EXPLORING THE FACTORS THAT INFLUENCE THE PERFORMANCE OF LOGISTICS MANAGEMENT INFORMATION SYSTEMS IN LIRA DISTRICT.

Essential Medicines

Essential medicines are those that satisfy the priority healthcare needs of the population. (EMHSLU, 2016)

Logistics management information systems

A logistics management information system (LMIS) is the system of records and reports that is used to collect, organize, and present logistics data gathered from all levels of the system. A health LMIS collects data about medicines and other health care products. (USAID SURE, 2013)

Procurement in the context of this proposed study refers to the process by which a health system acquires the selected medicines. (MOH, 2012)

Drug stock out(s) is defined as the absence or lack of drug(s) at the health facility pharmacy store at the time of filling the prescription. (MOH, 2012).

CHAPTER ONE

BACKGROUND

The world as a whole (mainly developing countries) is faced with plethora of health problems ranging from pestilence, poor and inadequate health facilities, lack of logistics for effective and efficient health service delivery, lack of health service providers and many others (Manso, Annan & Anane, 2013). These factors have negative influences such as high rate of mortality and poor service delivery at the health sector. It is the aim of every country to achieve SDG 3 which is to ensure healthy lives and promote well-being for all at all ages which is important for building prosperous societies (UNDP, 2015). Major strides have been made in the areas of HIV/AIDS, malaria, maternal mortality preventable childhood illneses such as measles and all these have mostly been through focus on commodity availability and access (UNDP, 2015)

For developing countries especially in Africa such as Uganda, designing an effective and sustainable supply chain system for medicines and other health commodities is important and can be complex. (Manso et al 2013) Referring to Ghana, they noted that a correctly run distribution system should also keep medicines in good condition, rationalize drug storage points, use transport as efficiently as possible, reduce theft and fraud and provide information for forecasting needs. This requires a good management of the system along with a simple but well-designed information system in place (Manso et al, 2013).

The World Medicines Situation 2011 – Procurement of Medicines section shows that public sector health-care procurement systems which rely on LMIS can play an important role in helping countries achieve the Millennium Development Goals (WHO, 2011).

Uganda has a National medicines policy whose overall goal is the attainment of the highest standard of health for the population of Uganda by ensuring the availability, accessibility, affordability and appropriate use of essential medicines of appropriate quality, safety and efficacy at all times (MOH, 2015). All these can only be achieved through having a robust LMIS which continuously guides the different stakeholders who play various roles in achieving this overall goal. A well-functioning LMIS provides decision-makers throughout a supply chain with accurate, timely, and appropriate data, such as stock on hand, losses and adjustments, consumption, demand, issues, shipment status, and information about the cost of commodities managed in the system (UHSC, 2015).

The use of Logistics Management Information Systems (LMIS) for the management of fast and accurate information flows will become essential in future business environments (Shankar, 2001). Health care organizations in all countries are looking for ways to improve operational efficiencies and reduce costs without affecting patient care services (Msimangira, 2010).

Effective and efficient logistics management plays a key role in organizations and the economy. Because logistics plays key roles in every economy, the drug supply chain partners must coordinate all activities in logistics management to ensure efficiency (Manso et al, 2013).

Availability of affordable essential drugs, vaccines, and contraceptives depends on effective logistics systems to move essential commodities down the supply chain to the service delivery point, ultimately, to the end user (Bossert et al. 2007) and in turn an effective logistics system depends on an effective LMIS.

Uganda spends US$33 per capita on health, about the same as its low income country peers but much lower than the regional average. In contrast to the region, public financing of health in Uganda is low at 22.6 percent of total health expenditures (THE), a situation which cannot deliver the Uganda National Minimum Health Care Package (UNMHCP) to all (MoH, 2012). However, as early as 2009 (New Vision, March 21, 2009) reported that Uganda was facing a shortage of essential drugs in Government health facilities, according to the latest survey by Uganda Country Working Group. This has not changed much because even as recent as 2019, reports still show stock out of vital health supplies like safe delivery kits which were stocked out in 43% of the facilities, dispersible amoxicillin was stocked out in 45% of facilities, measles vaccine in 24% of the facilities (PD MOH 2019). A study, conducted over four years, show that 32-50% of essential medicines to treat common diseases like malaria, pneumonia, diarrhea, HIV/AIDS, TB, diabetes and hypertension are not readily available. An essential medicines crisis is looming in Uganda because a major stock-out is establishing itself in government hospitals and clinics (UHSC/USAID 2018).

The expiry of medicines in the supply chain is a serious threat to the already constrained access to medicines in developing countries (Nakyanzi, et al 2010). It was noted that the expiry of medicines highlights a problem with the supply chain, which includes medicine selection, quantification, procurement, storage, distribution and use. These all depend closely on LMIS (UNHCR 2006). In Uganda, volumes of valuable medicines have expired at the National Medical Stores, in district and hospital stores (Nakyanzi et al, 2010).

While innovation is limited, there are a number of important developments in medicine LMIS in developing countries. Firstly, a number of countries have adapted mobile LMIS where the timeliness and quality of reporting of logistics data has improved. (DELIVER Project, 2010). Secondly, some countries have adapted web-based computerized information systems with online reporting of logistics data (e.g., in Bangladesh for contraceptives) to improve data visibility, a key characteristic of well-functioning supply chains.

There are so many problems that exist in drug logistics management in developing countries which result in shortages (stock outs), uneven distribution of drugs, and expiries. In Uganda there are stock-outs of drugs, particularly of contraceptive supplies, at national, district and facility levels, and that by inadequate drug needs assessment at district and facility levels are critical bottlenecks to good medicines logistics management (Sowedi et. al. 2006). This current study thus aims to understand the challenges facing LMIS so as to better focus interventions designed to improve decision making for supply chain. It is expected that results will highlight the long processes and stock outs caused by poor quality of LMIS in Uganda.

1.1 Statement of the Problem

Although there has been a surge of attention toward pharmaceutical management and national health supply chains, the quantity and variety of available resources may have created incoherence in the indicators reported in supply chain assessments. Evidence shows a string of accountability issues in a host of referral hospitals. More so, there is an increase in drug expiry and stock outs (Auditor General, 2010). In mainly rural areas, LMIS are not well maintained by facility staff for reasons unknown, yet this has affected drug availability and led to stock outs (PD MOH, 2015). There is low stock card availability in facilities and the few are not correctly used. Physical counts for most cases did not agree with stock card balances. Stock books were even less available and correct use was much worse. When data use was evaluated, it was observed that it was a challenge for the facility to compute their reorder level, a very poor picture was painted. It is however critical to note that orders were mostly timely. Their accuracy wasn’t looked in too although it would be a vital assessment. Finally, HMIS report accuracy was not perfect. (PD MOH, 2015)

Since a full drug supply chain consists of interconnected yet distinct functions, inaccuracy, inefficiency, or weakness at any point may compromise the strength of the entire supply chain. A disruption anywhere along a pharmaceutical supply chain may ultimately cause a stock-out, or unavailability of drugs. Stock-outs can cause patients to miss treatments, and may increase risk of mortality if the disruption persists (Pasquet et al., 2010). Other intermediate outcomes of poor supply chains include drug product expiration, theft, overstocking, under-stocking, order errors, and political/legal blocking (Supply Chain Management System, 2009). It has also been shown in Uganda that although a supply chain may be functional at national level, there may still exist a lack of strong supply management at the local site level, pointing to a need for improved logistical information, training and investment further down the chain (Kohler & Revathi, 2012).

1.2 Objectives

1.2.1 General objective

To explore the factors that affect the performance of logistics management information systems in public health facilities in Lira district.

1.2.2 Specific objectives

1. To explore the human resource capacity factors that influence the performance of logistics management information systems in public health facilities in Lira district.
2. To explore the logistics management information systems tools availability factors that influence the performance of logistics management information systems in public health facilities in Lira district.
3. To explore the implementing partners activities that influence performance of logistics management information systems in public health facilities in Lira district.

1.2.3 Research Questions

1. What is the capacity level of the human resource handling logistics management information systems in the public health facilities in lira district?
2. How available are the tools required for running a logistics management information systems in the public health facilities in lira district?
3. What activities are implementing partners carrying out to enable a competent logistics management information systems in the public health facilities in lira district?

1.3 Significance of the study

The study results will guide Ministry of Health, NMS and implementing partners on future projects aimed at supporting pharmaceutical logistics. Effective and efficient logistics management plays a key role in organizations and the economy and in the case of health, it is vital for commodity supply chain which in turn is important for patient care and good patient outcomes. However for an efficient logistics system, a functional and accurate LMIS is critical to provide navigation for the entire logistics and supply chain which heavily relies on information to inform decision making.

The study will clearly elucidate the challenges that affect the performance of LMIS in the facilities in Lira district. These challenges can help focus efforts designed to manage the bottlenecks affecting this critical area to once and for all solve the persistent problems affecting medicines availability by providing reliable LMIS data for planning the utilization of our limited resources.

The study will also guide health facilities like referral hospitals, health center IVs and III to understand that proper logistics management skills and information management have been implicated as contributing factors to stock outs and wastage in the form of expiries. This study therefore assesses LMIS bottlenecks and identify areas and strategies of focusing trainings and mentorships of personnel working at selected heath facilities using the results as a lens through which a focused strategy can be used to yield better results with less effort and resources. The end result in sight is reduced stock outs and expiry of drugs.

For practitioners, the study results may help clarify and contextualize the alternative methods of LMIS management and assessment, thereby facilitating the sharing of experiences and revealing the strengths and gaps of modern pharmaceutical supply chain LMIS. They may also make recommendations that may guide reduction in drug stock outs and expiry.

Finally the results of this study can be generalized for national level programing and intervention planning.

1.4 Justification of the study

In Uganda, explorative studies on logistics management information systems are limited most literature on LMIS can only be extracted as subsets in bigger supply chain assessments and projects such as USAID DELIVER, USAID SURE and most recently USAID UHSC. These have done baseline surveys followed by interventions and finally closing with a report. The USAID SURE project for example with a 38 million dollar budget designed SPARS which is a tool to asses and guide mentorship in medicines management. This tool has a section in LMIS as an indicator. It however gives no attention to the associated factors surrounding the results seen from the tool. This tool has since yielded results which have been short lived and sustainability has proved complex hence a follow on project USAID UHSC a 30 million dollar project which is also in its evening with similar challenges still in place.(USAID SURE, 2010,  USAID UHSC, 2015)

The aim of this study therefore is to evaluate the logistics management information system performance for medicines in public health facilities in lira district and also explore the associated challenges.

1.5 Conceptual framework

(Conceptual framework created for this study)

To assess an LMIS, one should know whether the distribution system is a “push” or a “pull” system. Other elements of the logistics system essential to understanding the LMIS include: Whether the distribution system is vertical (i.e., responsible only for family planning commodities) or integrated (i.e., responsible for other primary health care commodities, as well). It includes sources of supply, Products distributed, Number of levels in the system and Number and types of facilities at each level. It also includes types of service delivery points—clinic, community-based distribution (CBD), and others, Storage capacities and constraints, type of inventory control system. Others are maximum and minimum stock levels, Periodicity of orders and deliveries, Lead times and Transport modes/mechanisms (how products are moved between facilities). Finally LMIS involves management/supervision structure of the distribution system (LMIS derived from John Snow, Inc. 2000).

Once the quality of data in LMIS such as the one conceptualized above is in place, there is likely to be less drug stock outs thus availability. More so, this LMIS may lead to reduction in expiry of medicines in Uganda. The resultant effects will also affect public health, budgeting for health, economy and general health service delivery.

CHARPTER TWO

LITERATURE REVIEW

Pharmaceuticals may contribute as much as 40 percent of the health budget in developing countries, yet large portions of the population still lack access to the most essential medicines (WHO, 2011).  These budgets are, however, insufficient to finance adequate supplies. To maximize patient benefits, the value of these budgets should be maximized through good logistics management and in turn, good logistics management relies on a good LMIS (WHO, 2011)

In a public health setting, the collection of data for logistics operations has been, at times, confounded with the collection of data for other purposes, particularly with health information systems (HIS) that track incidence of disease and health service delivery (USAID, 2012).

