Effectiveness of prime vendor system on availability of medicines and medical supplies in the selected public health facilities in Arusha district council

INTRODUCTION

The shortage of medicines and medical supplies remains to be a major issue that is facing public health facilities in Tanzania. This situation has been influenced by lack of consistency in the supply chain, increase in healthcare demand, poor regulatory system, insufficient funds, and lack of conducive infrastructure. Formerly, the Government initiatives such as engagement with the Prime Vendor System (PVS) demonstrated great assistance in getting rid of this challenge. Despite the operation of PVS, a recent shortage of medicines and medical supplies has been noticed.

OBJECTIVES

This study aimed to assess the effectiveness of PVS on the availability of medicine and medical supplies in the selected public health facilities in Arusha District Council.

METHODS

The study used a case study design with mixed research approach. The study involved 77 respondents which included 25 health facility in-charges, 50 patients, 1 District Pharmacist and 1 Prime Vendor. Questionnaires, interviews, and observation methods were used to collect data. Data collected covered a period of 2021-2022. Thematic analysis was used to analyze the qualitative data whereas descriptive analysis was used to analyze the quantitative data with the help of Excel and the Statistical Package for Social Sciences (SPSS) version 28.0.

RESULTS

The analysis indicates that PVS is not completely effective in supplying medicines and medical supplies due to its low capacity to conform to the orders placed by the public health facilities, a lack of supply competition, and a failure to adhere to contractual terms. Furthermore, at the time of data collection, the average availability of medicines and medical supplies at the selected public health facilities was 74.8%, while 80% of the selected public health facilities reported having a scarcity of medicines and medical supplies, and 92% of the interviewed patients reported having no full access to medicines.

CONCLUSION

Despite the shortcomings associated with the operation of the PVS, the system still seems to be very important for enhancing the availability of medicines and medical supplies once its effectiveness is strengthened. This study recommends a routine monitoring of PVS operations and timely interventions to reinforce an adherence to the contracted terms and improve PVS effectiveness.

Multi-mitigation strategies in medical supplies for epidemic outbreaks

The outbreak of Coronavirus disease 2019 (COVID-19) highlights the importance of sufficient medical supplies stockpiling at the pre-event stage. In contrast, the potential disadvantages of maintaining adequate items at strategic locations (i.e., reserves) are considerable inventory-related costs. Unpredicted demand leads to a high degree of uncertainty. Efforts to mitigate the uncertainty should rely not only on prepositioning supplies at reserves but also on integrating various channels of medical materials. This paper proposes multi-mitigation strategies in medical supplies to ensure uninterrupted supply for hospitals and significant savings by introducing two-type suppliers, reserving and manufacturing suppliers. Thus, each hospital with uncertain demand is enabled to be served by various channels during pandemics: prepositioning in reserves, backups served by reserving suppliers, and medical commodities produced by manufacturing suppliers. Stochasticity is also incorporated into the raw materials available to produce. This research aims to develop an emergency response application that integrates preparedness action (reserve location, inventory level, and contract supplier's selection) with post-event operations (allocating medical materials from various channels). We formulate a two-stage stochastic mixed integer program to determine prepositioning strategy, including two-type suppliers' selection, and post-event allocation of multiple sources. A branch-and-Benders-cut method is developed for this problem and significantly outperforms both the classical Benders decomposition and Gurobi in the solution time. Different-sized test instances also verify the robustness of the proposed method. Based on a realistic and typical case study (inspired by the COVID-19 pandemic in Wuhan, China), significant savings, an increase in inventory utilization and an increase in demand fulfilment are obtained by our approach.

Pandemic COVID-19 ends but soil pollution increases: Impacts and a new approach for risk assessment

For three years, a large amount of manufactured pollutants such as plastics, antibiotic and disinfectant has been released into the environment due to COVID-19. The accumulation of these pollutants in the environment has exacerbated the damage to the soil system. However, since the epidemic outbreak, the focus of researchers and public attention has consistently been on human health. It is noteworthy that studies conducted in conjunction with soil pollution and CIVID-19 represent only 4 % of all COVID-19 studies. In order to enhance researchers' and the public awareness of the seriousness on the COVID-19 derived soil pollution, we propose the viewpoint that "pandemic COVOD-19 ends but soil pollution increases" and recommend a whole-cell biosensor based new method to assess the environmental risk of COVID-19 derived pollutants. This approach is expected to provide a new way for environmental risk assessment of soils affected by contaminants produced from pandemic.

