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DOI: 10.2174/1874944501912010550, 2019, 12, 550-557
The Open Public Health Journal
Content list available at: https://openpublichealthjournal.com
RESEARCH ARTICLE
Nurses’ Perceptions About Stock-outs of Essential Medicines at Primary Health
Care Facilities in Vhembe District, South Africa
Ogbodu Olubumni M1, Maputle Maria S2,* and Mabunda Jabu1
1Department of Public Health, University of Venda, Private Bag X5050, Thohoyandou, South Africa
2Department of Advanced Nursing, University of Venda, Private Bag X5050, Thohoyandou, 0950, South Africa
Abstract:
Background:
The development of generic medicines that are cost-effective and affordable aims to facilitate improved availability of essential medicines to meet
the health care needs of the majority of the population. However, these essential generic medicines are not regularly available at the community
health centres and clinics.
Aim:
This study aimed to determine the perceptions of professional nurses regarding the status of stock-outs of generic medicines at primary health care
health facilities in a selected province of South Africa.
Materials and Methods:
The study was conducted in five primary health care facilities; three clinics and two health centres in Thulamela B municipality of Vhembe
District, Limpopo Province.
A qualitative, exploratory, descriptive and contextual research design was used to obtain the perceptions of the participants. Thirteen professional
nurses were purposively selected. Data were collected through face-to-face in-depth interviews until data saturation was reached. Data were
analysed using Tesch’s open coding method.
Results:
Key findings showed that essential medicines were not always available, with the health centres reporting fewer stock-outs than clinics. The
perceived major contributors to stock-outs were institutional inefficiency and practices by both health service providers and patients.
Conclusion and Recommendations:
The study concluded that primary health care facilities in rural communities still grapple with poor access to essential medicines due to poor
availability. Therefore, the provision of sufficient funding for procurement, and training of inventory management practices were recommended. In
addition, community public awareness campaigns to discourage patients’ self-medication and multiple consultations should be put in place.
Keywords: Essential medicines, Stock-outs, Perceptions, Primary health care facilities,, Funding for procurement, Inventory management
practices.
Article History Received: September 08, 2019 Revised: November 14, 2019 Accepted: December 11, 2019
1. INTRODUCTION
The availability of essential medicines has been described
as one of the eight elements of Primary Health Care (PHC) [1].
Essential medicines are defined by Chen et al. [2] as those that
* Address correspondence to this author at the Department of Advanced Nursing,
University of Venda, South Africa, Private Bag X5050, Thohoyandou, 0950,
South Africa; Tel: +2715 9628125; E-mail: sonto.maputle@univen.ac.za
satisfy the health needs of the majority of the population,
intended to be always available at health facilities in correct
dosage forms, and at a price that the community and
individuals can afford. Consequently, generic drugs were
developed as part of efforts by the World Health Organisation
(WHO) to make essential medicines more available and
accessible to the populace [1 - 3]. Despite the adoption of the
essential medicine concept, its goal of advancing health equity
The Open Public Health Journal, 2019, Volume 12 551
by identifying cost-effective drugs for priority conditions is
unmet. Quick [1] confirmed that in resource-constrained
developing countries, poor availability of essential drugs at
health facilities is still experienced [2, 3]. At primary health
care facilities, generic medicines are prescribed. Generic drugs
are identical to brand name drugs in dosage form, strength,
safety, route of administration, quality, performance
characteristics and intended use. Generic medicines are
efficacious, cost-effective and affordable, compared to the
original brands, to meet the health care needs of the majority of
population [4, 5]. PHC facilities, community health centers and
clinics are the first level of contact for individuals, in the
community with the national health system, which brings
health care as close as possible to where people live and work.
These facilities have been established to ensure that citizens
receive health services at the local level [6]. Essential
medicines are therefore expected to be available all the time at
the clinics and health centres, with the lower level of health
care institutions being the closest to the people in the
community.
The unavailability of essential medicines is a global
challenge, as evidenced by different reports from the United
States, Europe and China [2, 7, 8]. Recent essential drug
surveys by the WHO/HAI in 39 low and low-to-middle income
countries found average availability to be and 56% in the
private sector Wangu and Osuga [9] compared to the 80% drug
availability benchmark by WHO [10]. In different African
countries such as Nigeria, Mozambique and Uganda, limited
availability of some essential generic drugs had been reported.
