Philosophiae Doctor - PhD (School of Public Health) / Access to medicines (ATM), specifically for those medicines that are related to the priority health needs of a population has been cited as a fundamental part of universal health coverage and a key element for service delivery and high-quality care. Therefore, ensuring reliable access to and appropriate use of safe, effective and affordable medicines is one of the core functions of an effective health system. With the rising demand for treatment of chronic diseases (e.g. HIV, diabetes and hypertension), ATM has increasingly received global attention. Yet as of 2011, it was estimated that at least one third of the world's population had no regular access to medicines. Globally, there is a dearth of in-depth country level evidence to influence policy responses, coupled with inadequate understanding of how pharmaceutical systems operate within broader health systems. This thesis comprises two main parts: 1) a situational analysis of the state of chronic medicines provision in the public sector in the Eastern Cape and Western Cape provinces of South Africa; and (2) an evaluation of an existing ATM model in one province. To situate this study within the ATM discourse, a conceptual framework was developed from a review of empirical and theoretical literature. The framework incorporated six ATM dimensions (availability, affordability, acceptability, accessibility, accommodation and quality) and their interplay at multiple levels including: health facility, individual, household and community levels. Then, at a health system level, the interaction of medicines (a health system building block) with other building blocks (information, financing, human resources, infrastructure and governance).

Thesis (M.A. Pharm. (Pharmacy Practice) -- University of Limpopo, 2020 / Background: Non-communicable chronic disease contributes to premature mortality in SA, threatening the socio-economic development of the country. The efficient management of essential medicines supply at the clinic level is vital as stock-outs of the medicines increase morbidity and mortality. Objectives: The study aimed to identify and determine the challenges in the inventory management of medicine for the treatment of non-communicable chronic diseases at public health clinics in the Dikgale community of Limpopo province. Methods: The study used a cross-sectional quantitative research design; the purposive sampling technique was used, as it requires people with specific skills, knowledge, and expertise. A Pre-validated questionnaire was used to collect data from pharmacists, professional nurses, and transport personnel. Stock card utilization review and checklist were used to verify the answers obtained from the participants. Descriptive and inferential statistics were used to analyse the data collected. All these processes ensure that stock is always available and at optimal levels. The availability of stock at optimal levels is dependent on the personnel following SOPs. Results: In total, 40% of pharmacists indicated to have never trained nursing personnel on stock management, and 66.7% which, is the majority of nursing personnel, reported they have never been trained on stock management. Only 26.67% of medicines used for NCDs did not have stock cards. The study further found that the stock-card was not used every time a transaction was made. Thirty-nine (39%) percent of the respondents did not know how to quantify order quantities; this factor contributes to stock-outs experienced at clinics. All the clinics did not have a secure dedicated area. Deliveries are offloaded outside the medicine room. Conclusions: There is a training gap that needs to be closed to meet the minimum requirements as per GPP guidelines and also help to reduce medicine stock-outs as personnel will be well equipped to handle stock. In terms of inventory management and stock control systems, all primary healthcare sectors used a manual/paper-based inventory management system. Stock control systems are in place but were not always utilised and, processes are not consistent among staff members across clinics. With distribution, it would work better if nursing personnel dedicated a person to place and receive orders as discrepancies will be picked up sooner, and quantities will be sufficient to last until the next ordering date. None of the clinics complied with “Ideal Clinic” standards for infrastructure, storage, and inventory management. / VLIR

Backround. Based of my personal observations when employed as a pharmacist in a Saudi hospital it was clear that there were problems with medicine supply to outpatients. This thesis was designed to scientifically investigate the types of shortages, the reason(s) for such problems and potential solutions to the problem. Methods . This study was undertaken using a variety of experimental techniques to determine the views and perceptions of patients, pharmacists, physicians and administrative staff of the hospital under examination. To establish the scale of the problem: focus groups (n=25), structured questionnaires, structured interviews/meetings for health care professionals and a national survey (n=650) were the research tools used to objectively determine the relevant data. The data were analyzed by appropriate statistical methods. Results and Discussion That there was a real problem was quickly established in the data obtained from patients. A similar finding was made for each of the 'professional groups'. The central problem was one of shortages of medicines for prescriptions presented by outpatients. It was not a case the medicines were simply not available because they were never stocked but rather a simple shortage in the dispensary stock. It was established the lack of medicines was not due to central budget arrangements but involved prescribing quantities outside of the hospital guidelines which no degree of planning could accommodate. There was also the very unexpected finding that a prescription could be filled in a variety of hospital dispensaries as individuals could access more than one hospital or they could consult more than one physician for the same condition and obtain effectively double the supplies. Communications between the hospital and patients and the health care professionals could all be improved by perhaps increasing the knowledge of the patient about the correct use of medicines. Recommendations. A series of recommendations for future work is provided