Hair embedding after transperineal prostate biopsy: two case reports

BACKGROUND

Transperineal prostate biopsy is gradually becoming the standard methodology for diagnosing prostate cancer because of its high accuracy and low risk of infection, but careful preparation is not always highlighted before a transperineal biopsy. we reported two cases of hair embedding during transurethral resection of the prostate following transperineal puncture biopsy with a Bard MC1820 disposable biopsy needle. Histological examination did not find the hair follicle structure required for hair growth. The hair source was suspected to be percutaneously brought in by needle during the biopsya simulated experiment was used to analyze and reconstruct the process of hair embedding in prostate tissue.

CONCLUSION

Hair embedding caused by perineal prostate biopsy is a consumable-related adverse event, and skin preparation before a transperineal prostate biopsy is recommended.

A bi-objective optimization model for the medical supplies' simultaneous pickup and delivery with drones

In the COVID-19 pandemic, it is essential to transport medical supplies to specific locations accurately, safely, and promptly on time. The application of drones for medical supplies delivery can break ground traffic restrictions, shorten delivery time, and achieve the goal of contactless delivery to reduce the likelihood of contacting COVID-19 patients. However, the existing optimization model for drone delivery is cannot meet the requirements of medical supplies delivery in public health emergencies. Therefore, this paper proposes a bi-objective mixed integer programming model for the multi-trip drone location routing problem, which allows simultaneous pick-up and delivery, and shorten the time to deliver medical supplies in the right place. Then, a modified NSGA-II (Non-dominated Sorting Genetic Algorithm II) which includes double-layer coding, is designed to solve the model. This paper also conducts multiple sets of data experiments to verify the performance of modified NSGA-II. Comparing with separate pickup and delivery modes, this study demonstrates that the proposed optimization model with simultaneous pickup and delivery mode achieves a shorter time, is safer, and saves more resources. Finally, the sensitivity analysis is conducted by changing some parameters, and providing some reference suggestions for medical supplies delivery management via drones.

Medical supplies scheduling in major public health emergencies

In the early days of the COVID-19 pandemic in Wuhan, there was an unreasonable allocation between hospitals and a lack of timely transportation of medical supplies, which reduced the cure rate of infected cases. To solve the problem, this research proposes a method for scheduling medical supplies in major public health emergencies to develop a rapid and accurate supply scheme for medical materials, including the allocation of medical materials per vehicle to each hospital and the supply sequence per vehicle to each hospital. Specifically, this paper solves the following two sub-problems: (1) calculating the shortest transportation times and the corresponding routes from any distributing center(s) to any hospital(s); (2) calculating the medical supplies per vehicle transporting to each hospital. The method of solving sub-problem 1 is performed by multiple iterations, each of which calculates the shortest route from a distributing center, through one or more hospitals, and back to the distributing center. According to sub-problem 2, this research proposes a distribution model of medical supplies in major public health emergencies. A multiple dynamic programming algorithm which is a combination of some separated dynamic programming operations is proposed to solve this model. This algorithm also realizes the rapid updating of the scheme in the context of the changing number of vehicles. The first sub-problem can be solved in normal times, while the second one should be solved on the premise of obtaining the corresponding data after the occurrence of a major public health emergency. In the case study section, the whole method proposed in this research is employed in the medical supplies scheduling in the early stage of the COVID-19 outbreak in Wuhan, which proves the availability of the method. The main innovation of the method proposed in this research is that the problems can obtain the optimal solution while the time complexity is within an acceptable range.