A study conducted in Kenya by the Health Action International
Africa revealed that essential medicines are available in only
50% of lower-level health facilities (clinics and health centres)
[11]. Several factors including inadequate budgetary
allocations for drugs procurement, poor stock control in supply
chain processes, poor quality drug formulations not containing
the minimum required ingredients for effectiveness, poor value
for money, uncoordinated government action and local non-
availability of quality generic drugs have been stated as
contributors to drug stock-outs at the PHC facilities by
different authors [12, 13].
In the Republic of South Africa, the health system structure
has the primary, secondary and tertiary levels of care [14].The
community health centres and clinics are the lowest tier of the
public health system in the District and they are out-patient
facilities. The community health centres generally are larger in
terms of infrastructure, human and other resources. They are
expected to also serve the community clinics in their
community. The health centres are open twenty-four hours,
unlike the clinics which are open for at least eight hours a day,
five days a week. The scope of services rendered by these PHC
facilities is immunization, mother and child care services,
antenatal and include postnatal care, including family planning,
sexually transmitted infections care, treatment of minor
ailments and curative services, mental health, treatment of
communicable and chronic diseases, oral health, rehabilitative
services and provision of essential medicines. The South
African government has put in efforts to improve the
availability of medicines, patient access to essential medicines
and to assist with decongesting public clinics, especially for
patients on chronic medication. Worthy of mention are two
pivotal efforts which are the establishment of the Office of
Health Standard Compliance and the implementation of the
Centralised Chronic Medication Dispensing and Distribution
(CCMDD) [15, 16]. The Office of Health Standards
Compliance initiative is a step to overcome drug stock-outs in
all provinces across the nation [15]. This office is charged with
the responsibility of inspecting public health facilities for six
basic health standards which are: medicine stock-outs, waiting
times, cleanliness, infection control, the attitude of staff, safety
and security of staff and patients. This initiative buttresses the
reality of drug stock-outs at health facilities across the country.
The CCMDD program, on the other hand, is aimed at reducing
patient waiting times at health facilities and is currently being
implemented in the 11 NHI pilot districts of the country [16].
An expected outcome of the implementation of this program is
that chronic stable patients in the public sector will no longer
have to travel long distances or wait long hours for their
medication.
At the PHC facilities, the end-to-end ordering process of
medicine from the medical supplies depot through the hospital
pharmacy and lastly to health facilities is presented below, as
summarised by the Public Service Commission [17].
1. The PHC facilities place orders through the District or
referral hospitals.
2. The district and referral hospitals submit the
consolidated orders, including theirs, to the Medical Supplies
Depot (MSD) for processing.
3. The MSD delivers such orders directly to the clinics.
This ordering schedule summarised above has implications
for the current study. Despite government efforts and programs
in South Africa to ensure consistent essential drug availability
at the health facilities, many districts in the RSA have reported
that health facilities do not have essential drugs in stock.
Survey results from different districts and provinces in the
country indicated that drug stock-outs at the health facilities
was a perennial challenge especially at the lower level
facilities, clinics and health centres [17 - 20] Since 2014,
Vhembe District has been serving as a pilot district for the
National Health Insurance (NHI) plan in the RSA as part of
phase 1 of the NHI implementation. As a pilot district, the
CCMDD program is also implemented at the health facilities to
ensure consistent essential generic drug availability as one of
health care delivery indices.
1.1. The Purpose of the Study
This study aimed to determine nurses’ perceptions about
the status of essential medicine stock-outs at public health care
facilities in Vhembe District, South Africa.
2. THE STUDY OBJECTIVES
The study objectives were to explore and describe the
perceived factors contributing to stock-outs of essential
medicine at primary health care facilities in Thulamela B
Municipality, Vhembe District, Limpopo Province. For the
purpose of this study, essential medicines referred to the first-
line treatment for chronic non-communicable conditions,
Nurses’ Perceptions About Stock-outs of Essential Medicines
552 The Open Public Health Journal, 2019, Volume 12 Olubumni M et al.
communicable disease, human immunodeficiency virus and
acquired immune deficiency syndrome (HIV/AIDS) and
vaccines.