Uganda currently has a complex decentralized health system which consists of the district health infrastructure consisting of Village Health Teams/Health Centre I (VHTs or HC Is), HCs II, III and IV plus general district hospitals. Beyond the district, the health system has Regional Referral Hospitals and National Referral Hospitals. Such a complex system calls for proper coordination, support supervision and inspection processes which are information driven (Ministry of Health, Health Systems 20/20, and Makerere University School of Public Health, 2012).

2.1 Components of LMIS data

There are three essential data items in any LMIS namely stock on hand, rate of consumption, and losses & adjustments (DELIVER, 2004; DELIVER, 2006a; Owens & Warner, 2003; PIP, 2002), although PIP (2002) suggests additional two data items which are dates of orders and receipts, and amounts of orders. They are completed by anyone who receives or issues stock from storage whenever products are received or issued, or who takes a physical inventory of stock.  Generally, stock on hand are quantities of usable stock available at all levels of the system; rate of consumption is an average of stock dispensed to users during a particular period of time; and losses include the quantity of stock removed from the pipeline for any reason other than consumption and adjustments are made when quantities are issued to or received from other facilities at the same level of the pipeline. These data must be available for every product, at every level, and in all times. At the end of a certain period, particularly monthly or quarterly, reports should be prepared and sent to the higher levels in the logistics systems for decision making, policy making, and planning among others. In most developing countries LMIS reports, such as summary and feedback reports, move from the service delivery points to the central levels on a fixed time table (DELIVER, 2004; PIP, 2002).

Logistics information and health information management are designed to facilitate very different decisions, often by different stakeholders. The types of questions that can be answered using logistics data are: What is the demand for a drug through this system over a certain period of time? Does demand change throughout that period? How long will current supplies last? When do we need to procure supplies? Where are our supplies in the pipeline? Do we need to move supplies between tiers in our system? Where is demand the highest? What are the implications for positioning inventory? They also ask “Are we experiencing losses from the system that require us to take action? “Where are losses occurring and what are the causes of these losses?” and whether drug supplies flowing smoothly through the pipeline? Do we need to adjust our inventory to account for bottlenecks in the system? (USAID, 2012).

2.2 History and evolution of LMIS in Uganda

Uganda has a comprehensive paper-based Health Management Information System (HMIS), and a computerized web-based system which captures all the data from the paper based system is currently being used (District Health Information System [DHIS2]. Although the focus of the new system is on the public sector, there is an opportunity to extend to the private sector. This web based system also has LMIS functions which have commodity ordering, order tracking capacities this is called the WAOS and most recently the TWOS for HIV and TB commodities respectively (PD-MOH, 2018).

In Uganda. LMIS information is sent to the district level as part of monthly reporting. However, the information is rarely considered for quantification and health commodity ordering. Unfortunately stock cards are often inaccurate, with inventory improperly calculated or recorded, most notably by the lack of a stock card column to denote losses/adjustments. Facility staff who are in charge of completing stock-cards have inadequate training, and may not have the time to complete accurate stock counts on a regular basis or calculate rates of wastage. Since the districts often lack staff responsible for supervising facility-level health commodity stock, district-level staff rarely check health commodity stock-level accuracy at the facility level. Further, since the LMIS is recorded via a paper-based system, staffs at the district level do not have the time to extensively analyze and review LMIS data for quantification and health commodity decision-making purposes. Also, Logistical Management Information System (LMIS) is included in the HMIS 105 section 5 on the ‘Essential Drugs, Vaccines and Contraceptives’. Appropriate use of the HMIS has the potential to improve the acquisition and distribution of medicines, its management, and management of the PHC funds. Under the current arrangements, health facilities are supposed to use information collected on HMIS forms to effectively manage resources including medical and other supplies. Health facilities are expected to complete this form every month. The data collected are supposed to inform the higher authorities on the state of stock at a given facility highlighting stock at hand, quantities used of each medicine and losses and adjustments, if any. It was noted that the HMIS 105 Section 5 was never completed in Kamuli district; partly filled in Mubende, Rukungiri and Apac. For Kamuli district and some of the sampled health facilities in other districts, leaving this section empty would imply no drug stock outs. While 71.8 percent of the in-charges reported submitting monthly reports to district level, there was no hard evidence to demonstrate that this happens. These forms were only access at the DHO office. It was observed that information on stock management and accountability of PHC funds was rarely filled in. While filling in the HMIS 105 would give a clear picture on disease burden and stock outs of commonly used drugs, the failure to dully complete the sections of medicines, this form raises concerns. No convincing explanation was obtained on why these particular section are almost never completed. (Ministry of Health, Health Systems 20/20, and Makerere University School of Public Health 2012).

Further, since the LMIS is recorded via a paper-based system, staff at the district level do not have the time to extensively analyze and review LMIS data for quantitation and health commodity decision-making purposes (Ministry of Health, Health Systems 20/20, and Makerere University School of Public Health 2012).

Electronic medical records (EMR) are still a new area for Uganda, but the Vision 2012 (MoH 2009) notes that Uganda plans to implement the system as part of the HMIS. At the time, several agencies had pilot-tested EMR systems. These include personal digital assistants (PDAs) (MoH), Rx Solution (MoH), notebooks (UBOS), and eHMIS (Tororo MCH). Findings from the eHMIS test indicated that there was significant improvement in timeliness, accuracy, and provider satisfaction with the system, and eliminated data loss during transmission (Ndira, 2008). These observations highlight the possible advantages of eHMIS. However, challenges such as network breakdowns, power cuts, and lack of funding beyond the pilot stage led to the abandonment of the schemes. The HMIS system was designed to track information for the broad health care package. It was also meant to produce more information for lower levels than for the national level, which receives aggregated data.

2.3 Human resource capacity factors that influence the performance of logistics management information systems

Council of Logistics Management (1991) defined logistics as part of the supply chain process that plans, implements, and controls the efficient,  effective forward and reverse flow and storage of goods, services, and related information between the point of origin and the point of consumption in order to meet customers’ requirements.

Logistics system is made up of logistics services, information systems and infrastructure/resources. Logistics services is made up of activities such as warehousing and transportation that support the movement of materials and products from point of origin to point of consumption, and vice versa. Information systems include modeling and management of decision making, and more important issues are tracking and tracing. On the other hand, infrastructure comprises human resources, financial resources, packaging materials, warehouses, transport and communications (BTRE, 2001).

Logistics, previously viewed as a classical function, which involves adversarial relationships among suppliers, customers and transportation providers, is emerging as a key source of competitive advantage and a leading reason for strategic alliance relationship between companies and their logistics providers (Hai & Yirong, 2002). A logistical system is made up of a large number of stakeholders. They include the suppliers, manufacturers, wholesalers or distributors and retailers who have to be managed strategically in order to deliver final products in the right quantities at the desired time and quality at the right place and at a reasonable cost to the final consumers. Logistics strategy has three main objectives; cost reduction, capital reduction and service improvement. In the last two decades, product flow has been greatly improved due to better technology in communication and transportation. Increased variety of goods, globalization of marketing and seasonal variations are among the major challenges of logistics system which leads to the necessity of developing effective logistics strategies in the agricultural sector (Gebresenbet & Bosona, 2012).

Efficient management is the key to success, especially in supply chain management. There are various factors involved in effective logistics management. For example, automation and perfect coordination are always a scope for improvising the process. When your business witnesses growth, you must find ways to streamline logistics planning processes for improving output. Here are some practices to manage logistics more effectively (Centobelli, Cerchione, & Esposito, 2019).

Proper Planning; efficient logistics is about planning. It involves procuring the goods, storage facilities, and delivery of products to the final destination. The purpose of planning is to attain maximum work in the least possible time, as well as aim at maximizing the profits. a good logistics manager will, therefore, make sure to plan well ahead in order to eliminate any delays in the supply chain. However, one must be prepared for the unforeseen circumstances as well. These situations can be related to: the products (sourcing, purchasing and production), unavailability of the transportation and any internal issue in the organization (Winkelhaus, & Grosse, 2020).

Adopting Automation; In the age of automation, technology plays a major role in increasing the efficiency of an organization. There are number of ways you can automate the logistics process, including tracking and monitoring each delivery (Hu, Dong, Hwang, Ren, & Chen, 2020).

Business process software like SAP or ERP can be integrated that provides timely updates regarding the movement of goods. The operator and the client will get details regarding: The goods that are dispatched from the supplier, Procurement of the goods at the warehouse, Delivery of the goods at the destination and This saves a considerable amount of time because manual interference is eliminated. Moreover, accurate tracking help in improving overall process management.

Robots for Inbound and Outbound Logistics; Robots perform functions at the request from an order fulfillment system. The order process automatically notifies robots in warehouses and triggers the flow of processes. Robotics Technology is not isolated to warehouse pulling for outbound logistics. They can be used to manage inbound and outbound processes and strategy. Through trends in automation and robotics, supply chain companies will have the tools and resources necessary to ramp up throughput and decrease product cycle from order to delivery

Internet of Things (IoT); IoT is the network of physical devices embedded with electronics, software, sensors, actuators, and connectivity which enable these things to connect and exchange data, creating opportunities for more direct integration of the physical world into computer-based systems, resulting in efficiency improvements, economic benefits, and reduced human exertions. The IoT can assist in the integration of communications, control, and information processing across various transportation systems. Application of the IoT extends to all aspects of transportation systems (i.e. the vehicle, the infrastructure, and the driver or user). Dynamic interaction between these components of a transport system enables inter and intra vehicular communication, smart traffic control, smart parking, electronic toll collection systems, logistic and fleet management, vehicle control, and safety and road assistance. In logistics and fleet management, IoT platform can continuously monitor the location and conditions of cargo and assets via wireless sensors and send specific alerts when management exceptions occur (delays, damages, thefts, etc (Crainic, T. G., Gendreau, M., & Jemai, L. (2020).

Autonomous Vehicles/ Trucks; With advances in technology and the IoT, most major companies, including Walmart, Google, and Amazon, have launched autonomous vehicle and truck pilot programs. These driverless vehicle programs will give supply chains access to a new inexhaustible resource for moving products, overcoming the challenges inherent in the driver shortage and capacity crunch. Autonomous vehicles have control systems that are capable to analysing sensory data to distinguish between different cars on the road, which is very useful in planning a path to the desired destination (Wollschlaeger, Sauter, & Jasperneite, 2017).

Value Relations; The team is an essential aspect of an organization that is responsible for the growth. Whether it’s the delivery guy or the warehouse manager, everyone should be professional in their respective field of work. Regular training workshops keep the employees updated with the latest trends in the logistics industry. This helps in increased efficiency and satisfaction of the clients. Logistics manager with impeccable interpersonal skills is crucial for the organization. There are times when the things don’t work according to the plan. In this situation, instead of panicking, you need a reliable person who can sort out the issues with utmost efficiency. Moreover, the manager should have authoritative contacts in the industry (Thirumoorthi, & Hemalatha,  2017).

Recruitment which is the process of generating a pool of capable people to apply for employment to an organization and selection which is the process by which managers and others use specific instruments to choose from a pool of applicants a person or persons more likely to succeed in the job(s) given management goals and legal requirements Bratton and Gold (2007). Recruitment and selection can play a pivotal role in shaping an organization’s effectiveness and performance, if organizations are able to acquire workers who already possess relevant knowledge, skills and aptitudes and are also able to make an accurate prediction regarding their future abilities. Performance improvement is not only a result of well-functioning system but also depends on effective human resource strategies that succeed in recruiting and maintaining a committed and motivated workforce (Al-Ahmadi, 2009).

Recruitment and selection has become ever more important as organizations’ increasingly regard their workforce as a source of competitive advantage. It is often claimed that selection of workers occurs not just to replace departing employees or add to the number but rather aims to put in place workers who can perform at a higher level and demonstrate commitment (Ballantyne, 2009). This function of HRM is presented as a planned rational activity made up of certain sequentially-linked phases within a process of employee resourcing, which itself may be located within a wider HRM strategy. The process of recruiting and selecting may come in four stages: defining requirement, planning recruitment campaign, attracting candidates and selecting candidates (Armstrong, 2010).

