15 10 5 0 0 Responded 1 Not responded 26

Source: Survey data, 2011

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4.1 Management skills of medicine in public health facilities From the study the researcher found the different skills used by managers to manage medicine in public health facilities. 4.1.1 Conceptual skills Are roles used by the Director Manager of the public health facility who is the top leader at the particular health facility. The director manager receives Information of medicine shortage from the senior pharmacist who gets complaints from other pharmacists, doctors and nurses about the shortage of medicine. 4.1.2 Human skills These are used by the doctors and nurses who interrupt directly with the patients during treatment. When doctor or nurse found that certain medicine is not available after crosschecking at the in-patient or out-patient departments they report this problem to pharmacists who then contact with the senior pharmacist. 4.1.3 Technical skills These are done by medical storekeepers who have the specific knowledge of managing medicine in health facility stores. They have knowledge of medicine handling in a particular facility. Are the ones who report the problem of medicine shortage to the senior pharmacist of the facility after being contact with a nurse or doctor and get information about medicine shortage at the particular facility. Medical storekeepers are the ones who take orders containing specifications of medicine needed to be purchased at Medical Store Department (MSD). 4.2.0 Management of medicine in public health facilities in Mbeya city The figure below shows the way medicines are managed in public health facilities. It consists of Managing director who controls the process medicine purchase at the particular facility. No purchase is made with ought his/her authority. The director manger, Procurement officer, senior doctor, together with pharmacists and medical storekeepers used to discuss the budget and procurement plan of medicine at the public health facility. The figure 4.2 below shows orders for each officer in managing medicine in public health facilities.

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Managing director

Senior pharmacist

Assistant pharmacists

Medical storekeepers

Doctors/ Nurses

In public health facilities medicines are managed by the director manager for the facility, medical storekeepers and pharmacies at such particular facility. This is done as follows: when doctor or nurse found that certain medicine is not available after crosschecking at the in-patient or out-patient departments, then they report this problem to the medical storekeeper, then storekeeper report to pharmacists who report to the senior pharmacist of the hospital through minute sheet. The senior pharmacist takes note to the director manager. The minute sheets contain specifications from user departments (in-patient or out-patient); it describes the kinds of medicine needed. Thereafter, the file from the director manager contains specifications from user departments are sent to the supplies office after being signed and authorized. The supplies officers go to MSD with their specifications to buy medicine. If at MSD there is stock out for the particular medicine the supplies officers are allowed to buy such medicines at the private pharmacies. In such a case when at the private pharmacies such medicines are not available the problem of unavailability of medicine continues at that public health facility.

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As 100 percent of responses shows that all public health facilities use similar methods of managing medicines, they also face similar problem of medicines shortage. This occurs when specifications of medicines ordered by the public health facility are not available at MSD and private pharmacies or it have high cost which exceeds health facilities available fund for buying medicine. 4.2.1 Management functions From the study the researcher found that every officer performs his /her own functions according to his/her level as indicated below:i. Managing director Planning and deciding quantity of medicines to be purchased depending on the available fund at the particular health facility and generating plans for action, he/she also Directs all activities concerning purchasing and managing of medicine in the public health facility he/she operates. ii. Senior pharmacist of the public health facility Organizing, ensure optimum use of the medicine required to enable the successful carrying out of plans. iii. Medical store department Controlling the available stock of medicine in public health facilities to check the progress against the plans. iv. Doctors and Nurses Reports to medical store department officers kinds of medicines that are not available and needed for treatment of the patients at that time.

Figure 4.3 below shows Supply chain of medicine from headquarter to Mbeya public health facilities.

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Medicines from outside the country and local manufacturers;

Medicine reaches to MSD headquarter (Dar es Salaam);

Medicines received to Mbeya MSD;

Medicine received to other public health facilities;

End user (Patients).

