Factors associated with medical consumable availability in Level 1 facilities in Malawi: secondary analysis of a facility census

Sakshi Mohan, Tara Danielle Mangal, Timothy Colbourn, Martin John Chalkley, Chikhulupiliro Chimwaza, Joseph H Collins, Matthew Graham, Eva Janouskova, Britta Jewell, Godfrey Kadewere, Ines Li Lin, Gerald Manthalu, Joseph Mfutso-Bengo, Emmanuel Mnjowe, Margherita Molaro, Dominic Nkhoma, Paul Revill, Bingling She, Robert Manning Smith, Wiktoria TafesseAsif Tamuri, Pakwanja Twea, Andrew N Phillips, Timothy Hallett

Research output: Contribution to journalArticlepeer-review

Abstract

Background
Medical consumable stock-outs negatively affect health outcomes not only by impeding or delaying the effective delivery of services but also by discouraging patients from seeking care. Consequently, supply chain strengthening is being adopted as a key component of national health strategies. However, evidence on the factors associated with higher consumable availability is limited.

Methods
In this study, we use the 2018-19 Harmonised Health Facility Assessment data from Malawi to identify the factors associated with consumables availability. We estimate a multilevel logistic regression model with a binary outcome variable representing consumable availability (of 130 consumables across 940 facilities) and explanatory variables chosen based on current evidence. Further subgroup analyses are carried out to assess the presence of effect modification by level of care, facility ownership and a categorisation of consumables by public health or disease program, Malawi’s Essential Medicine List (EML), type, and level of average national availability.

Findings
Our results suggest that the following characteristics had a positive association with consumable availability – level 1b facilities or community hospitals (64% higher odds of consumable availability than level 1a facilities or health centres), Christian Health Association of Malawi (CHAM) and private-for-profit ownership (63% and 49% higher odds respectively than government-owned facilities), availability of a computer (46% higher odds than in its absence), pharmacists managing drug orders (85% higher odds than a drug store clerk), proximity to the corresponding regional administrative office (facilities greater than 75 kilometres away with 21% lower odds than facilities within 10 kilometres of the District Health Office), and having three drug order fulfilments in the three months before the survey (14% higher odds than one fulfilment in three months). Further, consumables categorised as “Vital” in Malawi’s EML performed considerably better (235% higher odds) and drugs performed worse (79% lower odds than other medical consumables) in terms of availability across facilities.

Interpretation
Our results provide evidence on the areas of intervention with potential to improve consumable availability. Further exploration of the health and resource consequences of the strategies discussed will be useful in guiding investments into supply chain strengthening.
Original languageEnglish
JournalThe Lancet Global Health
Publication statusAccepted/In press - 5 Feb 2024

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