MGHD 2018

Rwanda Biomedical Centre/Medical Procurement and Production Division (RBC/MPPD) has the mission to avail to all Rwandan people the right medicines, in the right quantity, at the right place, at the right moment, in the right condition and at the right cost. To fulfill this mission, RBC/MPPD executes the active distribution to District Pharmacies who are the main customers serving all the public Health Facilities. The lead time (the time between when new stock of essential medicines is ordered and when it is received and available for use) is among the main factors to consider in this active distribution. The literature states that the lead time has a major effect on quantities required for stock levels and when lead times are underestimated, the likely results are shortages, expensive emergency purchases and poor customer satisfaction. This project assessed the distribution lead time of essential medicines at RBC/MPPD, and found that the average lead time is 20 days. Our goal was to find the root causes of the significant length and implement an intervention in order to shorten it from 20 days to 14 days in order to make the essential medicines regularly available to the population through improved work. We employed a mixed method explanatory sequential design composed of quantitative and qualitative data. For the quantitative part, we sampled 120 orders of active distribution, for the period December 2016-November 2017, and we measured the central tendency and the spread of each step of the process using the file audit. The following four steps were found as too long:  Time in days between when order is received by Order Processing (OP) staff and when order is processed by RBC/MPPD, taking 5 days  Time from starting picking products, checking and production of delivery note invoice, taking 5 days,  Time in days between picking creation, transmission and starting picking the products by RBC/MPPD, taking 4 days,  Time in days between Order submission by DP and order transmission to Order Processing staff by Customer care staff, taking 3 days. Thus, the delay is likely to be imputed only to RBC/MPPD side and not on customers’ side regardless the order submission step by DP. The qualitative study used a semi structured interview process with 11 RBC/MPPD participants. The thematic analysis results suggested that the main causes of the long lead time were related to the RBC/MPPD human resources, RBC/MPPD workload, RBC/MPPD stock level, RBC/MPPD warehouse facilities, active distribution calendar observance, RBC/MPPD distribution design and RBC/MPPD system. Those causes have been found interconnected, one impacting on another and their coincidence worsens the delay and this is the origin of the long maximum times observed in our results. We found the root causes of the long distribution lead time at RBC/MPPD and these findings should guide in future to disseminate the results and to implement the intervention in order to execute the recommendations delivered. This will contribute to the regular availability of essential medicines and to the customer satisfaction through an improved distribution system.