Training and Development

A formal definition of training and development is any attempt to improve current or future employee by increasing an employee’s ability to perform through learning, usually by changing the employee’s attitude or increasing his or her skills and knowledge. While training is seen to be the process of imparting specific skills, development is said to be the learning opportunities designed to help employees grow. According to (Armstrong 2001) training is the formal and systematic modification of behavior through learning which occurs as a result of education, instruction, development and planned experience. Training has the distinct role in the achievement of an organizational goal by incorporating the interests of organization and the workforce (Stone R J. Human Resource Management, 2002). For training to have a better effect on performance, its design and delivery should be well executed.

Training remains a vital to enhancing employee performance. The organizational commitment or “the relative strength of an individual’s identification and involvement in a particular organization” (Pool & Pool, 2007) depends on effective training and development programs. According to these authors, organizations demonstrating keen insight make provisions for satisfying the training needs of their current workforce. Cheng and Ho (2001) indicate that adequate training produces marked improvements in employee communication and proficiency of performances as well as extending retention time. Moreover, when programs target communication skills with co-workers, there are significant increases in profit as well as a greater number of reported positive working relationships that are formed. Also, training and education have been shown to have a significant positive effect on job involvement, job satisfaction, and organizational commitment (Karia & Asaari, 2006). Moreover, poor performance reviews due to inadequate job training can produce employee dissatisfaction and conflict.

Compensation

Compensation processes are based on compensation philosophies and strategies contained in the form of policies, guiding principles, structures and procedures which are devised and managed to provide and maintain appropriate types and levels of pay, benefits and other forms of compensation. This constitutes measuring job values, designing and maintaining pay structure, paying for performance, competence and skill and providing employee benefit. However, compensation management is not just about money, it is also concerned with that non-financial compensation which provides intrinsic or extrinsic motivation (Bob, 2011). Compensation has a motivational effect and therefore implies that having a compensation structure in which the employees who perform better are paid more than the average performing employees is vital to enhancing organizational performance (Hewitt, 2009).

Appraisal/Performance Management

Performance appraisal of employees is the systematic evaluation of employees′ performance and potential for development during a certain period of time by supervisors or others who are familiar with their performance. However, there has been a great realization that it is more important to focus on defining, planning and managing performance than merely appraising performance Pareek and Rao, (2016). The increased competitive nature of the economy and rapid changes in the external environment has forced many organizations to shift from reactive performance appraisals to proactive performance management to boost productivity and improve organizational performance (Nayab, 2011). Prasad (2005) defines performance management as the process of planning performance, appraising performance, giving its feedback, and counselling an employee or teams to improve performance. As Armstrong (2006) put it, performance management is a systematic process for improving organizational performance by developing the performance of individual and teams. Performance management is one of the most important developments in the field of HRM probably propelled into visibility in the early 1980s as a result of the growing importance of total quality management.

Employee Voice (Involvement and Participation)

The direct participation of staff to help an organization fulfil its mission and meet its objectives by applying their own ideas, expertise and efforts towards solving problems and making decisions is termed as employee involvement. Research has shown that organizations that tap the strength of their people will be stronger and more aggressive than those that cannot. Firms will never realize the full potential of employees if they regard people as automatons or mere cogs in a wheel. In the long run, such companies′ inefficiencies attract competition, and unless the management philosophy changes, they will disappear (Apostolou, 2000).

So many studies have shown how much of an impact employee participation can have on the performance and wellbeing of an employee, team or the entire organization: improved organizational decision-making capability, and reduced costs through elimination of waste and reduced product cycle times (Apostolou, 2000); empowerment, job satisfaction, creativity, commitment and motivation as well as intent to stay (Apostolou,2000; Light, 2004); increased employee productivity across industries (Jones, Kalmi, &Kauhanen, 2010)

Information Sharing and Knowledge Management

In a study by Brian Hackett (2000) titled, “Beyond Knowledge Management: New Ways to Work and Learn,” knowledge management is defined as, “An integrated, systematic approach to identifying, managing, and sharing all of an enterprise’s information assets, including databases, documents, policies, and procedures, as well as previously unarticulated expertise and experience held by individual workers.” In essence, it is gathering all the information and resources of a corporation and making them available to the individual employee. In turn, the employee uses these resources to create new innovative processes and thus, gives back to the firm.

Job design

Job design refers to work arrangement or rearrangement aimed at reducing or overcoming job dissatisfaction and employee alienation arising from repetitive and mechanistic tasks. Through job design, organizations try to raise productivity levels by offering nonmonetary rewards such as greater satisfaction from a sense of personal achievement in meeting the increases challenge and responsibility of one’s work. Job enlargement, job enrichment, job engineering, job rotation and job simplification are various techniques used in a job design exercise. Opatha (2012) “Job design is the functions of arranging task, duties and responsibilities in to an organizational unit of work”. The process of job design has been defined as, “specification of the contents, methods, and relationships of jobs in order to satisfy technological and organizational requirements as well as the social and personal requirements of the job holder.” In this rapidly changing business environment, it is has become even more critical for jobs design to meet the requirement of challenging work. Changing technology, advanced communication, and changing organizational structures have all impacted job design. To be more responsive to the rapid pace of change, jobs must have some degree of built-in flexibility. This flexibility is achieved through careful attention to job design.

Job simplification standardizes work procedures and employs people in clearly defined and highly specialized tasks. Job rotation and job enlargement were designed to take advantage of specialization of labor from the job engineering approach (Luthans, 2005). Job rotation allows an employee to work in different departments or jobs in an organization to gain better insight in to operations. Job enlargement can be used to increase motivation by giving employees more and varied task. Job enrichment is the technique which entails the inclusion of greater variety of work content, requiring a higher level of knowledge and skill, giving workers, autonomy and responsibility in terms of planning, directing, and controlling their own performance, and providing the opportunity for personal growth and meaningful work experience (Garg & Rastogi, 2006). A wealth of studies showsthat there exists a correlation between job design and performance Al-Ahmadi (2009) indicated that the nature of job itself was found positively correlated with performance, which indicates that satisfaction with amount of variety and challenge in one′s job actually influence performance.

Job design gives a clear direction to how tasks are performed and this leads a positive change in job performance and analysis as a result of which the organizational productivity is enhanced though efficient work performance.

Career Planning

Career planning is the deliberate process through which someone becomes aware of his or her personal skills, interests, knowledge, motivations, and other characteristics; acquires information about opportunities and choices; identifies career-related goals; and establishes action plans to attain specific goals (Dessler, 2008). According to Edgar Schein career planning (Manolescu, 2003) is a continuous process of discovery in which an individual slow develops his own occupational concept as a result of skills or abilities, needs, motivations and aspirations of his own value system. In HRM, career planning seeks to identify needs, aspirations and opportunities for individuals′ career and the implementation of developing human resources programs to support that career.

The organization’s and the immediate managers′ responsibilities, if combined together would generate another dimension which is best named as organizational career management.

2.4 To explore the logistics management information systems tools availability factors that influence the performance of logistics management information systems in public health facilities in Lira district.

A  LMIS is a system of records and reports whether paper based or electronic used to aggregate, analyze, validate, and display data (from all levels of the logistics system) that can be used to make logistics decisions and manage the supply chain. A well-functioning LMIS provides decision-makers throughout a supply chain with accurate, timely, and appropriate data, such as stock on hand, losses and adjustments, consumption, demand, issues, shipment status, and information about the cost of commodities managed in the system (Gilbert, et al., 2020).

As countries continue to expand health programs and strengthen the supply chains that support them, there is an increased need for user-friendly tools and software packages to support the timely and accurate collection and reporting of logistics management information. This information can be used for operational decision making, advocacy, and resource mobilization. Automation of a logistics management information system (LMIS) can greatly facilitate the work of supply chain managers by enabling faster collection, transmission, and aggregation of data; by reducing human error in calculations; and by allowing for visibility of data up and down the supply chain. Reducing the time required for data collection, transmission, and aggregation results in data being available more quickly for timely decisions and actions to help ensure products are available where and when needed (Yu, 2019).

Uninterrupted supply of drugs like antiretroviral drugs (ARVs) for treatment of HIV/AIDS is a pre-requisite and a challenge for ART programs. With the increasing number of people on treatment, supply chains need to expand, which can be sustained only if they are fully accountable for their actions. Designing an effective and sustainable supply chain system for drugs and other commodities is important and can be complex. A correctly run distribution system should also keep drugs in good condition, rationalize drug storage points, use transport as efficiently as possible, reduce theft and fraud and provide information for forecasting needs. This requires a good management of the system along with a simple but well-designed information system in place. A number of AMDS partners have considerable expertise on setting up and managing a functioning supply chain system, and on this page are links to the relevant part of their web sites. There are many guidelines and tools publicly available from AMDS partners. WHO/AMDS, the

A logistics management information system (LMIS) is a system of records and reports whether paper-based or electronic used to aggregate, analyze, validate and display data (from all levels of the logistics system) that can be used to make logistics decisions and manage the supply chain. LMIS data elements include stock on hand, losses and adjustments, consumption, demand, issues, shipment status, and information about the cost of commodities managed in the system. Links the different levels in the system through information, Provides information each needs to perform their supply chain role (Gebre-Mariam, & Bygstad, 2019). Software development and, more specifically, the automation of an LMIS can and should follow project management and information technology (IT) best practices. These guidelines were written for managers in the Ministry of Health, program managers, donors, and MIS program officers as a reference when considering starting an LMIS automation project, planning for one, and executing that plan.

An automated LMIS is just one component of the systems that may be in place to manage supply chain operations in your country. There are likely also warehouse management systems (WMS), transportation management systems, as well as billing and accounting systems or any of the myriad other types of systems that support a logistics operation in place already. The difference between an LMIS and the other kinds of systems is the type of decision the system helps to inform. A WMS, for example, helps manage and control products within a warehouse. It also helps manage warehouse processes, such as receiving and storage, order processing picking and packing, and shipping products out of the warehouse (Adi, Andryana, & Sari, 2020).

While automation enables faster collection, transmission, and aggregation of data, and helps to eliminate human error in calculations, it will not solve every supply chain challenge. Often other interventions are needed prior to automation. As a case in point, automating bad management practices can waste money and make poor processes operate faster while achieving no performance improvement. As another example, if there are data quality issues at one level of the supply chain, automation will not improve the data quality without appropriate efforts in quality assurance, management, supervision, and data collection training. If strong business practices are not present prior to automation, the commitment of time and resources for process improvement will be necessary to ensure that the automation will successfully address the identified supply chain challenges and not exacerbate them (Ma’sum, & Aripin, 2020).

Automating any part of a logistics system involves input from a variety of people, including end users, developers, logistics personnel, funders, IT experts, and project managers. No single person will be able to grasp and explain what is needed from every level and dimension of the supply chain. Developing a strong automated system is dependent on having all perspectives involved during the design phase. If you are going to move forward on automating any aspect of your LMIS, you need to make sure that adequate personnel from key areas are available to participate in the design process. In addition, strong and capable leadership is an essential element for overall project success (Agyabeng-Mensah, Ahenkorah, & Korsah, 2019).

Electronic Data Interchange, EDI is a technique based on agreed standards which facilitates business transactions in a standardized electronic form in an automated manner directly from a computer application in one organization to an application in another organization. The growth of microcomputer usage in logistics is to direct electronic transmission of data and standard business forms between the buying organization and its suppliers. This helps the buyers and sellers to obtain and provide more timely and accurate information flow during the transportation of goods permitting greater administrative efficiency through paper work reduction. According to Monczka and Trent, 75% of the business units they surveyed have EDI capability with their various suppliers. The real growth of EDI comes in the increasing volume of transaction handled electronically. In the same survey, Monczka and Trent reveal that respondents reported that most businesses would be connected to 60% of their suppliers by 1997 even though by 1995 only 18% were connected to their suppliers. Electronic Data Interchange and the internet have made flow and exchange of information once an EDI system is in place and functioning properly, it produces a number of clear-cut operating benefits for the buying firm. An obvious reduction in paperwork and related administrative contributes noticeably to increased productivity. Because data is transmitted directly between computers, accuracy of the data throughout the process typically increased.