The figure above shows the supply chain of medicine from outside the country and local manufacturers, then medicine sent to headquarter MSD, there after medicines are distributed to other MSDS in regions to easy purchasing of public health facilities. The researcher found that medicine supplied to public health facilities, eighty percent (80%) of medicines are imported from outside the country while the rest twenty percent (20%) are manufactured locally 4.3 Programs used to manage of medicine in public health facilities. The researcher through interview and questionnaire found that in National wise, there are specific programs used to manage medicine in public health facilities, these are; extended

35

program for immunization (EPI) this deals with immunization especially for the pregnant mothers and children, the program is under World Health Organization (WHO). Another program is National Aids Control Program (NACP) used to manage all medicine for HIV i.e.Ant-RetriViral (ARV). Moreover program used to control malaria, and the program used to control Tuberculosis .The program were formed to make sure that there is availability of medicine for such diseases. The programs are there but the supply and management of medicine remains to be a problem in public health facilities. According to the study the researcher found that there is negligence among these programs which fail to manage medicine in public health facilities so as to reduce the problem of medicine shortage at those facilities. There are number of processes of managing medicine in public health facilities but people who used to manage medicines are working under these programs. From the study 88.46 responses shows that there is poor management of medicine in public health facilities, this causes shortage of medicine in public health facilities as explained below:I. II. Mis-management of medicines/ drugs at public health facility due to Insufficient of qualified staffs at public health facilities. Irrational use of medicine by doctors and nurses. For stance they supposed to give out medicines which they received early and store those which come later to avoid spoilage of medicine, but they usually give out medicine which come later leaving other medicine expire and become not good for treatment to human being. III. Negligence of medical storekeepers in timing of ordering medicine. They press order to MSD while medicine are totally finished at their facilities. Therefore during the process of ordering and purchase of medicine causes the particular facility to have shortage of medicine. IV. Unethical behavior of some medical storekeepers together with doctors and nurses who still medicine at public health facilities and send them to their private pharmacies or sell them illegally.

36

4.4 The nature of supply and distribution of medicine in public health facilities Observed actions revealed that, supply of medicine starts from headquarter in Dar es salaam MSD after medicine have been purchased from outside the country or bought locally. During the study it was observes that, 80% of Medicines bought by the country under the minister of health and social affairs (MSD headquarter) are imported from abroad while the rest 20% are manufactured locally. Medicines are transported to other regional MSDS ready for distribution to public health facilities It involves a lot of processes from the top downward to public health facilities. Poor supply is one among factors contributing to shortage of medicine in public health facilities. Therefore the supply of medicines in public health facilities is poor as it is associated with bureaucratic processes. In addition to that medicine supplied are not enough compared to the demand (order placed). The shortage of medicine in Mbeya city is sometimes beyond the Region (MSD) capacity because they used to take medicine to headquarter (Dar es Salaam) so if they miss specifications requested by public health facilities from Mbeya City it means the problem of shortage of medicine continues. Moreover the findings showed that supply of medicine is poor due to the fact that the country itself is poor. The poverty causes medicine not to deliver at the public health facility in time and those which are delivered are not enough compared to the societies demand. The supply of medicine in public health facilities is poor due to negligence of top leaders who fail to take measures and other alternatives to rectify the situation. Poor supply of medicine in the country is the major reason which causes patients to be always instructed to buy medicine in private pharmacies rather than being given at the particular health facility. As 77.78% of respondents argued that there is poor supply of medicine in the country from headquarter to Regional MSDS and lastly to public health facilities, this by implication means that supply of medicine is the accelerates shortage of medicine in public health facilities. Supply and distribution of medicine in Mbeya city.

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F ure 4.4: C ig urrent s upply and dis tribution s temof ys m ecine in Mbeya city

92.3

7.69

P supplyof oor m edicine (92.30% ) D ifferent a nswers (7.69% )

Source: Survey data, 2011 Figure 4.2 above shows that there is poor supply of medicine in Mbeya City. As 92.30 percent of responses shows that large number of population in Mbeya City are not satisfied by medicine supplied in public health facilities. Nurses and doctors who works in public health facilities faces the problems during purchases of medicine as most of times they dont find medicine at MSD. Patients also complained that most of times when they went to the public health facilities for treatment they just instructed to buy medicine at private pharmacies (after check-up) where cost of medicine is very high compared to their income. Bureaucratic processes from headquarter to other MSDS and public health facilities is the major cause of poor supply and distribution of medicine. Sometimes head officers make unnecessary delay to sign documents, inspect and then dispatch medicine to public health facilities. Moreover supply of medicine is poor due to the fact that the country itself is poor. The poverty causes medicine not to deliver at the public health facility in time and those which are delivered are not enough compared to the societies demand. Also supply of

