LEVY MWANAWASA MEDICAL UNIVERSITY

S C H O O L O F H E A LT H S C I E N C E S
P H A R M A C Y D E PA RT M E N T
Student Name: O liver Ngandwe
Student Number: 210400061
R e s e a r c h S u p e r v i s o r : D r. J i m m y H a n g o m a

Tittle of Proposal:

An Assessment of factors Contributing to

Medicines and Pharmaceuticals Expiries
at Zambia Medicines and Medical Supplies
Agency
 Introduction

 Medicines are very crucial for a well functioning healthcare system all
over the world.
 Although medicines comprise a significant proportion of healthcare
expenditure, there has been limited research on the causality and
economic impact of expired medicines (Barraclough and Clark, 2011).

 Some of the leading causes of expiry of medicines include poor

pharmaceutical management, lack of human resources and lack of
accountability (World Health organisation , 1998).
 Introduction Conti......

 This may impact on the quality of healthcare provided to patients and

ultimately the loss of confidence in the health system (Nakyanzi et al.,
2010).
 The World Health Organization recognizes the need for access to
quality, efficacy, safe and adequate medicines as one of the building
blocks of the public health system.

 This entails having adequate supply and availability of medicines and

pharmaceuticals in health facilities.
 Introduction Conti......

 The Zambian Medicines and Medical supplies Agency is a

government Institution mandated to Procure, Store and Distribute
Medicines and allied substances to Health Facilities in Zambia.
 In 2012, the office of the Auditor General conducted a performance
audit at ZAMMSA, formerly known as Medical stores limited and the
report indicated weaknesses in the distribution of medicines and
medical supplies, this included: lack of essential medicines at hospitals
and health facilities; over-stocking of the drugs; expiry of Medicines at
ZAMMSA central ware house.
 It is with such a background that this study aims at assessing the
factors contributing to the expiry of medicines and pharmaceuticals
at ZAMMSA.
 Statement of the Problem

 Supply chain management of medicines and pharmaceuticals is

very key in sustaining healthcare system.

 Wastage and expiry of essential medicine is still one of the most

serious public health problems (Tumwine, 2010).

 There has been a great concern over the rate of expiry of

medicines at ZAMMSA and public health facilities in Zambia.
Statement of the Problem Conti....

 Expired drugs might have effect on human health and the

government loses colossal sums of money.

 Globally expired medicines contribute to the poor performance of

health systems, driving up costs and reducing access to quality care
for patients (Dias, 2011).

 A well managed and controlled medicine supply may minimize

wastage, strengthen health system functioning and contribute to
public health trust (Dias, 2011, Jha and Roy, 2005, Kachwee and
Hartmann, 2012).
 Research Questions

 What is the value of medicines that expire at Zambia Medicines and

Medical Supplies Agency?

 What are the health workers factors associated with medicines &
Pharmaceuticals expiry at Zambia Medicines and Medical Supplies
Agency?

 What are the Cold-Chain and logistic factors that contribute medicines
and supplies expiry at Zambia Medicines and Medical Supplies
Agency?
 Research Questions Conti....

 What are the regulatory factors associated with medicines

and pharmaceuticals expiry at Zambia Medicines and Medical Supplies
Agency?

 What are the procurement factors that contribute to medicines

and pharmaceuticals expiry at Zambia Medicines and Medical Supplies
Agency?
 General Objectives

 To assess the factors associated with medicines & supplies expiry at

Zambia Medicines and Medical Supplies Agency.
 Specific Objectives

 To determine the value of medicines that are expired at Zambia

Medicines and Medical Supplies Agency.

 To establish the cold-chain and logistic factors contributing to

medicines and pharmaceuticals expiry at Zambia Medicines and
Medical Supplies Agency.

 To assess the health workers factors associated with medicines and

pharmaceuticals expiry at Zambia Medicines and Medical Supplies
Agency.
 Specific Objectives Conti....

 To determine procurement factors contributing to expiry of medicines

and medical supplies.

 To determine the regulatory factors associated with medicines &

supplies expiry Zambia Medicines and Medical Supplies Agency.
 Study Justification

 Expiry of medicines is a concern to the health sector worldwide, as

medicines cost significant amount of money.
 It is a health concern, as not all expired medicines get destroyed.

 Research has shown likelihoods of expired medicines being

recirculated into private markets(Kamba et al., 2017).

 Expired medicines become ineffective which may result in resistance

and toxicity in human bodies (Mani & Thawani, 2019).
 Study Justification Conti......

 This study sought to assess the factors contributing to the expiry

of medicine and pharmaceuticals at ZAMMSA.

 The findings would inform policy to improve on management

of medicines and pharmaceuticals.

 The research will enable the government and relevant institutions to

come up with strategies on how to prevent medicines from expiring.
 Literature Review

 Expiry of medicines leads to significant wastage of resources which may

result in reduced availability of medicines. This may impact on the quality
of healthcare provided to patients and ultimately the loss of confidence in
the health system (Nakyanzi et al., 2010).

 The leading causes of expiry of medicines include poor pharmaceutical

management, lack of human resources and lack of accountability (World
Health organisation, 1998).
 A study conducted in Uganda in 2006, reviewed that revenue loss was
due to expired medicine which was estimated to be at least $550,000 for
that year (Mwesige, 2006).
 Literature Review Conti...

