Pharmaceutical stockouts: problems and remedies for faith-based health facilities in Africa

Background and aims: Faith-based organizations (FBOs) provide a substantial portion of the health care services in many countries but despite this coverage, many health facilities have struggled to maintain adequate stocks of supplies. The purpose of this study was to identify the types of supply chain systems used by African faith-based health facilities to acquire reproductive health commodities, the performance of the different supply chain system types, their associated challenges and possible corrective actions.Methodology: Through email surveys, phone interviews, and on-site visits, supply chains and challenges of faith-based health facilities in 13 African countries for 16 selected reproductive health (RH) commodities, including contraceptives were studied. Results: Of the 46 facilities surveyed, 55% faced stockouts of one or more products in the three months prior to the survey. Stockouts were less common for contraceptives than other RH products. Significant strengths of the FBO supply chain included creativity in finding other sources of commodities in the face of stockouts, staff designated to monitor quality of the commodities, high capacity for storage, low incidence of expired products, few instances of poor quality, and strong financial sustainability mechanisms, often including patient fees. Weaknesses included unreliable commodity sources and power supplies, long distances to depots, and problems maintaining the cold chain. Five supply chain types were identified. As a result of this study, FBOs in Cameroon have already taken steps to strengthen their supply chain systems and reduce stockouts by forming the Alliance of Christian Faith-Based Organizations for Family Planning (ACFBOFP) in Cameroon. This coalition is raising the profile and fortifying the voice of FBOs toward strengthening FBO commodity security in Cameroon. Conclusions: By studying the supply chains of faith-based health facilities, Christian Connections for International Health (CCIH) and its members have created new awareness among FBOs and international agencies of the importance and challenges of these systems and suggested actions toward improvement. This study can serve as a frame of reference as we move forward, anticipating an acceleration in interest to strengthen FBO supply chains to reach as many communities as possible with supplies and services. The alliance formed in Cameroon to strengthen commodity security may be a good model for other FBOs to consider.