38

medicine in public health facilities is poor due to negligence of top leaders who fail to take measures and other alternatives to rectify the situation. As 92.30 percent of the results shows that there is poor supply of medicine in the country from headquarter to Regional MSDS and lastly to public health facilities. This by simplification mean that medicine supply in the country is poor then this causes supply to be poor in Mbeya City also, this by the case imply that demand is higher that supply of medicine in the Mbeya City. 4.5 Reasons to why patients are instructed to buy medicine in private pharmacies after check-up in public health facilities From the study, 86.47 percent of responses show that medicine is not available in public health facilities because of poor management and supply. This proves that communities of Mbeya are aware of medicine shortage in public health facilities. This is the major problem affects their health and then daily activities as when they are sick they fail to get treatment in such a case the situation causes poverty among the society of Mbeya City since the workforce cannot work properly.

100 90 80 70 60 50 40 30 20 10 0

F ure. 4.5 5es ig : pons to whypatientsareins es tructedto buym edicineat privatepharm ies ac
86.47

23 2 unavailabilty 7.69 1 3.85

theydon't know

Bad leadreship Percentage (% )

Num of respondents ber

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Source: Survey data, 2011 Factors influence shortages of medicine in public health facilities. 4.6.1 The study found number of factors which causes shortage of medicine in public health facilities. In addition to those factors many respondents complained about National Essential Drugs List (NEDL). This is the tool which is used by the nation to procure medicine. The tool is used for procurering uniform medicine in the whole country. The problem of this tool is that since it has created no changes have been made to it. There are new diseases erupting daily, because medicines to treat such diseases are not in the list it causes death of the patients who face particular diseases. There was a case on July 2010, one patient brought at Referral hospital suffering from the disease known as Gangling, the disease was new to such hospital because there was no medicine to treat him the patient died with ought any help. 4.6.2 Other factors other than NEDL which causes shortage of medicine in public health facilities are the follows:i. ii. iii. Low fund given to public health facilities for buying medicine either at MSD or at private pharmacies. Mis-management of medicines/ drugs at public health facility due to Insufficient of qualified staffs at public health facilities. Irrational use of medicine by doctors and nurses. For stance they supposed to give out medicines which they received early and store those which come later to avoid spoilage of medicine, but they usually give out medicine which come later leaving other medicine expire and become not good for treatment to human being. iv. Negligence of medical storekeepers in timing of ordering medicine. They press order to MSD while medicine are totally finished at their facilities. Therefore

40

during the process of ordering and purchase of medicine causes the particular facility to have shortage of medicine. v. Unethical behavior of some medical storekeepers together with doctors and nurses who still medicine at public health facilities and send them to their private pharmacies or sell them illegally. vi. There are some medicines which are used by pregnant women only therefore its order is usually small. When particular medicines are out of stock and not available at MSD then it creates the problem of insufficient of medicine at that facility. Examples of such medicines are Quinine, Folic Acid, (iron sulphide) Fe so4, Antworms, TT-Injection. vii. Medicines for children and pregnant mothers are given free to the patients (no cost sharing) while the facility is not given free from MSD, this creates the problem of ordering other medicine in time because of financial problems. viii. ix. Low fund by the government to health sector, they give low salaries to the doctors and nurses that is why they still some medicine and sell so that they can survival. Also bureaucratic in the process of supplying medicine. It was found that 80% of medicines are imported from outside the country and the rest 20% are manufactured in the country. Therefore when medicine are finished at headquarter in Dar es salaam (MSD) , it means all MSDS and all public health facilities are in trouble as they must wait until medicine brought in the country, inspected, send to MSD headquarter then distributed to other MSDS and lastly to the health facilities. x. There is also a serious lack of coordination and transparency in donor assistance. In many cases, it is even difficult to estimate the total amount of funding going to support medicines. The lack of transparency and multitude of donors create significant transaction costs for Tanzania, which must devote scarce staff of managing the morass (confusing situation) of reporting requirements. The study found that about 84.62 percent of the respondents had been are aware of other factors and National Essential Drugs List (NEDL) used by the country to procure and manufacture medicine used by in the public health facilities. The other 7.69 percent of

41

respondents knows other factors only, while the remaining 7.69 percent they dont know exactly answer. The figure below shows 84.62 percent of respondents are aware with NEDL and other factors which causes shortage of medicine in public health facilities. 7.69 percent are those who aware with other factors only and the remaining 7.69 percent do not know exactly answer.