According to Bialy et al, technological progression necessitates that organizations should have formulated plans to handle development for example in the development of EDI as one of the information technologies used in supporting logistics activities. It is imperative that purchasing has an appropriate supplier who can jointly develop and use this technology.

In addition to the above, there has been different views concerning the integration of materials and information flows, both internally and externally for example; MRP, MRP II and integrated information systems such as EDI and supply chain concepts such as value streams and pipeline or logistics management.

According to Christopher (2005), organizations with quite different internal information systems can now access data from customers on sales or product usage and can use that information to manage replenishment and to alert their suppliers of forth coming requirements. This can be achieved by use of extranets.

At the same time, organizations can successfully run a home shopping and delivery systems for consumers over the internet. Within these businesses, intranets are put in place to enable information be shared between stores and this facilitates communication across the business making the internal operations become much more efficient as a result. For example, by capturing customer demand data sooner, better utilization of production and transport capacity achieved through proper planning and scheduling.

Managers have found ERP implementation projects to be one of the most difficult systems development projects (Kumar, Maheshwari, & Kumar, 2003). In part, this is due to the significant change that must occur in the organization.  Olsen et al (2005) found that all jobs are going to change and employees need to adapt.  Many people are resistant to change, so good organizational change management techniques have to be used. Additionally, it is difficult to implement any organizational change without cooperation.  We might speculate the resistance is exacerbated given the magnitude of organizational change in an ERP system.  The necessity of informing employees as to how the system can help them do their jobs better cannot be overstated (Olson et al., 2005).  Effective communication and continuous support throughout the implementation has been noted to be beneficial (Bierwirth, KirschsteinDirk, & Sackmann, 2019).

Bar codes and scanners       

Barcode is a visual representation of information in the form of bars and spaces on a surface. The bars and spaces are designed with different widths and consist of numbers, characters and symbols such as dot, colon and others. Different combinations of these alphanumeric characters are used to represent information. There are various types of barcodes in use today e.g. Code 128, Code 39, EAN etc. (Brain, 2000) .The successful of barcode technology has been constantly improving in order to accommodate more information in the minimum possible space. Today barcodes are widely used on books and at retail stores in order to keep track of the products available and easy checkout of the products. The barcodes are normally read using scanners using laser beams or cameras.

Bar code and scanners represents a series of alphanumerical characters, bar code readers to interpret bar code zymology, and bar code printers to reliably and accurately print bar codes on labels, cartons, and/or picking /shipping documents. The review is included here because bar code systems are the foundation for many paperless warehousing systems, but the review is meant only as a brief introduction to bar code system. In logistics, bar coding is useful in receiving inbound materials. This helps in quick and accurate data entry, faster checking and clearing of shipments, automatic tracking of the shipments throughout the logistics (Garg, 2012).

As in image processing, the thresholding is the one of element to be consider as a way to describe an image. Thresholding is the simplest method of image segmentation. From a grayscale image, thresholding can be used to create binary images. During the thresholding process, individual pixels in an image are marked as object pixels if the value is greater than some threshold value (assuming an object to be brighter than the background) and as the background pixels otherwise. This convention is known as threshold above.

Some of the types of barcode scanners include; laser barcode Scanners Laser barcode scanners work the same way as pen type barcode readers. The only main difference is that Laser barcode scanners use a laser beam as their light source, and typically employ either a reciprocating mirror or a rotating prism to scan the laser beam back and forth across the bar code. As with the pen type bar code reader, a photo diode is used to measure the intensity of the light reflected back from the bar code (Dabrowski, Krombholz, Ullrich, & Weippl, 2014).

Pen Type Readers or Bar Code wands, Pen type barcode readers have a light source and a photo diode placed next to each other in the tip of a pen or wand. To read a bar code, you drag the tip of the pen across all the bars, in a steady even motion. The photo diode measures the intensity of the light reflected back from the light source and generates a waveform corresponding to the widths of the bars and spaces in the bar code. The barcode reader sends the waveform to the decoder, which decodes the waveform and sends it to the computer in a traditional data format

Integration of GPS/GIS tracking system

Recently, organizations are focused on tracking the location of their personnel and vehicles(including service technicians, drivers, sales agents or merchandisers, and assets such as trucks, high value assets, trailers or heavy equipment), in order to decrease costs, improving productivity and increasing visibility( Zhironget al. 2010). A lot of companies want to go further than just monitoring vehicle movement to comprise tracking of other assets and resources outside (Walker 2005). This is becoming realistic due to several factors. Specifically, the widespread of mobile GPS (Global Positioning Systems) applications combined with the lower costs of GPS handsets; the growing selection of wireless data solutions. Also, the popularity of the Internet has enabled most organizations to implement some type of GPS tracking of their resources. At the present, determining the location of workers and/or assets in real-time is critical for most enterprises (Chinchu, 2012).

Geographic Information System (GIS) and mobile GIS/GPS technologies to the common mobile logistics business tracking to respond on the requirements of efficient logistics management. In the full investigation of GIS and GPS technologies dominance in logistics, this paper focuses on the system design concerns and methods, and puts forward a GIS/GPS based solution apply to logistics business tracking. A Mobile Geographic Information System Platform (MGISP) is designed independently.

The revolution of vehicle tracking and navigation has been brought to us by the appearance of GPS technology. The progress in mapping solutions has come with GIS/mobile GIS technology to the everyday activities of common people (Devyani and Neelesh2012; Omarahet al. 2010;Paul 2009;Xuping et al. 2008). Mobile technologies such as GPS, General Packet Radio Service (GPRS) and GIS coupled with advanced Internet solutions provide transparency and more specific information to supply chain collaborators in terms of instant localization, shipments traceability and delivery status.

Tracking physical goods at real-time significantly improves logistics performance, cost efficiency and customer satisfaction (Chinchu2012;Wang, 2004;Xuping2008).

The logistics industry and transportation be able to implement GIS integrated with GPS technology to improve several services; as delivery schedules and to reduce shipping costs associated with delivering products, fleet management, and vehicle tracking. In order to compute optimal routes, not just the shortest route, along a transportation network saving both time and money, GIS technology offers network algorithms (ESRI 2007; Paul, 2009; Sui and Li2012).

Satellite

Satellite is a technology that allows communication across a very wide geographical area. Satellite communication provides a fast and high volume channel for information movements. Satellite technology facilitates real time interaction which provides up to date information about location and delivery information about the products in transit. The satellite devices can also be used in tracking and tracing the materials in transit. In an era where business and logistics have become global, satellite tracking has become a conventional means of pinpointing a person or object’s location anywhere in the world. This tool for monitoring has changed logistics tremendously since its inception back in the 50s. Satellite tracking technology uses the Global Positioning System (GPS). The GPS measures the distance between your location and the satellites that orbit the earth. Tracking solutions help people monitor the location and movement of objects in real time. By Global Positioning Systems (GPS) or similar technology, objects can be dynamically tracked on a map that can be shared through the Internet or intranet. Nowadays, there are many solutions supporting a diverse range of asset tracking applications such as; personnel tracking, mobile asset tracking and traffic control (Lanko, Vatin, & Kaklauskas, 2018).

Image processing

This uses fax and optical scanning technology to transmit and store freight bill information and supporting documents such as POD or BOL. Through image processing, the buying company is in position to get timely customer shipment information which is transmitted through the central Data base therefore, providing improved customer service in the form of more timely and accurate delivery, quick shipments, tracing and quicker transfer of sales and inventory information (Borstell, 2018).

Internet

The strategic importance of information is recognized by most people and organizations. The internet thus far is primarily a tool for information sharing between the buying company and the selling company with the potential for electronic commerce being explored. Some companies are setting up private internet used to share data with workers and provide access to the larger internet. In logistics, the internet is used in order to enhance efficient, effective and timely communication between the buying and selling organization, tracking and tracing of the cargo during the actual process of logistics (Hua, Jin, Xu, & Huang, 2018).

Some of the internet systems that can be used in logistics organization include; Warehouse. Devices that allow an accurate registration of entries and exits of goods; volume and weight sensors in shelves to find out if the good being stored in them is the right one; weather sensors control to guarantee the good condition of goods; sensors for detecting the availability of space; smart glasses and labels that let us find the goods and their exact locations in the warehouse and Cargo, Remote monitoring sensors for temperature and humidity to make sure the handling of goods meets the required care; damage prevention and theft detection sensors; real time monitoring of the goods’ location during transport (Tu, 2018).

Fleet. Cargo distribution software; trackers to pinpoint the exact location of units; units’ routes’ historical data collection; sensors to identify the driving style of drivers; fuel usage controls; and detection of fluid levels and polluting emissions.

Enterprise resource planning

Enterprise wide software solutions address the problem of disparate information in business organizations (Zietsma et al., 2019).  They serve as the starting point for information capture and dissemination via a variety of mathematical models that continue to grow as technology innovation grows.  Enterprise Resource Planning Systems have moved into the maturity phase of their lifecycle serving as the platform of choice for most manufacturing firms. In fact, ERP has shown a level of maturity where simple issues related to implementations are known by vendors and businesses (Han, Swanner and Yan., 2010). ERP implementations frequently come with new software and hardware systems and business processes that substantially alter workflow and jobs

(Monk and Wagner, 2013).

These alterations change processes, job responsibilities and often lead to major training and other organizational initiatives.  These organizational changes are usually positive, however, significantly higher value is achieved if the most appropriate types of information sharing are used, while other types of information sharing rather contribute to decreased value (Jonsson and Mattsson, 2013).  Enterprise resource planning (ERP) systems have been used in integrating information and accelerating its distribution across functions and departments with the aim to increase organizations’ operational performance.

The US Department of Transportation estimates final users purchase or consume 9% or close to $1 Trillion of the goods and services in the GDP basket to serve their transportation needs (2014). An effective logistics operation can provide a competitive advantage for a firm and increase market share (Monk and Wagner, 2013).There is no wonder that businesses are diligently working to reduce their logistics costs as a huge area of opportunity. According to Whitman and Pollen, (2014) most research on logistics and technology has focused on the ability to reduce costs and provide delivery solutions according to customer need.

2.5 To explore the implementing partners activities that influence performance of logistics management information systems in public health facilities in Lira district.

Logistics management deals with the planning and control of material flows and related information in organizations, both in the public and private sectors. Generally speaking, its mission is to get the right materials to the right place at the right time, while optimizing a given performance measure and satisfying a given set of constraints. Logistics is one of the most important activities in modern societies. It is constructed on subsystems which in turn contain a collection of interrelated components. The relationship between the subsystems and components takes the form of coordination and exchange of materials and information. The aim of the system is to supply customers efficiently with their required products. Each subsystem controls the size of the flow of materials through the system via storage, transportation and various stages of handling and value adding. The logistics systems do not only consist of flows of materials, components and products which are processed and distributed to customers, but also include supply chain flows of spare parts and return flows of defective and used products and packaging (Jonsson, 2008).

Generally, manual systems are very slow, inconsistent, and error prone, with frequent information delays. A manual system seriously restricts a company’s ability to reduce total costs while simultaneously maintaining or improving customer service. Some common problems include the inability to detect pricing errors, and lack of access to timely credit information, or difficulties in determining inventory availability. Timely and accurate information has value. Computerized systems can potentially help managers to integrate various aspects of the logistics systems and allows the reduction of costs through improved inventory and freight management. The communication network is clearly a key factor in achieving effective logistics systems (Stock and Lambert, 2001).

Information System factors

As the output of an information system or the message in a communication system, information can be measured at six different levels which include the Information quality, Service quality, system quality, usage, user satisfaction and Net benefit (Deleon & Mclean, 2003). They defined the six as the accuracy and effectiveness of the system, the success of the information in conveying the intended meaning, and the effect of the information on the receiver respectively.

