# Drug supply management at first-level public health facilities: Case of Pyay District, Myanmar

## TL;DR

This study examines drug supply management at public health facilities in Myanmar, finding significant issues with manual processes, expired drugs, and inconsistent adherence to standards.

## Contribution

The study provides a detailed assessment of drug supply chain maturity and management practices in first-level public health facilities in Pyay District.

## Key findings

- Most facilities lacked formal drug supply management training and used manual forecasting methods.
- A significant percentage of facilities stored drugs in non-standardized ways and had expired drugs.
- Overall supply chain maturity was at a marginal capability level with poor adherence to SOPs.

## Abstract

First-level public health facilities (PHFs) serve as primary providers of essential medicines, necessitating critical attention to drug availability and quality assurance. This study aimed to examine the status of functional areas within the drug supply chain management framework and assess the overall capability maturity at first-level PHFs. The cross-sectional study was conducted among 183 drug store sites from six townships of Pyay District. Only situational analysis was exercised to determine the existing situations. The overall capability maturity was determined according to the definitions of levels of the Capability Maturity Module Tool. 58.47% lacked formal drug supply management training, with 23.5% not undergoing performance reviews. Drug forecasting predominantly relied on a pen-paper system (91.6%) and factors like patient load (87.39%), drug consumption (85.71%), and disease prevalence (64.71%). Store site analysis revealed that 65.03% exhibited marginal capability, lacking standardized drugstores and employing unstandardized procedures. Storage practices varied, with 48.69% storing drugs conveniently and others categorizing them by drug type (32.79%) or using the first-expired-first-out system (40.98%). Approximately 42.69% reported having expired drugs. Concerning transportation costs, 37.16% incurred expenses exceeding 20,000 Kyats per time, with management staff often covering the costs. Waste management methods included burial pits (49.18%), incineration (62.84%), and sharp pits (55.19%). A majority (78.14%) used safety boxes, and 57.38% implemented a color-coded system for waste bins. The logistics management information system was entirely paper-based (100%). On average, assessments of drug quality conditions and physical damages scored 46.51% and 48.20%, respectively. The overall supply chain maturity at first-level public health facilities is at a marginal capability level (36.35%). While some basic drug supply chain management procedures were in place, they were not consistently followed, and many systems remain manual. The findings underscored significant inconsistencies in the management functions of supplied drugs, with poor adherence to Standard Operating Procedure guidelines.