Factors affecting implementation of the medicine redistribution guidelines in Western Uganda

Medicine redistribution involves the movement of medicine commodities from facilities with surplus stock to areas with deficit to reduce medicine waste. Recognizing the immense potential of medicine redistribution, the Uganda Ministry of Health launched the "Uganda National Redistribution Strategy for the Prevention of Expiry and Management of Expired Medicines and Health Supplies" in 2012, revised in 2018. Despite this strategy, effective implementation of redistribution remains a challenge and information on factors affecting implementation of the guidelines is limited. Therefore, this research was conducted to bridge this gap.

A cross-sectional study was conducted in 69 primary healthcare facilities in Hoima and Kabarole Districts in Western Uganda. Two data collection tools were utilized including a compliance checklist used to assess the compliance of primary healthcare facilities to the medicine redistribution guidelines. A semi-structured questionnaire was used to determine the factors affecting implementation of the guidelines as reported by the healthcare workers in the selected primary healthcare facilities. The compliance assessment focused on key procedural domains, including the triggers for redistribution, the roles and responsibilities players involved in the process, and the documentation required. Additionally, knowledge of the redistribution process was evaluated through aspects such as routine inventory checks, coordination within and across districts, and the formal authorization steps required for the process. Data were analysed using IBM SPSS version-29. Facilities that achieved a compliance score of 75% or higher were deemed compliant. Logistic regression analysis was used to determine the associated factors at 0.05 level of significance.

Compliance of primary healthcare facilities to the medicine redistribution guidelines in Western Uganda was low, with only 29.5% of the facilities meeting the 75% compliance threshold. The main factors statistically associated with compliance to the redistribution guidelines included facility level of care (p = 0.002), awareness of the existence of guidelines (p = 0.003), knowledge of the triggers and steps of redistribution (p = 0.001), and availability of updated guideline documents (p = 0.018). In addition, respondents highlighted operational and logistical barriers faced during implementation including poor means of transportation of medicines 54 (51.4%), delays in authorization of redistribution 10 (9.5%) and presence of surplus stock in the receiving facilities 8 (7.6%).

Less than a third of the facilities complied with the medicine redistribution guidelines. The facility's level, knowledge and awareness of the guidelines, and access to updated guidelines were key factors associated with compliance to the medicine redistribution guidelines. The Ministry of Health should intensify efforts to raise awareness and ensure easy access and dissemination of the latest guidelines.