According Rai et al (2002) user friendliness and ease of use are the two instruments to measure System quality. For this IS success measuring system quality involved nine items: ease of use, ability to locate data, data quality, ease of learning, user requirements, system features, system accuracy, sophistication and integration. Wixom and Todd (2005) defined reliability, flexibility, integration, timeliness as the measures of system quality in their combined model of user satisfaction and technology acceptance. Lambert et al, (2004) Usage measures everything from a visit of the Website to its navigation within the site, to information retrieval, to execution of a transaction. User satisfaction is measured through efficiency and effectiveness of the system and net benefit measures through the positive and negative impact from the customer.

The functions of the information system can include operational (process routine transactions), monitoring (check performance of activity at regular interval), decision support, and communication (Boddy, Boonstra et al. 2005). The driving force behind a logistics system is a well-functioning logistics management information system (LMIS) (Avgerou 1998). Efficient management of the flow of information on stock levels and consumption from lower levels to the center has been shown to stimulate the flow of medicines back down the supply chain. An LMIS helps determine what quantities of each product need to be sent to a particular location, at the right time, for the right cost. The flow of stock-level and consumption data along the same channels can inform decisions critical to meeting current and future family planning needs.

Data from the LMIS are also useful for evaluating programs and supply chain operations. The LMIS can be manual (paper-based), semi-computerized, or fully computerized.

Most developing countries are eager to exploit the potential benefits of information systems, which typically increase productivity, organizational effectiveness, and business competitiveness (Enns and Huff 1999). Although deploying information systems should not be viewed as a magic bullet for solving problems inherent in any country, an effective LMIS that provides a flow of complete, accurate, and timely data can help health program managers improve their systems by reducing commodity costs, enhancing program management, informing policymakers by providing decision making data, providing better and more consistent customer service, and allowing greater control of contraceptive flows and accountability of donated contraceptives.

Developing country organizations, however, face a number of obstacles in designing and implementing multi-tier LMISs, including a dearth of technical skills for designing and implementing such systems, lack of resources, inadequate infrastructures for technical and communication services, and low literacy rates. These challenges are exacerbated for organizations working in the public sector, as they must also deal with such barriers as formalistic bureaucracies oriented toward control rather than service (Azad, Erdem et al. 1998) rapid staff attrition, and an underdeveloped organizational capacity for management (Serafeimidis and Doukidis 1999) Another problem that many developing country organizations face is that the processes for design and implementation of information systems often entail a top-down approach but fail to address the needs or support the activities of those using the system. Experience has shown that externally designed and developed systems imposed on a country or program have limited chances of success or adoption(Walsham 1992). The most successful examples of adoption and continued use of information systems in developing countries are those systems designed by the user to support their specific needs (Burbridge 1988). An LMIS that enhances the flow of information is critical to the successful implementation of a logistics system (Owens Jr and Warner 1996)

Logistics management information system (LMIS), whether manual or automated, seems to be one of the weakest links in the logistics chain in the developing countries which requires a lot of attention. There are so many problems that exist in the drug logistics management in the developing countries which result in the shortages (or stock outs) and uneven distribution of drugs, overstocking leading to expiries, among others. This affects the customers at the health facilities. According to some studies carried out in Jordan, Malawi, Mozambique, Nepal, Tanzania, Uganda, and Zambia, some of the problems in the drug logistics management include lack of accurate information, lack of staff training and support, weak supervision and monitoring, and shortage of human resources at all levels. (Macueve 2003) argues that, in Mozambique, the flow of information and medicines are not well synchronized which leads to many problems including stock-outs, expiry dates, and poor treatment of patients among others. (Sowedi et al. 2006) found out that in Uganda there are stock-outs of drugs, particularly of contraceptive supplies, at national, district and facility levels and several logistics issues were identified mainly inadequate drug needs assessment at district and facility levels.

Studies indicate that Tanzania (USAID DELIVER, 2007c) and Zambia (DELIVER 2007d, Bates & Rao 2000) face problems of lack of quality logistics data from the service delivery sites to district and central levels for proper decision making and monitoring system performance at the lower levels. (Lufesi, Andrew et al. 2007) argue that there is evidence that drug shortage is a major barrier to access essential drugs in the sub-Saharan Africa and suggest poor drug logistics management system as one of the causes of this problem. Other reasons suggested by other scholars (Conticini 2004, Lufesi, Andrew et al. 2007):include (1) weak data collection mechanisms to foresee customer’s drug requirements; (2) the time taken between ordering and receiving the drugs; (3) weak information management; and (4) insufficient deliveries of the drugs from regional medical stores to the health facilities, among others.

Medicines Availability in Uganda

(Birabwa, et al, 2014) argued that medicines availability is a challenge for low income countries due to lack of resources for medicines and health supplies, poor infrastructure and lack of workforce capacity. They noted that following the establishment of the WHO Model Essential Medicines List (EML) in 1977, many countries have adopted this concept in order to prioritize their medicine needs (Laing et al, 2003). (Birabwa et al, 2014) reported that under the Ugandan National Drug Policy essential medicines are a means of ensuring that safe, efficacious and good quality medicines are available and accessible at all times and that they are affordable and used appropriately ( MoH, 2002: Uganda National Drug Policy).

The Ministry of Health developed the first national EML list (EMLU) was released in 1991 and is updated approximately every five years, most recently in 2016 (MOH, 2016). (Birabwa et al, 2014) argue that although essential medicines should be freely available at public health facilities this is not necessarily the case forcing the population to rely on pharmacies and drug shops in the private sector, particularly for obtaining life-saving medicines (Medicines Transparency Alliance, 2010; MoH, 2010; Uganda Bureau of Statistics, 2012). Few studies have looked at the availability of essential medicines in private outlets. In this study, it is important to note that LMIS may affect the availability of these essential medicines and possible stock outs. The study will be done in Eastern and Northern Uganda.

Economic Policy Research Centre (2010) reported that by 2009, a top HSSP II policy target was increasing the percentage of health facilities without any stock outs of first line anti-malarial drugs, measles vaccine, Depo Provera, Oral Rehydration Solution (ORS) and cotrimoxazole from 40 percent in 2003/04 to 100 percent in 2009/10. This policy target has not been attained. The in-charges of the public health facilities reported (in nine out of every 10 cases) that they experienced stock outs of anti-malarials and basic medical supplies – such as gloves within the six months that preceded the visits. This is worse than the MoH report that “72 percent of government health units experience stock outs of at least one indicator medicines”. Some dissatisfied patients who were being asked to purchase medicines and medical supplies satisfied from private drugs shops alleged that health workers were diverting public medicines to their private clinics/drug shops. No concrete evidence of this was found. What is clear is that drug stock outs are a huge obstacle that must be overcome if people’s access to medicines is to improve dramatically (Economic Policy Research Centre (2010).

The stock outs of the antibiotics were not common with only 14.3 percent and 15.6 percent of the facilities with up dated stock cards for septrin and amoxicillin respectively (cited in Economic Policy Research Centre (2010). These findings corroborate with those of UBoS (2009). The stock outs for septrin and amoxicillin lasted on average 41 and 69 days for septrin and Amoxicillin respectively. Most of the health facilities visited lacked gloves and syringes; patients are required to buy such items to enable medical personnel to examine or treat them. Lack of gloves poses health risks for the medical staff.

In December 2010, MoH and the SURE Program conducted an assessment of the kit system (MoH 2011). The study found that since the introduction of the kits, the per capita funding for essential medicines and health supplies has increased. In addition, average days of stock-outs per month for all EMHS decreased from 20 to 5 days following introduction of the kits. Among five tracer drugs assessed, a 69 percent decrease in the number of stock-out days was observed. However, the study also found that 63 percent of products were oversupplied, suggesting potential risk of expiry.

Use of LMIS

For quantification and determining orders for drugs and other health commodities (not including equipment), the Uganda health system relies on dispense-to-user data gained from health unit monthly reports. The reports, part of the HMIS, list rates of consumption for a variety of health commodities, and note number of stock-out days. This report is completed at the facility level and provided to the district level. At the district level the District Assistant Drug Inspector and District Health Officer utilize the dispense-to-user data for planning the distribution and reordering of health commodities. Thereby, all district health commodity orders cover all facilities in the district (MOH, 2008).

While procurement for the public sector is based on the Essential Medicines List of Uganda (EMLU), NMS does not stock all of the medicines on the EMLU. For instance, of the 22 anti-cancer medicines on the EMLU, NMS stocks 2, and health facilities rely on the private sector for the others. According to a value-for-money audit conducted by the Office of the Auditor General, NMS stocks drugs without regard to buffer stock levels; as such, certain drugs are in excess of the one-year requirement, while others are understocked. This was blamed as one factor that leads to the expiry of drugs and high incidences of stock-outs for vital medicines within NMS stores (Ministry of Health, Health Systems 20/20, and Makerere University School of Public Health. April 2012).

Consequences of poor LMIS

An assessment report by (Steve Wilbur et al, 2000) about Uganda logistic systems for public Health commodities identified several logistics factors leading to recurrent stock outs at facility level and two of them are poor storage and lack of knowledge about the logistics management systems. (Kitaka, 2010) also assessed the nature of storage facilities and adequacy of training of some of the staff in Logistics at the two health units.

Management process issues speak of functional operation of an organization such as budgeting, personnel, and general management. Organizational environment issues are identified as factors which are less tangible such as organizational culture, change, and behaviour. Leadership issues relate to the areas which involve the interaction and direction of the organization executive. Technical systems issues are mainly those referring to the hardware and software considerations of information technologies. Personnel issues are those issues surrounding each individual in the organization. These issues impact the planning, procurement, and deployment of information systems in their organizations (Beaumaster, 1999).

According to Kwon and Zmud (1987), MIS implementation processes were not easy to achieve. They also identified some issues which many organizations have faced and these factors also impacted organizational processes and products associated with each implementation stage. These factors include characteristics of the organization (specialization, centralization, formalization), characteristics of the system being adopted (complexity), characteristics of the task to which the system is being applied (task 20 uncertainty, role and responsibility of person performing the task, task variety), and characteristics of the organizational environment (uncertainty, inter organizational dependence). Another perspective of MIS challenges is also shown by Lucey (2005) that the problems relate to MIS included the following; lack of management in the design phase of the MIS, inappropriate emphasis of the computer system, undue focus on low level data processing applications, lack of management knowledge of computers, poor appreciation by information specialists on information requirements and lack of top management support.

CHAPTER THREE

METHODOLOGY

3.1 Study Area

The study was conducted in public health facilities in Lira district located on the northern part of Uganda. Lira district is the regional capital for Lango sub-region which is also referred to as north Kyoga region. Lira district had a recorded population of 515,666 people by 2012 as quoted by (Lira district local government, 2012). The district has 26 public health facility at different levels of care with one (1) regional referral, two (2) health centre IVs, twelve (12) health centre IIIs and eleven (11) health centre IIs.

Many programs with a focus on logistics have been run in Uganda case in point is SURE, UHSC. All these programs have not had the capacity to cover the whole country as such, many districts have been left out in the interventions. Lira district is one such district which has been left out of these logistics programs (MOH, 2015) The SPARS tool which assesses logistics indicators however was taken up as a national tool and was applied to all districts from all strata that is those that were in the intervention and those that were not. From the district league table which shows the district performance, it is generally visible that the districts outside the intervention had a generally poor score with Lira being in the lower percentile. These characteristics make the district virgin for the study as information obtained will have minimal confounders from previous logistics programs. Lira district was therefore chosen for these properties and convenient location for the research team

3.2 Study design and period

The study was conducted as a facility based cross-sectional study design to explore the factors that influence LMIS performance of the selected facilities including data quality, reporting rates. The study was conducted over a period of one (1) month in 2019. The period of review that was considered was FY 2018/2019 however data from other periods was reviewed to check the strength of archiving LMIS data.

Inclusion Criteria

Public facilities which attained their current level of care according to the Uganda health system hierarchy before F/Y 2013/2014 will be eligible for the study.