 In the United States of America and Switzerland, wastage rates have been
estimated at 16% and 29% respectively, with more than $1 billion (Toerper
et al., 2014) and $436 million (Vogler et al., 2014) lost per annum.

 a study conducted in Nigeria to assess availability of ARVs in treatment

centers found that 64% of the facilities had expired ARVs worth more than
$146 000 (World Health Organization, 2003). The national figure for expiry
reported in Ethiopia in 2003 was as high as 8%(Tadeg et al., 2014).

 in 2014, the Viennese Sickness Fund reported that medicines worth $8.8
million had expired in the country (Vogler et al., 2014)
 Literature Review Conti...

 According to (Mwesigwa, 2006 and MoH, 2006), volumes of valuable

medicines have expired at the National Medical Stores in Entebbe and
in some Ugandan district hospital stores.
 High inventory levels also increase the chance of medicines to expire
(Bukhari et al., 2010). This could be due to poor quantification of
medicines where facilities receive more medicines than their needs.
 Around the world, expiry costs are often 3% to 5% of pharmaceutical
inventory per annum (Dias, 2011). However, in Spain, more than 50% of
medicines evaluated in community pharmacies had expired (Coma et
al., 2008).
 Methodology

 The study will consist of research design, area of study, study population, sampling
procedures, sample size, sampling techniques, data collection methods and
instruments, quality, data analysis, ethical considerations and study limitations.

Study Design
 This study will adopt a cross sectional survey/design that involves mixed methods that is;
gathering of both quantitative and qualitative data. It will allow for data collection in
time to determine the level and factors associated with medicines and supplies
expiry at Zambia Medicines and Medical Supplies Agency. According to Uradhi
(2009), a survey method of gathering information by interviewing a respondent
through a questionnaire is the most often used method for data collection on
people‟s habits in a variety of education and social issues.
 Methodology Conti…

Study Population and Sampling

 The qualitative component of the study will consist of semi-structured in-depth interviews with key
stakeholders, as well as observation notes will be made by the researcher. Participants will include
managers, pharmacists and pharmacy assistants who had been working at ZAMMSA for a minimum
of 12 months, and are therefore familiar with the medicine management policy. Purposive sampling
will be-used to select the 15 participants for the interview. These participants will be chosen because
they occupy positions that are central to medicines management and therefore of direct relevance
to the study, such as pharmacists and managers.

Inclusion Criteria
 Managers, pharmacists and pharmacy Technologist who had been working at ZAMMSA for a
minimum of 12 months,

Exclusion criteria
 All other staff will be not included in the Study and those who have worked at ZAMMSA for less than
12 months.
 Methodology Conti….

Data Collection
 The research will use will use a questionnaire containing closed ended questions to
collect data. It will also use semi structured interviews as another data collection
instrument.
Interview Guide
 Interviewing involves asking questions and getting answers from participants in order to
collect the data. According to Emzir (2010), interview consists of several preset
questions which are addressed to people who become the research subject. Besides,
Creswell (2012) stated that interview is a period when researchers ask one or more
participants, asking questions and record their answer. The researcher will use semi-
structured interviews to collect the data.
 Methodology Conti…

Data Analysis
 Data will be edited, coded and classified to systematically present the data
collected. Statistical package for the social sciences (SPSS)and MS Excel will
be used to analyze the data. Furthermore, data on expired medicine will be
filtered and treated to find significant information to present in charts and
tables.
Validity
 For validity of the findings, data collections tools have been designed and will
be applied to obtain data on expiry of medicines and supplies at ZAMMSA.
The researcher will abstain from unethical manipulation of pharmaceutical
and medicines data obtained from the study respondents.
 Methodology Conti….
Reliability
 Pre-testing of the questionnaire on expiry of medicines and supplies will be done
before the start of the research to ensure its comprehensiveness and consistency in
providing the information required. The data collection tools will be constructed in
simple language, and clear instructions appropriate for the respondents will be
provided.
Ethical Consideration
 Permission to conduct the research will obtained from the school. Similarly,
administrative clearance will be sought from the facility prior to the commencement
of the study. Informed consent will be sought from the participants before any
interview or a data collection instrument was administered. With Confidentiality, all
data pertaining to this study will be kept confidential under key and lock and will be
used for the purpose of this study only.
 Dissemination of Findings

The findings will be shared to study participants, other

researchers, media outlets, health departments, community
groups and members, government/policymakers and
Published through journals.
 References

 I. and Mutshinda C.M. 2010. Health status assessement using reverse

supply chain data. Management Research Review. 33 (2) : 111-122.
 Asamoah, D., Abor, P., and Opare, M. 2011. An examination of
pharmaceutical supply chain for artemisinin-based combination therapies
in Ghana. Management Research Review. 34 (7) : 790-809.
 Bendavid, L., Boeck, H., and Phillipe, R. 2010. Redesigning the
replenishment process of medical supplies in hospitals with radio-
frequency identification technology.Business Process Management
Journal. 16 (6) : 991-1013.
 Breen, L., and Crawford, H. 2005. Improving the pharmaceutical supply
chain. Assessing the reality of e-quality through e-commerce application
in hospital pharmacy. International Journal of Quality and Reliability
Management. 22 (6) : 572-590.