Polylactic acid production from biotechnological routes: A review

Polylactic acid (PLA) has been highlighted as an important polymer due to its high potential for applicability in various areas, such as in the chemical, medical, pharmaceutical or biotechnology field. Very recently, studies have reported its use as a basic component for the production of personal protective equipment (PPE) required for the prevention of Sars-Cov-2 contamination, responsible for the cause of coronavirus disease, which is currently a major worldwide sanitary and social problem. PLA is considered a non-toxic, biodegradable and compostable plastic with interesting characteristics from the industrial point of view, and it emerges as a promising product under the concept of "green plastic", since most of the polymers produced currently are petroleum-based, a non-renewable raw material. Biotechnology routes have been mentioned as potential methodologies for the production of this polymer, especially by enzymatic routes, in particular by use of lipases enzymes. The availability of pure lactic acid isomers is a fundamental aspect of the manufacture of PLA with more interesting mechanical and thermal properties. Due to the technological importance that PLA-based polymers are acquiring, as well as their characteristics and applicability in several fields, especially medical, pharmaceutical and biotechnology, this review article sought to gather very recent information regarding the development of research in this area. The main highlight of this study is that it was carried out from a biotechnological point of view, aiming at a totally green bioplastic production, since the obtaining of lactic acid, which will be used as raw material for the PLA synthesis, until the degradation of the polymer obtained by biological routes.

A multicountry, multicommodity stochastic game theory network model of competition for medical supplies inspired by the Covid-19 pandemic

In this paper, we construct the first stochastic Generalized Nash Equilibrium model for the study of competition among countries for limited supplies of medical items (PPEs, ventilators, etc.) in the disaster preparedness and response phases in the Covid-19 pandemic. The government of each country is faced with a two-stage stochastic optimization problem in which the first stage is prior to the pandemic declaration and the second stage is post the pandemic declaration. We provide the theoretical constructs, a qualitative analysis, and an algorithm, accompanied by convergence results. Both illustrative examples are presented as well as algorithmically solved numerical examples, inspired by the need for N95 masks and ventilators. The results reveal that, in addition to the preparedness of countries before the pandemic declaration, their ability to adapt to the conditions in different scenarios has a significant impact on their overall success in the management of the pandemic crisis. The framework can capture competition for other medical supplies, including Covid-19 vaccines and possible treatments, with modifications to handle perishability.

Beyond SARS-CoV-2: Lessons That African Governments Can Apply in Preparation for Possible Future Epidemics

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has placed unprecedented pressure on healthcare systems, even in advanced economies. While the number of cases of SARS-CoV-2 in Africa compared to other continents has so far been low, there are concerns about under-reporting, inadequate diagnostic tools, and insufficient treatment facilities. Moreover, proactiveness on the part of African governments has been under scrutiny. For instance, issues have emerged regarding the responsiveness of African countries in closing international borders to limit trans-continental transmission of the virus. Overdependence on imported products and outsourced services could have contributed to African governments’ hesitation to shut down international air and seaports. In this era of emerging and re-emerging pathogens, we recommend that African nations should consider self-sufficiency in the health sector as an urgent priority, as this will not be the last outbreak to occur. In addition to the Regional Disease Surveillance Systems Enhancement fund (US$600 million) provided by the World Bank for strengthening health systems and disease surveillance, each country should further establish an epidemic emergency fund for epidemic preparedness and response. We also recommend that epidemic surveillance units should create a secure database of previous and ongoing pandemics in terms of aetiology, spread, and treatment, as well as financial management records. Strategic collection and analysis of data should also be a central focus of these units to facilitate studies of disease trends and to estimate the scale of requirements in preparation and response to any future pandemic or epidemic.

Rethinking health sector procurement as developmental linkages in East Africa

Health care forms a large economic sector in all countries, and procurement of medicines and other essential commodities necessarily creates economic linkages between a country's health sector and local and international industrial development. These procurement processes may be positive or negative in their effects on populations' access to appropriate treatment and on local industrial development, yet procurement in low and middle income countries (LMICs) remains under-studied: generally analysed, when addressed at all, as a public sector technical and organisational challenge rather than a social and economic element of health system governance shaping its links to the wider economy. This article uses fieldwork in Tanzania and Kenya in 2012-15 to analyse procurement of essential medicines and supplies as a governance process for the health system and its industrial links, drawing on aspects of global value chain theory. We describe procurement work processes as experienced by front line staff in public, faith-based and private sectors, linking these experiences to wholesale funding sources and purchasing practices, and examining their implications for medicines access and for local industrial development within these East African countries. We show that in a context of poor access to reliable medicines, extensive reliance on private medicines purchase, and increasing globalisation of procurement systems, domestic linkages between health and industrial sectors have been weakened, especially in Tanzania. We argue in consequence for a more developmental perspective on health sector procurement design, including closer policy attention to strengthening vertical and horizontal relational working within local health-industry value chains, in the interests of both wider access to treatment and improved industrial development in Africa.