3. METHODOLOGY
3.1. Study Design
Based on the purpose of the study, a qualitative,
exploratory, descriptive and contextual research design was
used in order to allow the participants to share their views and
first-hand experiences about the topic [21]. Participants were
interviewed in their natural setting, where the dispensing and
ordering activities took place daily [21, 22]. This research
design adopts a flexible questioning approach that produces
quality information as it allows for a deeper understanding of
the subject matter until data saturation is reached.
3.2. Study Setting
The study was carried out in the Thulamela B Municipality
which is located in Vhembe District, a large, mainly rural
(76%) district, situated at the northern part of the Limpopo
Province. Thulamela Municipality is divided into; Thulamela A
(Malamulele area), based in the Eastern part of the district and
Thulamela B (Thohoyandou area). The focus of this study was
Thulamela B Municipality which is further divided into 3 local
areas, namely; Sibasa, Shayandima and William Eddie local
areas. There are 24 clinics and 2 health centres under
Thulamela B municipality and they are provincially owned.
3.3. Target Population and Sample
The population comprised all professional nurses working
at the 26 PHC facilities (24 clinics and 2 community health
centres) in the Thulamela Municipality during the period of
data collection. Non-probability, purposive and convenience
sampling was used to sample PHC facilities and participants
from the population. Five PHC facilities were purposively
selected based on the three local areas (Sibasa, Shayandima
and William Eddie) in Thulamela Municipality B based on the
highest and lowest headcount for the month of May - August
2015 (Table 1). The justification for the use of headcount was
based on the assumption that there is a need to verify if PHC
facilities with high patient headcount will experience more
medicine stock-outs compared to the PHC facilities with a low
patient headcount. The 5 selected facilities were 3 clinics and 2
Community Health Centres (CHCs) as highlighted in Table 1.
At the PHC facilities, due to the scarcity and the absence of
sufficient medical doctors, pharmacists and Pharmacy
Assistants (PAs), as well as professional nurses carried out the
following tasks; consultation, prescription, dispensing and
ordering medications for use. Sampling of participants was
purposively done. A total of 20 professional nurses from the
selected five PHC facilities were envisaged, however, the
sample size was 13 as determined by data saturation, where no
new information was obtained. Each PHC facility had a
minimum of 6 professional nurses; only professional nurses
who were on duty during data collection were included in the
study. The inclusion criteria were registered professional
nurses working at selected PHC facility, consulting and
dispensing medicine and with at least two years of working
experience.
3.4. Data Collection
Data were collected over a 10-day period in the month of
June 2016. In-depth interviews using a semi-structured guide
were conducted by the same interviewer, who was the principal
researcher. The interview guide was written in English, with a
central opening question and probing questions. The central
opening question was - How would you describe the
availability of essential medicines at your primary health care
facility?
The follow-up analysis focussed on essential medicines
kept, factors affecting the availability of these essential
medicines, duration of stock out, the procedure of ordering of
medicines at the facility, any standard ordering procedure and
processes of inventory control management carried out in a
facility, training on inventory control and medicine
management conducted, any supervisory visits from the district
hospital and or district office, suggestions to reduce medicine
stock-outs and improve consistent availability of essential
medicines at the primary health care facility. The interviews
were conducted in English and held during lunch in the nurses’
lounge and lasted about 30 - 45 minutes per participant. Data
saturation was reached at the point when there was no new
information provided by the participants during the interview.
The interviews were audio-recorded and transcribed by the
principal researcher. The project supervisors (MS and JT) who
are experienced qualitative researchers checked the transcripts
to ascertain the accuracy of data. The duration of work
experience ascertained that the participants will be
knowledgeable about the phenomena studied.
3.5. Data Analysis
Tesch’s open coding method was used to analyse the data.
