Effect of COVID-19 disruptions on supplier logistics performance, costs, and availability of medicines in public referral hospitals in Uganda

Abstract

Background: COVID-19 pandemic caused widespread economic disruptions globally at its peak. It was characterized by lockdowns, shutdowns of factories and international transport, and panic responses such as restrictions on pharmaceutical exports by leading manufacturers such as India. Since Uganda depends on imports for most of its pharmaceutical supplies, global disruptions in the pharmaceutical supply chain could result in: reduced medicines availability on the Ugandan market, price increments and longer supplier lead times. The aim of the study was to evaluate the effects of COVID-19 pandemic disruptions on supplier logistics performance, costs, and availability of medicines in public referral hospitals in Uganda.

Methods: An analytical cross-sectional study was conducted to compare supplier logistics performance, costs, and medicines availability in public referral hospitals in Uganda before and during the 2020 COVID-19 lockdown. Quantitative data collected included COVID-19 related factors as the independent variables whereas supplier logistics performance, supplier invoice costs for medicines and medicine availability were the dependent variables. Data was entered using MS excel 2016 while the SPSS version 16 was used to analyze it. Data was summarized using descriptive statistics and levels of significance were determined using the Fischer’s exact test and a paired samples t-test (P<0.05).

Results: The mean percentage of medicines products which were stocked out before COVID-19 was 35.8% versus 31.9% during the lockdown. Overall, 33.6% of the referral hospitals experienced stock-out of at least one of the medicines in the basket assessed before COVID-19 pandemic versus 26.2% during the lockdown. There were statistically significant differences in proportions of hospitals with the following medicines available, oral rehydration salts (p= 0.026), diazepam injection 5 mg/ml (P=0.025), glucose (dextrose) 5% infusion, 500ml (P=0.013) and tetracycline eye ointment (P=0.026). The differences in the mean number of stock-out days were not statistically significant for all medicines analyzed. There were statistically significant differences in the average prices of the following medicines during and before the 2020 COVID-19 lockdown, amoxicillin 250mg capsules (P=0.008), azithromycin tablets 500mg (P=0.024), metronidazole tablets 200mg (P=0.028), oxytocin injection 5 IU/ml (P=0.030), magnesium sulphate injection 2500mg/5ml (P=0.021) and tetracycline eye ointment (P=0.043). The difference in average lead time during and before the lockdown was 7 days (P<0.05).

Conclusion: COVID-19 disruptions significantly affected the prices of particular medicines in public referral hospitals in Uganda. The pandemic disruptions negatively affected supplier logistics performance by significantly increasing lead time for delivery of medicines to the study sites whereas minimal significant effect was realized on medicine availability.