Figure 4.6: Responses towards NEDL and other factors which causes medicine shortage 90 80 70 60 50 40 30 20 10 0 Total Total Total 22 2 2 Responses

NEDL and other factors (84.62% )

Others (7.69% )

Different (7.69% ) 4.7 Measures

suggested to be taken by the government and NGOS to reduce medicine shortage in public health facilities. The following were measures suggested by number of workers from different health facilities and patients so as to overcome the problem of medicine shortage in public health facilities. These were the follows:I. MSD should send medicines directly to the public health facilities so as to make sure that all medicines bought by a particular facility reached real destination (at public healthy facility) and not otherwise.

42

II.

There should be close supervision to supplies officers, doctors, nurses and medical storekeepers to make sure there is no negligence which can lead to expire of some medicine and un ethical behavior of steeling medicine should be reduced or stop if possible. (from high level to low level)

III. IV.

National Essential Drugs List (NEDL) should be changing regularly due to eruption of new diseases so as to avoid the problem of insufficient of particular medicine. To provide health education to the society so that preventive should be taken rather than wait until disease becomes critical while medicine are not available all the time.

V.

Storage capacity should be increased in size so as medicine should be taken in large amount to avoid the problem of insufficient especially at the time when there is stock out at headquarter. As the population increases always which cause demand of medicine to be higher than supply.

VI.

Training of staffs especially management skill of medicine, this could reduce the problem of irrational use of medicine at public healthy facilities and could reduce the problem of medicine expire while the demand is high.

VII.

Government should make sure that medicines for women and children are available all the time by purchasing large number compared to other groups of people. Women and children are more prone to diseases medicine should be available at all time to reduce the number of deaths of women and children.

VIII.

There should be close supervision to supplies officers, doctors, nurses and medical storekeepers to make sure there is no negligence which can lead to expire of some medicine and un ethical behavior of steeling medicine should be reduced or stop if possible.

IX. X. XI.

To give strong punishment to health officers who steel medicine and sell it illegally or send to their private health facility. To increase salaries to doctors, nurses, medical store keepers which relate to their job so as they could not be tempted to steel medicine due to difficulty of life. Doctors and nurses should make sure that medicine is available at their health facilities so as to serve their lives.

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XII.

The government of Tanzania should make sure that they allocate enough funds which could be able to buy medicine in time and enable public healthy facilities to hold enough funds for purchasing medicine at private pharmacies at the time of stock-out.

XIII.

Also the government should take care with government fund which are allocated in politics rather than keep for health purposes.

As 96.15 percent of responses seemed to need changes at public health facilities, this by simplification mean that changes in whole process of supply, management and distribution of medicine should be taken into consideration so as to reduce the problem of unnecessary deaths of people especially pregnant mothers and children who cannot afford to go at private hospitals for treatment.

4.8 Changes suggested to be made in the overall system of medicine supply in public health facilities.

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F ure: 4.7 s ig howsres pons towardschang of es es m edicine s uplly in public health facilitiesin Mbeya city.

P ercen ta g (% e ), 92.3

R pondents es Percenta e (% g )

R pond es ents 24 ,
Source: Survey data, 2011 Figure above shows 92.3 percent of responses needs changes in the process of medicine supply in public health facilities. As most of the societies living in Mbeya city are low income earners. Most of them depend in agricultural activities and small businesses, this prohibit them to afford the cost of medicine charged by private pharmacies and private health facilities. Therefore there is a need for changes in medicine supply so as to serve their lives especially pregnant mothers and children who are more prone to diseases. 4.9 Things to be done towards supply, management and distribution of medicine in public health facilities. From the observation 92.30 percent of responses need changes of medicine supply and management in public health facilities, the following the changes which can help to solve the problem medicine shortage in public health facilities. i. MSD should send medicines directly to the public healthy facilities so as to make sure that all medicines bought by a particular facility reached real destination (at public healthy facility) and not otherwise.

