Safe and Secure: Twenty-six Ugandan facilities increase storage space and improve management of health commodities

 {Photo credit UHSC staff/MSH}Henry Oundo, UHSC staff member, reviews stock records with Opolot Grace, assistant inventory management officer at Princess Diana Health Center, Uganda.Photo credit UHSC staff/MSH

In the foothills of Uganda’s fabled Moon Rwenzori Mountains, in the far west of the country, sits Bundibugyo Hospital. From its front steps you can see the Democratic Republic of the Congo (DRC) in the distance. Many refugees who fled their homes during DRC’s internal conflict are treated here. The hospital regularly serves a population of nearly 49,000, many of whom rely on its HIV clinic for prevention, treatment, and care. 

Built in 1969, Bundibugyo Hospital had always faced the challenge of limited storage space for medicines and health supplies. Boxes of medicines were stored throughout the hospital, from the kitchen to the veranda and even on the floor of the hospital corridor, posing high risk of theft, damage, and expiry. According to Reuben Angole, the store manager at the hospital, there were numerous challenges for store staff who manage the medicine and supply stock. “Because the store was a small space only intended for one person, the two other store staff worked from the veranda,” he explains. “There were frequent power cuts and the roof always leaked during rainy weather.”

Because of the continued HIV and AIDS epidemic in Uganda, there is a consistent need for testing and treatment, and adequate storage space for antiretrovirals (ARVs) is a necessity. Through the test-and-treat strategy, patients who test positive for HIV are initiated on ARV therapy immediately, regardless of their CD4 cell (the white blood cells that fight infection) count. The differentiated service delivery model dispenses three months’ worth of ARVs at one time to stable patients, reducing clinic visits and improving treatment adherence. In Uganda, about 60% of HIV patients are stable, making storage space and efficient ARV management in hospitals critical. Without careful planning and implementation, scale-up of these strategies could cause widespread ARV stock-outs, putting many patients at risk.

Bundibugyo’s storage challenges are not uncommon in Uganda. In 2013, an assessment conducted by the Ministry of Health found that one in five health facilities lacked adequate storage space for medicines. In collaboration with the Pharmacy Department and AIDS Control Program, with funding from the US President’s Emergency Plan for AIDS Relief (PEPFAR) and the US Agency for International Development (USAID), in 2019 the Uganda Health Supply Chain (UHSC) project, hosted by MSH, provided 26 medicine storage units to 22 districts in Uganda. Each prefabricated storage unit expanded storage space by 70 square meters and cut down on costs and building time associated with traditional construction. Each unit was furnished with 12 shelves, 4 pallets, and a 24-hour backup power system.

{A total of 26 medicine storage units were provided to 22 districts in Uganda. Photo credit: UHSC staff/MSH}A total of 26 medicine storage units were provided to 22 districts in Uganda. Photo credit: UHSC staff/MSH

The program trained 400 district supervisors to properly manage and account for the large volume of ARVs. Angole was one of the district supervisors to be trained, and the new skills he and other supervisors gained ensure that facilities can track and fully account for all the medicines they receive.

{Store Manager, Rueben Angole inside the Bundibugyo Hospital prefabricated medicine storage unit: Photo credit: UHSC staff/MSH}Store Manager, Rueben Angole inside the Bundibugyo Hospital prefabricated medicine storage unit: Photo credit: UHSC staff/MSHWith the expanded space and shelving, Angole and his colleagues can properly organize, track, and dispense medicines, reducing damaged and expired medicines. Security has improved as well. “The threat of theft is now reduced,” says Angole, “thanks to the security lights and double door locking system.”

All medicines and health supplies are now in one place. The 24-hour backup power system has provided an uninterrupted power supply during outages, enabling staff to track stock levels and consumption of supplies through RxSolution, an electronic inventory management software. Now, with the use of RxSolution and the storage units, the hospital can respond more quickly to stock-outs by receiving more medicines from neighboring facilities that are overstocked. According to Angole, expiry of medicines has reduced because “items are on shelves and their expiry dates can be clearly viewed. We can now comfortably issue out medicines using the first expiry first out approach.”

Increased storage space and improved management of health commodities has contributed to reducing the number of new HIV infections and AIDS-related deaths in Uganda. Health providers are able to more quickly treat those diagnosed with HIV. Angole and other district supervisors can now track and dispense medicines, ARV medicines are always available, and people living with HIV can consistently receive their lifesaving medicines.