The interviews were transcribed by the principal researcher and
analysis was carried out by selecting one interview transcript at
a time, making a list of topics, clustering together similar
topics, abbreviating the topics as codes, looking for the most
descriptive wording, making the final decision, grouping data
belonging together into categories and creating themes while
also recoding existing data [22]. The co-supervisor (JT) served
as an independent coder hence she was provided with an
organized set of transcribed data to help identify categories,
themes and sub-themes. Discussions were held by the
researcher and her supervisors to reach a consensus about
these. The themes and sub-themes generated from the collected
data were analysed and presented in a report.
3.6. Trustworthiness
The criteria for ensuring trustworthiness were observed
[23]. Credibility was ensured by prolonged engagement with
the participants, by visiting the PHC facilities prior to the
conduct of the interviews. The scheduled visits enabled the
researchers to become familiar with the participants during the
interaction and the interviews. This assisted in building a
trusting relationship with the participants. The researchers had
contact with the participants during the appointment making
The Open Public Health Journal, 2019, Volume 12 553
session and data collection. Field notes were taken during the
interviews to record findings, hence providing a suitable record
and a voice recorder was used. Transferability was ensured by
the provision of a detailed description of research
methodology. Member checking was also conducted by
engaging the participants after the interview to confirm the
responses provided during the interview, to validate the truth
and confirm the results.
3.7. Ethical Issues
The University of Venda Ethics Committee provided the
ethical clearance (SHS/16/PH/10/1304) to conduct the study.
Permission from the Limpopo Provincial Department of Health
(Ref 4/2/2) and approval from the Vhembe District Department
of Health (Ref S5/2/5) were obtained. The five (5) facility
managers were contacted for permission and to make
appointments that facilitated meetings with the participants.
The interviewees were informed about the study purpose and
objectives stated in an information sheet. Informed consent was
obtained in writing from participants after the content of the
information sheet was provided prior to conducting interviews.
Permission was obtained from the interviewees to use a voice
recorder during the interviews. The participants were informed
that participation was voluntary and that the confidentiality of
their information would be ensured. Numerical codes were
used instead of participants’ names and alphabets were used for
the PHC facilities to ensure confidentiality and anonymity;
therefore, the identity of the participants and health facilities
were kept confidential.
4. RESULTS
The findings are presented based on emergent themes and
sub-themes.
4.1. Participants’ Socio-demographic Information
Eight of the participants were from clinics, while the other
five were from health centres. The ages of the participants
ranged from 29 - 58 years, the median age group was 39 - 48
years (n=6) and the majority of participants were females
(92%, n=12). All had a basic professional nursing degree
(B.Cur). A third had additional post-basic qualifications (39%,
n=5), of which, about a quarter had Post basic Diploma in
Health Assessment, Treatment and Care and possessed
dispensing certificate which allowed them to prescribe drugs
(23%, n=3) while a few had Post-basic Diploma in Education
and Administration (15%, n=2) despite holding supervisory
positions at work. More than half of the participants had
working experience ranging between 10 - 19 years (69%, n=9)
while more than three-quarters held supervisory positions at
work (85%, n=11).
4.2. Theme 1: Status of Medicine Stock-outs
This theme summarises the participants’ experiences on
the status and duration of stock-outs and the medicines which
were out-of-stock at the time when this research was
conducted. Participants described a varying level of medicine
stock-outs, experienced at the PHC facilities with the health
centres having better availability compared to the clinics.
‘Hmmm…this facility is much better than
other clinics in having treatments, because the
patients are coming from surrounding villages,
far away from Vhembe, like Elim, Nzhelele,
Vhumbedzi, Mutale areas coming and we
question them; they tell us that they visit our
facility because there are no treatments in
clinics close to them’. (Participant 4, Health
centre)
Furthermore, all the participants from the clinics concurred
that first-line drugs for chronic ailments like high blood
pressure and diabetes were not always available and the stock-
out period ranged from a few days to several weeks.
‘Enalapril has been unavailable for 2 weeks
now in this clinic and even hydrochloro-
thiazide tablets in 4 weeks’. (Participant 10,
Clinic).
This was supported by another participant from another
local area (Shayandima).