Exclusion Criteria

Public facilities which opted out of the study were excluded from the study.

Study Population and sampling procedure

The USAID delivery project guideline in the document a logistics indicators assessment tool recommends that at least 15% of the total facilities need to be sampled to increase the power of generalizability for a logistics assessment (USAID DELIVER, 2009). Following this recommendation therefore, a sample size of fifteen (15) out of twenty six (26). Basing on this recommendation, a sample size of 4 would be adequate thus the sample size above was chosen to increase data reliability and improve the quality of the study and yield statistical soundness of the data collected. Accordingly therefore the facilities were stratified according to the level of care for inclusion and representation of all the levels of care. To pick the health centers to participate in the study, the facilities were clustered based on their level of care. From these clusters, facilities were picked randomly as in the strata below. The regional referral hospital, and health center IVs will be included by default and purposively for their critical volume.

• One (1) regional referral
• 2 Health Centre (HC) IV
• Six (6) health center III s (randomly chosen from baskets representing health center IIIs)
• Six (6) health center II s (randomly chosen from baskets representing health center IIs)

3.3 Data Collection

A three (3) man team composed of the principle   investigator and two (2) research assistants traversed all the facilities selected collecting data for a period of four (4) weeks. The research assistants were pharmacy graduates doing their internship in lira regional referral hospital. These are expected to have a good understanding of LMIS and are trainable to be able to collect reliable data. The research assistants were subjected to a one-day training led by the principle   investigator. The training included an introduction to the survey’s purpose. The operational definitions were explained to improve uniformity in data collected. The data collection tool was reviewed in this training to ensure familiarity with the terminologies and general flow of the tool. The training had practice sessions where research assistants practiced using the data collection tools as well as pretest the tool in a non-participating facility. The principal investigator closely supervised the data collectors. A data quality assessment was carried out for every completed data collection tool to ensure all applicable fields have been filled and data had consistency.

3.4 Data Collection Tool (s)

The study used interviewer administered structured questionnaires to collect quantitative data. Checklists and observation tools and a key informant interview guide to collect qualitative data. These are attached in the appendices.

3.5 Data Collection Procedures

Data collection was done in one phase using tools designed for data collection. Quantitative data was collected using semi-structured questionnaires and checklists adopted from USAID deliver guidelines, the SPARS tool and the NSCA tool with adjustments and review of key LMIS tools at the facilities. Socio-demographic data, facilities’ reporting rates, availability and utilization of reporting and recording tools, data quality of all reviewed LMIS data and factors associated with LMIS performance will be collected from these tools. Physical counts of medicines will be carried out and results used to compare against recorded stock card balances as a parameter for stock card accuracy. Qualitative data will be collected through guided key informant interviews and this will yield the challenges and possible solutions associated with LMIS performance. The subjects of these interviews will be selected purposively for their distinct knowledge and experience in the subject matter.

Document analysis is a form of qualitative research in which documents are used to give voice, interpretation and meaning. This study will use mainly standard operating procedures manual of health commodities logistics management system (DELIVER, 2006b) and (WHO, 2011) plus (MoH, 2012), Management of Medicines and Health Supplies Manual. These documents provide standardized operating procedures and guidelines for the management of health commodities in the integrated supply chain of the Ministry of Health. HMIS-105(Monthly Stock out Report), delivery notes, receipts, OPD register, HMIS-015 (Stock cards) and Order books/Forms will be also reviewed for purposes of collecting secondary supportive data and assessing usage of the three HMIS-015 ,017, 105.

For the qualitative wing of the study, one KII Participant will be recruited at each study site by the team. The key informants will be purposively selected for their knowledge on the subject matter. These will mainly be assistant inventory management officers (AIMO) or the dispenser/pharmacy technician where available or the head of pharmacy where available.  Permission will be sought from the relevant heads of departments/facility. Potentially eligible officials will be asked if they would be interested in talking to the study interviewer. Those that agreed will be introduced to the interviewer, who then will describe the study to the participant, determine their eligibility, and obtain their written informed consent to participate. KII participants will complete interviews in English. Face to face in-depth interviews with the KII will be conducted to collect qualitative data especially about challenges and possible solutions. The interviews will be conducted by the principal investigator to maintain the consistency of information. The interview will be tape recorded. The participants will be asked in-depth and probing questions to get broad information on the topic of interest. Each interview on average is expected to last 15 min.

3.6 Study variables

The dependent variable is the performance of Logistics and supplies management system, LMIS and the independent variables will be;

• LMIS Human resource factors
• LMIS tools availability.
• Implementing partner support for LMIS.

3.7 Performance of LMIS

The performance of LMIS data will be judged based on data collected on key elements of the LMIS status found at the facility. The data will be collected and recorded on the different research tools attached in the appendix of this proposal. These will try to highlight elements such as;

Presence of vital LMIS components at the facilities eg. Stock cards, requisition vouchers, delivery notes, dispensing logs, monthly summaries / report, by-monthly forms, annual procurement plan, discrepancy notes, invoices and stock taking sheets.

• Completeness – the available LMIS data will be analyzed for completeness i.e all the incomplete vital fields in the above LMIS components will be captured in the data entry sheets and reported appropriately. These vital fields include; item descriptions, dosage forms, strength, date of event, quantity, expiry date, batch number e.t.c.
• Accuracy – selected indicator medicines adapted from the modified WHO indicator medicines will be used to measure the accuracy of the LMIS data found at the health facility. LMIS data found on these medicines will be cross referenced with raw data from requisition vouchers and delivery notes. This will be done mainly for the stock cards in the main stores and or central pharmacy stores in-cases where these are different. Also analysis will be made to evaluate if information captured from stock taking if any is captured in the stock cards.
• Timeliness of submission – reports and orders which are supposed to be submitted on schedules were reviewed against the provided schedule. The date of submission was obtained from a receipt stamp date or for electronic reports or orders the electronic time stamp was extracted to obtain a comparison. The medicines management manual will then be used to guide the timeliness basing on the recommendations therein.

3.8 Data Management and Analysis

The raw data from the tools was coded and entered in to a data management software particularly statistical package for social sciences (SPSS) version 20. The data was then analyzed using descriptive and inferential statistical methods the outputs were then summarized using tables & figures. Relevant tests particularly chi-square test were then run to determine the associations between the dependent and independent variables. A critical values p < 0.05 was considered as statistically significant to assert an association.

The recorded KII were then transcribed in word then, the findings were analyzed manually using the thematic analysis technique. The dominant themes were then described and a report produced from the same.

3.9 Ethical Considerations

Ethical approval was obtained from the School of Health Sciences Institutional Review Board. Permission to conduct study activities was also obtained from the office of the DHO to be able to access the selected facilities for the study.  Written informed consent was obtained from all study participants.

Apart from that consent, confidentiality, non-payment for information and anonymity was ensured in this study and the report.

CHAPTER FOUR

PRESENTATION AND ANALYSIS

4.0 introduction

This section presents the findings of the study in relation to the study objectives and the study questions.

4.1 Demographic composition of respondents

This section presents the demographic composition of the respondents specifically the Bio data which included; gender of respondents and educational level of respondents.

4.1.2 Gender of the respondents

The table below presents the gender of the respondents as found from the Lira regional referral hospital;

Table 1: Gender of respondents

The findings from the table above indicates that majority of the respondents 53.3% were male and only 46.7% were female. This findings also further indicates that both gender of the respondents was well represented during the study. This study results also further indicates that the male gender is slightly more than the female gender in the lira pharmacy department.

4.1.2 Educational level of respondents

The table below presents the findings on the educational level of the respondents;

Table 2: Educational level of respondents

The study results further indicates that majority of respondents were either diploma or certificate holders while only 6.7% () of the respondent were a master’s degree holder. This results also indicated that the people of lira regional referral hospital are well educated and therefore could answer the questions asked from an informed perspective.

4.1.3 Facility level care

The table below presents the type of Health facilities;

Table 3: Facility level care

The study results indicates that majority 40% (6) of the facilities HCIII, 40% (6) were HCII. The table further indicates that 13.3% (2) were HCIV and the remaining while 6.7% (1) was RRH. This study results also shows that HCIII and HCII are the main prevalent health facilities around.

4.1.4 Time spent at the facility

The findings from the table below indicates the time the employees spend at the work place

Table 4: Time spent at the facility

The findings in the study indicates that majority 46.7% (7) of the respondents have spent between 1-2 years, between 2-5 years 20% (3), below 1 year 20% and the remaining 13.3% 5-10 years. Since most of the respondents have spent a considerable amount of time at the facility therefore this indicates that majority of the respondents have knowledge regarding the subject matter and therefore they could answer the questions asked from a well-informed point of view.

4.1.5 Findings on time spent in public service

The table below shows the time employees spend at public service;

Table 5: time spent in public service

The table results indicates that majority 33.3% (5) of the respondents had spent 2-5 years in public service, while between 5-10 years had 26.7% (4). On the same note only 6.7% (1) had spent below one year and 13.3% (2) has spent more than 10 years in public service. This study results also indicates that majority of the respondents have the required knowledge regarding the LMIS in lira regional referral hospital.

4.2 To explore the human resource capacity factors that influence the performance of logistics management information systems in public health facilities in Lira district.

This section discusses the findings in the study in relation to human resource capacity factors that influence the performance of logistics management information systems in public health facilities in Lira district

4.2.1 Findings on the responsibility of respondents in medicines in management

According to the results in the study 80% (12) of the respondents have responsibility of medicines in management and only 20% (3) do not have responsibility in medicines. The results also indicated that majority of the respondents given questionnaire have a direct responsibility on the medicines therefore they answered the question based on the knowledge they have.

4.2.2 Number of facility pharmacy staff

The table below indicates the number of pharmacy staff

Table 6: Number of facility pharmacy staff

The study results also further indicates that 80% (12) of the facilities had one pharmacists for their respective facilities.  This results therefore indicates that most pharmacies have very few staff to carry on their activities. It has also been revealed that Lira Regional referral hospital have one pharmacy staff.

4.2.3 Training Staff

The researcher used scales to enable in the analysis of nominal data in SPSS. The scale include; 0-no, 1-yes.

Table 7: Findings if the Staff have been trained

The table results indicates that majority of the respondents indicated that there is no pre-service training in school. The table further indicates that the respondents disagreed that formal training is offered. Table results also further shows that majority of the respondents indicated that they have been offered on-job training by other facility staff and still on the same results majority of the respondents indicated that majority of the staffs indicated that on-the-job training by outside persons is offered while only very few respondents indicated that they have never been trained.

4.2.4 Findings on the staff knowledge on storage

This section presents the knowledge of staff on storage;

Table 8: Staff knowledge on storage

According to the findings of the study the respondents indicated that they can fill and update inventory tools. This response therefore indicated that the staff were knowledgeable in this area. The study findings further indicates that they can make orders this was represented by the fact majority of the respondents agreed that yes.

The table results further shows that majority of the staff also further indicated that they know the good storage practices and very few indicated that they can prioritize the needs.

On regarding the question if the staff can review reports it was reported that very few of the staff indicated that they can review reports. This also indicates that the staff cannot review reports.

On regarding the question if the staff can categorize expenditure it was revealed that majority of the staff indicated that they cannot categorize expenditure. The respondents further indicated that on the question if LMIS can maintain optimum stock levels it was revealed that majority of the respondents disagreed.

4.2.5 Number of staff trained in LMIS

This section presents the findings on the Number of staff trained in LMIS

Table 9: Number of staff trained in LMIS

According to the findings in the study majority 66.7% (1) of the staff are trained in LMS, 13.3% (2) of the respondents had 0, and facilities with 2, 3, and 5 or more trained in LMS were 6.7%. The results above also indicates that Lira regional referral hospital has only one staff trained LMS. This results also further indicated the challenge Lira regional referral hospital is facing regarding the low numbers of staff.

4.3 To explore the logistics management information systems tools availability factors that influence the performance of logistics management information systems in public health facilities in Lira district.