45

ii.

It is the time for the Government to find strategies of increasing medicine production in the country so as to easy supply of medicine in public health facilities.

iii.

Supervision in the process of supplying medicine to reduce negligence of top leaders to bottom and increase of medicine production in the country to improve supply of medicine.

iv.

Medicine should be manufactured locally rather than importing from other countries which increase cost of buying and transportation.

The figure below, 76.92 percent of responses needed changes in supply of medicine in public health facilities, 15.39 percent of responses do not need any changes while 7.69 percent they do not know what should be done. Since the percentage for those who needs changes is high i.e. 76.92 percent there is a need of changes in medicine supply for the development of Mbeya city and the country in general.

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Figure, 4.8: Responses towards supply change of medicine in Mbeya City

80 70 60 50 40 30 20 10 0 Total 20 Total 4
Responses
Source: Survey data, 2011

Need supply cgange (%) Donot need supply change (%) They dont know%

Total 2

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CHAPTER FIVE: CONCLUSIONS AND RECOMMENDATION 5.0 Introduction Chapter Four concentrated on the analysis of the data collected during the study. This chapter gives the conclusions of findings and recommendations on what should be done to rectify the situation. The chapter Starts with the introductory part while section one gives the main conclusions which were drawn from the findings of the study. Section two gives the recommendations and section three gives the strategies which should be implemented in order to reduce the problem of medicine shortage in public health facilities. 5.1 Conclusions From the study 92.30 percent of responses needed changes in public health facilities so as to overcome the problem of medicine shortage. The supply nature of medicine clearly increases medicine shortage in public health facilities. The supply system involves a lot of processes and red-tape actions which causes medicine being delivered late to public health facilities. Another cause of medicine shortage is eighty (80) percent of medicine are importing from outside the country, a lot of government fund is consumed for medicine transportation costs and money value of the country is compared to the money value of other countries. Since a lot of money is used for importation of medicine this causes public health facilities to be given insufficient fund which are not enough for buying medicine at the time when they are not available at MSD. Also the tool for used for medicine procurement in the country is outdated, it needs frequent changes as new diseases are erupting daily while medicine for treating are not available in National Essential Drugs List. This causes shortage of medicine in public health facilities. Sometimes some medicine are not procured because they are not listed in National Essential Drugs List (NEDL) The study found that most of communities in Mbeya City does not take any measures to make sure that the problem of medicine shortage is eliminated. They were just blaming among themselves something which had no help to them. Most of complaints were directed to the government, nurses and doctors who not only instructed them to buy medicine in private pharmacies after check-up but also they treated them badly especially when patients demanded medicine at the particular facility.

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Hence, there is a need to take deliberate measures against the procurement, supply, management and distribution of medicine in public health facilities. The Government, Civil Societies, Non Government Organizations and other stakeholders have to initiate, support and extend health programs aimed at manufacturing medicine in the country. They also have to take measures on changes of management, supply and distribution of medicine so as to overcome the problem of medicine shortage in public health facilities in Mbeya City and the country in general 5.2 Recommendations I. From the results researcher advices to change the supply system of medicine in public health facilities either by reducing unnecessary processes which cause medicine fail to reach at the public health facility in time. II. Also medicine should be manufactured in the country rather than importing from outside the country which leads to long processes in medicine delivery to public health facilities. Importation of medicine from outside the country increases the cost and reduce fund which could be used to other areas in health sector III. Managing director and senior pharmacist of the particular health facility should make sure that inspection is regularly made to the medical storekeepers records so as to improve the availability of medicine at public health facilities. IV. The researcher advises the government to take measures concerning health services especially to make regular changes to the National Essential Drugs List (NEDL) and to increase fund to health sector and find ways to reduce red tape (bureaucratic) for the medicine supply and distribution in public health facilities. V. Emergency procurement is needed from time to time to handle the fluctuating demand. MSD should be able to use this method with the appropriate conditions and controls. MSD would need to negotiate with the government and Ministry of health on how to handle the price of items (medicine) if procured under emergency conditions.