‘We have not had hydrochlorothiazide tablets
for 2 months now’. (Participant 2, Clinic)
At the time of conducting this research, the out-of-stock
drugs included Hydrochlorothiazide tablets, Enalapril tablets,
Rifafour tablets, Metformin tablets, Actrapid injection, BCG
vaccine, Hexazim vaccine, antibiotics such as amoxicillin
capsules and Gelusil tablets. These are essential drugs for
chronic conditions in addition to antibiotics and vaccines.
One of the participants said with emphasis:
‘We have not had Metformin tablets for
diabetes and hydrochlorothiazide for high
blood pressure in this clinic for about four
weeks’. (Participant 5, Clinic)
4.3. Theme 2: Structurally Related Factors
Structural factors that relate to procedures within the
organizational structure contributing to the unavailability of
essential generic drugs at the PHC facilities were described by
the participants. They reported activities such as inappropriate
selection, insufficient funding and inadequate distribution as
contributory factors. The factors ranged from management and
administrative concerns, supplier-distribution constraints,
institution-based challenges to the shortage of human
resources. The comments from the participants are highlighted
Structure Related Factors below.
‘I don’t think phasing out of some medicines
is a wise decision because they do not involve
us, like Gliclazide tablets; we just found that
the medicines are no longer available when we
Nurses’ Perceptions About Stock-outs of Essential Medicines
554 The Open Public Health Journal, 2019, Volume 12 Olubumni M et al.
ordered from the depot’. (Participant 1,
Clinic).
Another participant commented as follows regarding
funding:
‘You see because the financial year starts in
April, we are having medicines now because
this is June but soon before the end of the
year, the medicines will not be there again and
you wonder if there is sufficient money for
procuring these treatments’. (Participant 11,
Clinic)
The distribution and transportation challenges were also
highlighted:
‘I think that the depot does not have enough
vehicles to deliver orders on time because the
orders take long before they are supplied”
(Participant 8, Clinic).
‘A lack of a dedicated van for each facility
affects picking up of orders from the hospital,
even when you phone the hospital they tell
you that your order is ready but there is no
transport to deliver it to your facility’.
(Participant 6, Health centre)
Dissatisfaction arising from insufficient number of
pharmacy assistants to assist with ordering at the clinics was
expressed:
‘There insufficient manpower contributed to
poor ordering of drugs from the medical depot
through the district hospital, more-especially
because orders are compiled manually at the
clinics, eish we suffer a lot. We never order on
time’. (Participant 13, Clinic).
Participant further said
“You find that the person ordering is ignorant
and not order properly. Some treatments are
not in the facility yet the person ordering does
not request from the hospital pharmacy in the
medicine order form”…Participant 13, Clinic).
4.4. Theme 3: Human Related Factors
Participants mentioned practices by service providers and
patients that are contributory to drug stock-outs at the facilities.
The practices by service providers mentioned were inadequate
training and poor adherence to standard treatment guidelines,
poor quantification of orders resulting from the use of
estimations instead of standard methods and irrational,
inappropriate prescription habits. The clinics reported a lack of
use of standard ordering methods while the health centres used
the consumption method because of the presence of permanent
pharmacists and PAs, hence reported better availability. The
statements about poor dissemination of standard treatment
guidelines included;
‘Like before when we did not know the doses
of some antibiotics because there were new
guidelines, we turned back the patients saying
no treatment but now we know this, after the
pharmacist from the hospital came to explain
to us’ (Participant 12, Clinic)
The lack of the use of standard quantification methods to
calculate reorder quantity highlighted:
‘There is a formula for ordering but I don’t
know it, we just estimate and sometimes we
order too little or overstock’ (Participant 2,
Clinic)
‘Ha! We are failing to order on time in this
clinic because when you are doing your
normal work as a nurse, you still have to order
treatment from the hospital pharmacy. We use
a medicine order form to request medications
from the depot and it can take a long time
before the pharmacy assistant comes to collect
our order forms’. (Participant 9, Clinic)
On the contributory role of patients, multiple consultations
and demand for specific treatments at different health facilities
by patients were described by the participants. The participants
highlighted that despite the use of clinic booklets, patients
register in many clinics and obtain the booklet for each, which
enable them to consult and get similar drugs even on the same
day from multiple PHC facilities. Clinic booklets are given to
everyone who consults at the clinic. It contains personal
demographic information.