4.3.1 Findings if the facility have LMIS

The table results indicates that all the facility have LMS. From the above findings it is evident that Lira regional referral hospital has the logistics management information system.

4.3.1 Findings on which form LMS

The table below presents form(s) of LMIS are there

Table 10: Findings on which form LMS

In line to the question regarding the form of LMIS systems used in Lira regional referral hospital it was revealed that, Majority 80% (12) of the respondents stated that the LMIS is paper based only while only 20% indicated that the LMIS is paper and electronic.

4.3.2 Filling and updating inventory tools

The results indicated that all 100% (15) of the respondents stated that they can update inventory tools. This therefore further indicated that all the staff know how to update inventory Books. According to the study results it was also further reveled that it has been imperative in filling and updating inventory tools.

4.3.3 Findings if the respondents can estimate the annual requirements

Table below presents if respondents can estimate the annual requirements

Table 11: Respondents can estimate the annual requirements

Table results also indicates that majority 86.7% (13) of the respondents indicated that they cannot estimate the annual requirements, while 13.3% (2) of the respondents indicated that they can estimate. The fact that very few respondents can estimate the annual requirements therefore indicates Lira regional referral hospital must train its employees on estimate the annual requirements so that there is efficiency in the supply chain of the drugs in the hospital.

4.3.4 Inventory Filling

The table below present’s response on the knowledge of the response on respondents can estimate the annual requirements

Table 12: Inventory Filling

The results indicates that majority of the respondents indicate that they have received training in filling and updating inventory tools. This indicated by the fact that all the respondents agreed with the findings.

According the response on whether respondents have received training in making inventory reports majority of more than 60% of the respondents agreed.

Table also represents the fact that majority of the respondents disagreed with the statements that have you received training in quantifying needs majority of the respondents disagreed more to that in line with the findings of the study it was also further revealed that all he respondents indicated that they have received training in estimating annual requirements.

According to the findings on the study it was also further revealed that very few respondents stated that they have received training in prioritizing needs. The study findings also further reveals that respondents further indicated that they not received training in categorizing expenditure.

The response from the study also further indicates that majority of the respondents stated that they have received training in reviewing reports, this is indicated by the fact very respondents acknowledged.

4.3.5 Findings on the importance level to maintaining an efficient LMIS

The study results indicates that majority 80% (12) of the respondents indicated that that is important to maintain levels of LMIS at optimum levels. This was also further indicated by the fact that only the remaining 20% (3) stated that not important, useless, and very important.

4.3.6 Are LMIS reports generated and sent anywhere

According to the findings in the study it has been revealed that 100% of the respondents indicated that LMIS reports are generated and sent anywhere.

From the above findings it has therefore revealed that LMIS reports are generated and sent anywhere.

4.3.7 ARV order and report

The study findings shows that majority 56% (9) of the respondents stated that ARV order and report is one of the different ways of enhancing the Logistics management information system in Lira regional referral hospital.

4.3.8 Analysis of supervision frequency

On analyzing the frequency of supervision using the scale of; Never, 1- weekly, 2-monthly, 3-Quartely, 4-Bi-annually, 5-Annually.

According to the study findings it was revealed that majority of the respondents indicated that most recent supervision was performed Bi-annually and supervision frequency was also discovered to have been at least quarterly. This responses indicated that the rate of supervision is slow and needs to be improved in Lira regional referral hospital.

4.3.9 Findings on the knowledge skills of the respondents regarding LMIS

On findings out on the knowledge and skills of the respondents it was revealed that; 0-no, 1-yes, 2-Idont know, while on findings out on the different ways

According to the findings in the table above it has been revealed that MAJORITY of the staff at Lira Regional referral hospital have gaps in Knowledge regarding LMIS this therefore indicates that there is need for the training of these employees on the key skills regarding LMIS. It was revealed that majority of the staff indicated that there is need for coaching and mentorship while others indicated that there is need for written instructions on how to improve.

4.3.9 Findings on supervision tools

The researcher used scales of which 0=no while 1= yes, 2= I don’t know and the results are presented in the table below;

Table 13: Findings on supervision tools

On the findings whether there is a supervision tool most of the respondents indicates that they are not aware of the supervision tool. On the question regarding the supervision schedule it was revealed that there are most of the respondents indicated that they are not aware.

The study results indicates that majority of the respondents indicates that Review procedures for stock control is done since most of the respondents indicated yes.

In line with the table it was also revealed that reviewing procedures for ordering and reporting was accepted by majority of the respondents. The study results also further indicates that majority of the respondents indicated that Conducting stock checks is imperative in managing the stock.

The study findings further shows that majority of the respondents agreed that it is imperative to institute on job training to improve performance and this is also in line with the Review of changes made since last supervision visit.

The study findings further indicates that majority of the respondents indicated that majority of the respondents Discussed what is working and what is not working in the study.

4.3.10 Findings on the reporting systems

On finding out regarding the commodities it. The researcher used scales of which 0=no while 1= yes.

The results are presented in the table below;

Table 14: Findings on the reporting systems

The study findings further shows that majority of the respondents indicated that regarding HIV commodities the response was no, while Tb commodities the response was also no. on the matters of FP/RH commodities the answers was no. the study results was also further indicated by the fact that tracer commodities the answers was no and all commodities the answer was no.

To explore the implementing partners activities that influence performance of logistics management information systems in public health facilities in Lira district.

4.4.1 Activities that influence performance of logistics management information systems

The researcher used scales to enable in the analysis of nominal data in SPSS. The scale include; 0-no, 1-yes, 2-I don’t know.

According to the table results above it has been revealed that Inventory management is the main activity that affects performance of the LMIS in Lira regional referral Hospital and also on the same note majority of the respondents also disagreed that Budgeting, waste management and scheduling visits have little influence of LMIS and other factors with the main influence on LMIS are redistribution.

According to the findings in the study it has been reported that majority of the respondents in Lira regional referral hospital assert that  Inventory management is one of the Activities that influence performance of logistics management information systems in Lira regional referral hospital.

None of the respondents indicated that Budgeting and waste management are key in in the inventory  while on the question of Scheduling supervision visits very few respondents hold the view that it is essential in influencing performance of logistics management information systems.

4.4.2 ANALYSIS OF BUDGET of LMIS

The researcher used scales to enable in the analysis of nominal data in SPSS. The scale include; 0-no, 1-yes, 2-I don’t know.

Table 15: Analysis of budget of LMIS

In analyzing the budget situation of LMIS. It was revealed that on regarding the question of availability of the budget for LMIS majority of the respondents disagreed this also indicated that there was no budget for LMIS. On another note the respondents also disagreed that there was government funds.

The table further indicates that IP funds was not there, while on regarding facility income of funds it was revealed that there were not available.

Table indicating the responses

In analyzing the inventory data quality, LMIS report quality, LMIS, LMIS utilization level. The study used the following scale to determine the responses from the respondents.

The scales included; 1-excellent, 2-very good, 3-good, 4-fair, 5-poor and 6-very poor.

Table indicating the responses

From the table results it can be noted that the respondents indicated that Inventory data quality mean value of 3.20 indicating that majority of the respondents stated that the Inventory data quality is good. Regarding the LMIS report quality it can be noted that majority of the respondents indicated that LMIS report quality was good. The table further indicates that LMIS utilization level is good.

CHAPTER FIVE

DISCUSSION, CONCLUSION AND RECOMMENDATIONS

5.0 Introduction

This section presents discussion, conclusion and recommendations of the study.

5.1 Discussion of the study findings

This section discusses the findings of the study in line to study objective which included; to explore the human resource capacity factors that influence the performance of logistics management information systems in public health facilities, to explore the logistics management information systems tools availability factors that influence the performance of logistics management information systems in public health facilities  and to explore the implementing partners activities that influence performance of logistics management information systems in public health facilities.

5.1.1 To explore the human resource capacity factors that influence the performance of logistics management information systems in public health facilities in Lira district.

From the study it has been indicated that there is no pre-service training in school, this study results further shows that the LIRA regional referral hospital does not offer training services to the employee.  From the results in the study it has been evident that the respondents indicated that formal training is not offered. This therefore acts against the need for training in the organization. From the above analysis it can therefore be revealed that since there is no pre-service training it can therefore be started that lack of appropriate training mechanism can affect the performance of logistics management information system, this finding also contradicts with Pool & Pool, (2007) who indicated that training remains a vital to enhancing employee performance. The organizational commitment or “the relative strength of an individual’s identification and involvement in a particular organization. Depends on effective training and development programs. According to these authors, organizations demonstrating keen insight make provisions for satisfying the training needs of their current workforce. It is therefore imperative for Lira regional referral hospital to train its employees.

On further analyzing the findings it was also discovered that the results indicated that majority of the respondents indicated that they have been offered on-job training by other facility staff and still on the same results majority of the respondents indicated that majority of the staffs indicated that on-the-job training by outside persons is offered while only very few respondents indicated that they have never been trained this therefore indicates that the logistics management information system is faced with challenges.

On the findings whether there is a supervision tool most of the respondents indicated that they are not aware of the supervision tool. On the question regarding the supervision schedule it was revealed that most of the respondents indicated that they are not aware if there is supervision tool at the facility this has thus affected the ability of the organization to supervise the employees hence affecting their performance. Results therefore indicates that supervision of the human resource at Lira district is not effected something that further poses challenges on the performance of logistics management information systems , this results also further contradicts with the findings of  Pareek and Rao, (2016) who indicates that Performance appraisal of employees is the systematic evaluation of employees′ performance and potential for development during a certain period of time by supervisors or others who are familiar with their performance and it is very important for the employers to ensure that employees are supervised to enhance better quality input and output.

In the study it has been evident that Review procedures for stock control is done since most of the respondents responded with acknowledgement from this analysis it therefore can be said that the organization carries out review procedures for stock. The results therefore indicates that essentiality of reviewing of procedures for stock control is recognized by Lira regional referral Hospital in the effort of ensuring that can enhance better performance of logistics management information systems, this is also in line with Hu, Dong, Hwang, Ren, & Chen, (2020) adopting Automation; In the age of automation, technology plays a major role in increasing the efficiency of an organization. There are number of ways you can automate the logistics process, including tracking and monitoring each delivery.

In line with the table it was also revealed that reviewing procedures for ordering and reporting was accepted by majority of the respondents. The study results also further indicates that majority of the respondents indicated that Conducting stock checks is imperative in managing the stock. It can therefore be indicated that lira district is supposed to carry out periodic review of stock control.

From the results it can also be concluded that it is imperative to institute an on job training mechanism so as the human resource has the necessary skills to enable it be in position to achieve better performance of logistics management information systems to have an overall improvement in the performance of the organization, this is also in line with Winkelhaus, & Grosse, (2020) who indicates that it is imperative to ensure that the organization plans  well for both its human resource and LMIS to enable better resource utilization the authors further indicated that; efficient logistics is about planning. It involves procuring the goods, storage facilities, and delivery of products to the final destination. The purpose of planning is to attain maximum work in the least possible time, as well as aim at maximizing the profits. a good logistics manager will, therefore, make sure to plan well ahead in order to eliminate any delays in the supply chain and on the same note Hewitt, (2009) further calls for Compensation on employees and also indicates that motivational effect and therefore implies that having a compensation structure in which the employees who perform better are paid more than the average performing employees is vital to enhancing organizational performance.

On the analysis of the competence of the human resource it was revealed that majority of the respondents stated that they can fill and update inventory tools, this view therefore indicates that the organization has made an effort in training the human resource to gain some knowledge on the critical issues of filling and updating inventory tools this therefore has improved on the performance the quality of Human resource as regards to performance of logistics management information system.

On regarding the staff who were knowledgeable in the area of inventory management it was revealed that some few staff had knowledge however majority did not poses this critical knowledge therefore it is imperative to train the human resource to gain knowledge in the key areas which is a pre-requisite in logistics management information systems, this view was also indicated by Opatha (2012) who indicated that organizations should design the job specification that is easy for employees to interpret.