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5.3 Measures to be taken and strategies to be implemented so as to rectify the situation. 5.3.1 Measures should be taken so as to overcome inefficiencies at any stage of the supply chain which can cause stock-outs like:

Inadequate funds for procurement of medicines ; Inaccurate and non-participatory forecasting ; Inadequate buffer stock of essential medicines at all levels of the supply chain; Inefficient distribution systems at national and regional levels and Inadequate record-keeping.

5.3.2 Strategies to be implemented in order eliminate stock-outs of medicine in public health facilities.

City health management teams should be participatory to encourage transparency and accountability in the supply chain; Monitoring of availability of medicines at the health facilities; Advocacy for 100% availability of medicines and advocacy for increased funding for medicines. Adequate data on its safety, and efficacy should be available from clinical studies. Choice of medicine manufactured should be made on the basis of relative efficacy, safety, quality, price and availability. Cost Benefit Ratio (CBR) remains a major consideration in health services so as to provide public health facilities with minimum fund which should be used for emergency purchases of medicine in case there is shortage.

The change of National Essential Drugs List (NEDL) should be a continuing process, regularly updating drug selections in light of new therapeutic options and changing therapeutic needs.

Religious organizations, in collaboration with the ministry of health and other development actors should increase assistance of building number of health

50

facilities with minimum cost sharing which could enable low income earners to get treatment when they are sick.

Training should be given to health providers and medical storekeepers so that they could be rational in medicine management so as to increase the availability of medicine in public health facilities.

Strong punishments should be made to unethical doctors, nurses, medical storekeepers and health officers at MSDS who still medicine and sell them at their pharmacies where the cost is very high compared to public pharmacies.

Government should increase fund to health sector which could be used for emergency purchasing of medicine and paying salaries to health officers on time so as to they can work comfortable as well as to reduce unethical behavior of stilling medicine in public health facilities.

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APPENDICES Interview Questions Dear Respondent, My name is Atupele A Mwanyangala, a student at Mbeya Institute of Science and Technology (MIST) pursuing Bachelor degree of Business Administration (BBA). I am conducting a research on Management Skills Pertaining Supply and Distribution of Medicine in Public Health Facilities. At Medical Store Department (MSD), Referral hospital, Regional hospital, META reproductive health and Ruanda health centre. The purpose of this questionnaire is to seek your views on this study. The information provided will be treated as confidential as possible and be used for the academic purpose. I request your cooperation in completing and feeling the enclosed questionnaires which will guide me in conducting the study.
(a)Personal particulars

Gender Department Experience.. Position (b) Interview questions 1. How do medicine being managed in public health facilities? 2. Can you give your opinion about supply and distribution system of medicine in public health facilities? .. 3. Are current supply and distribution system of medicine satisfying the population of Mbeya City? 52

4. Why do you think patients are instructed to buy medicine in private pharmacies after check-up in public health facility? 5. May you give factors which influence the shortage of medicine in public health facilities? 6. Despite the measures taken by the government and NGOS to reduce or eradicate medicine shortage in public health facilities, can you suggest other measures? 7. Are there any changes you would like to see on the overall system of supply and distribution of medicine in public health facilities? Which are they? Put a tick to the most appropriate answer 8. Can you give your opinion concerning supply nature of medicine in Tanzania from Dar es Salaam to Mbeya region? Is it poor or effective? (a) Yes (b) No (c) Moderate (a) If the answer is Yes How? (b) If the answer is No why?

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 (c) If the answer is moderate How?

REFERENCES 1, Amir Attaran (2011) Global health issues, published by Journal of the American medical Association states, America 2. Berkman LF, Kawachi (2005) Social Epidemiology 1st Edition, New York 3. Kearney Twiter, (2011) an imperative for public health care, published bi RSS Feeds, America 4. Kumarian, (1997) Managing Drug Supply, Cuba 5. Marmot M, Wilkinson (2000) Social Determinants of Health 5th Edition, Oxford University; and. R. editors. 6. Northwestern university Journal of International Human Rights, (2011) Resolving the public health crisis in the developing world, Califonia. 7. Westport (CT), (2006). Saving the lives of mothers and children 8. World Health Organization, (2004) Joint United Nations Programme on

HIV/AIDS Rev Edition, Geneva.

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55