‘Some of these patients visit three or four
clinics complaining of the same symptoms,
using different clinic booklets, you see. These
patients are very much cunning’. (Participant
9, Clinic)
The request for specific drugs by patients makes the
patients prone to over-use and abuse.
‘Patients sometimes request specific medicines
and this leads to irrational prescribing especia-
lly the magogos (old ladies). They tell you that
Brufen works well for the pain in their leg. We
have to explain the side effects to them especi-
ally for ulcer and asthmatic patients before we
give to them if they insist’. (Participant 2,
Clinic).
The Open Public Health Journal, 2019, Volume 12 555
Table 1. PHC facilities headcount in Thulamela B Municipality.
S/N Sibasa Local Area PHC Headcount Shayandima Local Area PHC Headcount William Eddie Local Area PHC Headcount
1 Dzingahe Clinic 8,749 Dzwerani Clinic 10,401 Damani Clinic 5,122
2 Fondwe Clinic 8,192 Lwamondo Clinic 13,439 Gondeni Clinic 5,814
3 Muragoni Clinic 3,301 Magwedzha Clinic 8,399 Makonde Clinic 10,759
4 Pfanani Clinic 9,635 Muledale Clinic 12,525 Mukula Clinic 8,627
5 Phiphidi Clinic 10,690 Mulenze Clinic 6,791 Sterkstroom Clinic 10,824
6 Sibasa Clinic 17,688 Shayandima Clinic 14,521 Thondotshivase Clinic 9,277
7 Tshififi Clinic 7,120 Tshisaulu Clinic 12,030 Tshiombo Clinic 8,034
8 Mbilwi Clinic 4,928 Tswinga Clinic 9,932 Vhufuli Tshitereke Clinic 10,167
9Thohoyandou Health
Centre
31, 374 William Eddie Health Centre 11,058
Table 2. Themes and sub-themes as nurses’ perceptions about stock-outs of essential medicines.
Themes Sub-themes
1. Status of medicines stock-outs 1.1 Health centre versus clinics
1.2 Duration of stock-outs
1.3 Medicines with frequent stock-outs
2. Structure related factors 2.1 Management and administrative concerns
2.2 Supplier - distribution constraints
2.3 Institution-based challenges
2.4 Shortage of human resources for health
3. Human related factors 3.1 Service-providers related
3.2 Patient-related
5. DISCUSSION
5.1. Status of Medicine Stock-out
The study findings revealed that medicine stock-outs
remained a challenge in the municipality even though the
clinics experience more stock-outs than the health centres. This
was consistent with study findings from some African
countries which revealed that lower units of health care
facilities are associated with higher levels of stock-out rates
compared to the higher units [24 - 27]. Lower health facilities,
closest to the people, ought not to have essential medicine
shortages. The current research findings show that the stock-
out duration is in the range of 5 - 150 days and this validates
previous survey results from developing nations [9, 26, 28].
The protracted stock-out duration worsened patients’
conditions and facilitated achieving health for all, a mirage. On
the other hand, poor availability of essential generic drugs for
chronic conditions such as diabetes and hypertension and child
health at PHC facilities remains a great challenge for
developing nations despite the increasing burden of chronic
diseases in these regions [9, 28, 29]. South Africa was not
exempted from essential medicine shortages at the PHC
facilities as revealed by this research and other research
projects [18 - 20]. Additionally, however this research results
served as an indicator of the readiness of the Thulamela B
District for the NHI rollout.
5.2. Structure Related Factors
The availability of drugs at health facilities was guided
through clearly outlined four processes: selection, procurement,
distribution and usage of medicine in addition to management
support which are inter-related in a cycle known as drug
management cycle [30]. These processes formed the core of
structural factors revealed by this study. This study showed that
insufficient funding, inappropriate drug selection due to
insufficient consultation with professional nurses, inadequate
distribution and shortage of pharmacy assistants were
contributors to drug stock-outs at the health facilities.
Selection, funding, procurement and distribution are domiciled
within government structures to ensure consistent availability.