Backround. Based of my personal observations when employed as a pharmacist in a Saudi hospital it was clear that there were problems with medicine supply to outpatients. This thesis was designed to scientifically investigate the types of shortages, the reason(s) for such problems and potential solutions to the problem. Methods . This study was undertaken using a variety of experimental techniques to determine the views and perceptions of patients, pharmacists, physicians and administrative staff of the hospital under examination. To establish the scale of the problem: focus groups (n=25), structured questionnaires, structured interviews/meetings for health care professionals and a national survey (n=650) were the research tools used to objectively determine the relevant data. The data were analyzed by appropriate statistical methods. Results and Discussion That there was a real problem was quickly established in the data obtained from patients. A similar finding was made for each of the ¿professional groups¿. The central problem was one of shortages of medicines for prescriptions presented by outpatients. It was not a case the medicines were simply not available because they were never stocked but rather a simple shortage in the dispensary stock. It was established the lack of medicines was not due to central budget arrangements but involved prescribing quantities outside of the hospital guidelines which no degree of planning could accommodate. There was also the very unexpected finding that a prescription could be filled in a variety of hospital dispensaries as individuals could access more than one hospital or they could consult more than one physician for the same condition and obtain effectively double the supplies. Communications between the hospital and patients and the health care professionals could all be improved by perhaps increasing the knowledge of the patient about the correct use of medicines. Recommendations. A series of recommendations for future work is provided / Government of the Kingdom of Saudi Arabia

Indian pharmaceutical companies spend one-third of their revenue from supply chain management (SCM) activities due to inherently poor transportation infrastructure. SCM is a vital function for many companies, as it is usually employed to lower expenses and increase sales for the company. SCM costs are higher in India than they are in other areas of the world, amounting to 13% of India's GDP. The purpose of this study was to explore SCM strategies Indian business leaders in the pharmaceutical industry have used to reduce the high costs associated with SCM. This study used a single case study research design and semistructured interviews to collect data from 3 SCM business leaders working in Indian pharmaceutical organizations and possessing successful experience in using SCM strategies to reduce high costs. Goldratt's (1990) theory of constraints was used as the conceptual framework for this study to identify challenges associated with SCM strategies. Data from semistructured interviews, observations, and company documents were processed and analyzed using data source triangulation, grouping the raw data into key themes. The following 3 themes emerged: distribution and logistics challenges, impact of SCM processes, and best practices and solutions. The implications for positive social change include the potential to reduce supply chain risk, which could lead to lower product prices for consumers, increased stakeholder satisfaction, and a higher standard of living.

Magister Public Health - MPH / The introduction of National Health Insurance (NHI) and the Ideal Clinic Monitoring System have highlighted gaps and challenges with regard to medicine supply management (MSM) at primary health care (PHC) facilities. PHC facilities are the first point of contact communities have for their health needs, however, frequent stock-outs of medicines at PHC facilities in uMkhanyakude district, a rural district in KwaZulu-Natal, and have raised questions as to how medicine stock is managed at these facilities.

The purpose of this study was to develop a framework for provision of essential medicines for the district health services. A qualitative descriptive, exploratory and contextual action research design was followed. The data collection was conducted through site visits and semi structured interviews targeting the responsible pharmacists who were purposively selected on the basis of their expert knowledge and experiences from the eight of the nine provinces of the Republic of South Africa which is a developing country with limited resources for provision of healthcare services. The study found that there was no standardised framework for provision of essential medicines for the District Health Services. Based on the site visits and action research findings a proposed framework covering the selection, procurement, warehousing, distribution and management support components for provision of essential medicines for district health services was developed and subjected to national pharmaceutical experts and district health services managers review and critique which is finally presented, after taking into consideration the experts inputs as a proposed framework emanating from the study. The proposed framework will contribute towards improving the provisioning and availability of essential medicines within the district health services. / Health Studies / D.Litt. et Phil. (Health Studies)