In congruence, different authors point out that uncoordinated
government actions played a dominant role in the continued
drug stock-outs experienced at the PHC facilities [2, 9, 30].
Human resources have been enumerated as a key performance
driver within public health supply chains [31, 32]. Due to the
substantial human resources crisis facing the health sector in
South Africa, the primary health care system is mainly nurse-
driven [33]. This study established that the presence of a
pharmacist and pharmacy assistant at the health centres results
in reduced stock-out rates.
5.3. Human Related Factors
Adequate training and supervision are drivers of an
effective and efficient health system [30]. Service provider
practices revealed by this study were a consequence of
inadequate training on STGs, poor quantification methods and
inept stock control at the clinics, akin to these findings are
reports Nigeria and Uganda [13, 24]. The poor dosing practices
shown by this study were not unlikely due to the fact that most
of the professional nurses did not possess a dispensing
certificate approved by the South African Pharmaceutical
Council. Supervisor-related factors included the dissemination
of new treatment guidelines without organising workshops
Nurses’ Perceptions About Stock-outs of Essential Medicines
556 The Open Public Health Journal, 2019, Volume 12 Olubumni M et al.
prior to the dissemination, contributing to irrational prescribing
by the professional nurses.
Patients in developing countries generally are found not to
use drugs appropriately and the tools for promoting the
appropriate use of medicines are weak in such countries [34].
This study finding of irrational use of essential drugs by
patients was evidenced by “drug shopping” and multiple
consultations from one clinic to another. This undoubtedly
affected the goal of ensuring the consistent availability of drugs
at the PHC facilities. Various studies support these results,
stating that patients’ shop around, multiple consultations at
different clinics and indulge in self-medication [18 - 20, 35]
The misuse of drugs by patients are attributable to ignorance,
lack of knowledge or insufficient information about the
dangers of inappropriate use of prescribed drugs.
5.4. Limitation
The PHC facilities where the study was conducted were
situated in rural areas; therefore the findings cannot be
generalized to the entire Limpopo Province. However, a
detailed description of the study was given, which gives the
readers a choice to know about the generalizability of the study
findings.
CONCLUSION
The study concluded that the nurses perceive that
contributory factors to medicine stock-outs at the PHCs were
broadly classed into two categories, namely; structural and
human performance-related factors. The structural factors
included, though not limited to the reliance on a cascade from
depot to hospital to PHC facilities and reliance on nurses for
dispensing medicines as opposed to dedicated pharmaceutical
personnel, poor inventory control practices, inadequate
transportation and multiple consultations by patients
contributed to stock-outs at the facilities.
RECOMMENDATIONS
The shortage of medicine at the primary level of care
remains a key determinant factor of health care services
utilization and services uptaken by the community. An
intervention of improved transportation and supply chain
strengthening, with training on standard quantification methods
for professional nurses to conduct better drug forecasting is
recommended. Additionally, community awareness campaigns
on the proper use of drugs and dangers of medication overuse
are recommended.
Further quantitative study on the assessment of medicine
availability in the Vhembe District is recommended as there
are few reports of medicine shortage in this district; most
stock-out reports from Limpopo Province are from Mopani
District.
ETHICS APPROVAL AND CONSENT TO PARTI-
CIPATE
The University of the Venda Ethics Committee provided
the ethical clearance (SHS/16/PH/10/1304) to conduct the
study. Permission from the Limpopo Provincial Department of
Health (Ref 4/2/2) and approval from the Vhembe District
Department of Health (Ref S5/2/5) were obtained.
HUMAN AND ANIMAL RIGHTS
Not applicable.
CONSENT FOR PUBLICATION
Informed consent was obtained from all the participants
prior to data collection.
AVAILABILITY OF DATA AND MATERIALS
The data supporting the findings of this research are
available within the article.
FUNDING
The study is funded by the University of Venda
(SHS/16/PH/10/1304).
CONFLICT OF INTEREST
The authors declare that there are no conflicts of interest,
financial or otherwise.
ACKNOWLEDGEMENTS
Declared none.
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Nurses’ Perceptions About Stock-outs of Essential Medicines