On regarding the question if the staff can categorize expenditure it was revealed that majority of the staff indicated that they cannot categorize expenditure. The respondents further indicated that on the question if LMIS can maintain optimum stock levels it was revealed that majority of the respondents disagreed.

5.1.2 To explore the logistics management information systems tools availability factors that influence the performance of logistics management information systems in public health facilities in Lira district.

According to the findings in the study it has been revealed that LMIS reports generated and sent anywhere as it has been revealed by the fact all of the respondents indicated that LMIS reports are generated and sent anywhere. This view also further indicates that the LMIS reports are generated and sent anywhere. This also further points to the fact that Information systems technology of Lira district are effective as they are generated and sent any were. From the study results it has been revealed that the ARV order and report is one of the different ways of enhancing the performance of logistics management information systems. This is also in line with Ma’sum, & Aripin, (2020) who indicates that automation enables faster collection, transmission, and aggregation of data, and helps to eliminate human error in calculations, it will not solve every supply chain challenge. Often other interventions are needed prior to automation. As a case in point, automating bad management practices can waste money and make poor processes operate faster while achieving no performance improvement. As another example, if there are data quality issues at one level of the supply chain, automation will not improve the data quality without appropriate efforts in quality assurance, management, supervision, and data collection training. If strong business practices are not present prior to automation, the commitment of time and resources for process improvement will be necessary to ensure that the automation will successfully address the identified supply chain challenges and not exacerbate them.

5.1.3 To explore the implementing partners activities that influence performance of logistics management information systems in public health facilities in Lira district.

The study findings shows that Inventory management is the main activity that affects performance of the LMIS in Lira regional referral Hospital and also on the same note majority of the respondents also disagreed that Budgeting, waste management and scheduling visits have little influence of LMIS and other factors with the main influence on LMIS are redistribution, this was also further in line to the Economic Policy Research Centre (2010) who states that the stock outs of the antibiotics were not common with only 14.3 percent and 15.6 percent of the facilities with up dated stock cards for septrin and amoxicillin respectively. Most of the health facilities in Uganda lack gloves and syringes; patients are required to buy such items to enable medical personnel to examine or treat them. Lack of gloves poses health risks for the medical staff.

In analyzing the budget situation of LMIS. It was revealed that on regarding the question of availability of the budget for LMIS majority of the respondents disagreed this also indicated that there was no budget for LMIS. On another note the respondents also disagreed that there was government funds.

From the table results it can be noted that the respondents indicated that Inventory data quality mean value of 3.20 indicating that majority of the respondents stated that the Inventory data quality is good. Regarding the LMIS report quality it can be noted that majority of the respondents indicated that LMIS report quality was good. The table further indicates that LMIS utilization level is good.

5.2 Conclusion

The study made the following conclusions;

The human resource of lira district lack proper knowledge eon key areas of stores and inventory management like stores management, Inventory filling and update inventory lists. This should also be accompanied by acquiring modern inventory management techniques to enhance the proper management of the system.

Inventory management systems in lira district is still at a low scale and this has thus affected the performance of the organization in many different ways.

There systems is so manual and this has a lot of inefficiencies in the inventory and stores management cycle there by affecting the performance of an organization.

5.3 Recommendations

Lira district should increase more investments in improving the quality of Human resource in key areas like stores management, Inventory filling and update inventory lists. This should also be accompanied by acquiring modern inventory management techniques to enhance the proper management of the system.

Lira regional referral Hospital should also adopt modern methods of managing inventory this will help in enhancing the performance of the district logistics management systems.

There is need to automate the entire process of logistics management systems of lira district to reduce on the inefficiencies.

REFERENCES

Bates J, Chandani Y, Crowley K, Durgavich J, Rao S. (2000). Implications of health sector reform for contraceptive logistics: a preliminary assessment for Sub-Saharan Africa. Arlington, VA: Family Planning and Logistics Management/John Snow, Inc., for the US Agency for International Development (USAID); 2000.

Beith, A., et al. (2006). “Decentralizing and integrating contraceptive logistics systems in Latin America and the Caribbean with lessons learned from Asia and Africa.”

Birabwa, C., Murison, J., Evans, V., Obua, C.,Agaba, A., Waako, P and Pollock A (2014). The availability of six tracer medicines in private medicine outlets in Uganda. Journal of Pharmaceutical Policy and Practice 2014, 7:18 doi:10.1186/s40545-014-0018-y

Boddy, D., et al. (2005). Managing information systems: an organisational perspective, Pearson Education.

Bossert1, T, J.,  Bowser D, M and  Amenyah, J.K (2007). Is decentralization good for logistics systems? Evidence on essential medicine logistics in Ghana and Guatemala. Health Policy Plan. (2007) 22 (2): 73-82. doi: 10.1093/heapol/czl041

Chikumba, P. A (2009). Application of the Geographic Information System (GIS) in the Drug Logistics Management Information System (LMIS) at the district level in Malawi: Opportunities and Challenges. University Of Oslo, Master Thesis, 10th May 2009

Conticini, A. (2004). “Macroeconomics and Health in Malawi: What way forward.” WHO, October 64.

Economic Policy Research Centre (2010). Governing Health Service Delivery In Uganda: A Tracking Study Of Drug Delivery Mechanisms, Research Report. Economic Policy Research Centre, January 2010. Research Report No. 1

Global Health. 2008. From More to Better: Towards Leveraging Supply Chain Innovation Across Global Health Initiatives.

John Snow, Inc. Family Planning Logistics Management (FPLM). 2000 Logistics Management Information System Assessment Guidelines. Arlington, Va.: FPLM/John Snow, Inc., for the U.S. Agency for International Development.

Kitaka G (2010). Describing The Quality Of A Logistics And Supplies Management Systems At Kisasi And Kitende Health Centre Iis – Under Namirembe Diocese – Church Of Uganda. Pgd Thesis Makerere University College Of Health Sciences – Uganda.

Konde-Lule J, Gitta SN, Lidnfors A, Okuonzi S, Onama VON, Forsberg BC: Private and public health care in rural areas of Uganda. BMC Int Health Hum Rights 2010, 10:29.

Laing R, Waning B, Gray A, Ford N, t’ Hoen E (2003). 25 years of the WHO essential medicines lists: progress and challenges. Lancet 2003, 361(9370):1723-1729.

Levison L, Laing R. The hidden costs of essential medicines. Essent Drugs Monit. 2003;33:20–1. [Medicines Prices Special Supplement]

Lufesi, N. N., et al. (2007). Deficient supplies of drugs for life threatening diseases in an African community.” BMC Health Services Research 7(1): 86.

Manso, J. F., Annan, J., & Anane, S. S (2013). Assessment of Logistics Management in Ghana Health Service. International Journal of Business and Social Research (IJBSR), Volume -3, No.-8, August, 2013

Medicines Transparency Alliance: Report on the Uganda Pharmaceutical Sector Scan – Summary, June 2010. Amsterdam; 2010.

[http://www.medicinestransparency.org/fileadmin/uploads/Documents/countries/Pharma_Scan/MeTA_Uganda_Pharmaceutical_Sector_Scan_-_Summary_report.pdf]

Ministry of Finance, Planning and Economic Development (MoFPED). 2006. Development Cooperation Uganda 2005/06 Report. Kampala: MoFPED, Republic of Uganda.

Ministry of Finance, Planning and Economic Development. 2010. Reference forthcoming.

Ministry of Health, Health Systems 20/20, and Makerere University School of Public Health. April 2012. Uganda Health System Assessment 2011. Kampala, Uganda and Bethesda, MD: Health Systems 20/20 project, Abt Associates Inc.

Ministry of Health, Pharmacy Division-Republic of Uganda: Report on updating of the three year rolling procurement plan for essential medicines and health supplies 2009/10-2011/12 including evaluation of 2008/2009. Kampala: 2010. [http://www.health.go.ug/docs/Report_April.pdf].

Ministry of Health. 2006. The Health Management Information System Manual Vol. 1: The Health Unit Level. Kampala: Ministry of Health.

Ministry of Health. 2007c. Assessment of Public Expenditure on Health in Uganda. Kampala

Ministry of Health. 2008. Pharmaceutical Situation Assessment: Level II. Kampala.

Ministry of Health. 2009. Ministry of Health Draft Health Sector Strategic Plan. Kampala: Ministry of Health.

Ministry of Health. 2009a. Human Resources for Health Audit. Kampala: Ministry of Health and USAID Capacity Project.

Ministry of Health. 2009b. A Rapid Assessment of Community Case Management of Childhood Malaria, Pneumonia and Diarrhoea in the Context of Home Based Management of Fever (HBMF) and Home Based Care (HBC) in Northern Uganda. Kampala.

Ministry of Health. 2010. Status of Antiretroviral Therapy Service Delivery in Uganda. Kampala: AIDS Control Program, Ministry of Health.

Ministry of Health. 2011d. Policy Options Analysis for Uganda Pharmaceutical Supply System. Kampala.

Ministry of Health. 2011e. Annual Health Sector Performance Report Financial Year 2010/2011. Kampala: Ministry of Health

Ministry of Health-Republic of Uganda: Essential Medicines and Health Supplies List for Uganda (EMHSLU) 2012. Kampala; 2012. [http://childmed.ku.dk/uploads/media/Ministry_of_Health_-_Essential_Medicines_and_Health_Supplies_List_for_Uganda_2012_01.pdf]

Ministry of Health-Republic of Uganda: Health Sector Strategic Plan III 2010/11-2014/15. Kampala; 2010. [http://www.health.go.ug/docs/HSSP_III_2010.pdf]

Ministry of Health-Republic of Uganda: Uganda National Drug Policy. Kampala; 2002. [http://apps.who.int/medicinedocs/documents/s16463e/s16463e.pdf]

Ministry of Health, Health Systems 20/20, and Makerere University School of Public Health. April 2012. Uganda Health System Assessment 2011. Kampala, Uganda and Bethesda, MD: Health Systems 20/20 project, Abt Associates Inc

MINISTRY OF HEALTH AND POPULATION. 2003a. Measuring Health Sector Performance Handbook of Indicators. Malawi Government.

MoH (2012). Management Of Medicines And Health Supplies Manual.  Produced by: The Division of Pharmacy Services, Ministry of Health: Government of Uganda , March 2012

Msimangira K. A. B. 2010, Supply Chain Integration in New Zealand Public Hospitals: Impact on Supplier Commercial Relationships and Order Fulfilment, PhD. Thesis, Auckland University of Technology, Auckland

Nakkazi, E. 2009. Uganda: ARV shortage sets in as AIDS funding falls. East African (Nairobi). Aug. 3.

Nakyanzi, J. K., Kitutu, F. E., Oria, H., & Kamba, P. F. (2010). Expiry of medicines in supply outlets in Uganda. Bulletin of the World Health Organization, 88(2), 154–158. doi:10.2471/BLT.08.057471

Ndira, S.P., et al. 2008. Assessment of data quality of and staff satisfaction with an electronic health record system in a developing country (Uganda): a qualitative and quantitative comparative study. Methods of Information in Medicine (47): 48998.

Office of the Auditor General-Republic of Uganda: Value for Money Audit Report on the Regulation of Medicines in Uganda by National Drug Authority. Kampala; 2010. [http://www.oag.go.ug/uploaded_files/1305703459Regulation%20of%20Medicines%20in%20Uganda%20by%20National%20Drug%20Authority.pdf]

OWENS, R. C. & WARNER, T. 2003. Concepts of Logistics System Design. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for International Development (USAID).

Parliament of Uganda-Republic of Uganda: National Drug Policy and Authority Act. Kampala; 1993. [http://www.ulii.org/ug/legislation/consolidated-act/206]

Securing Ugandans’ Right to Essential Medicines (SURE, 2013). District level: Shelves Improve Medicines Management in Kisoro Hospital. http://www.sure.ug/?Success_Stories:District_level

Silve, B. 2009 ‘Health logistics is a profession: improving the performance of health in developing countries’ Field Actions Science Reports, Vol. 1, 19 Feb., PP 19-21.

Ssengooba, F. 2010. Performance-based contracting: a case study of non-profit hospitals in Uganda. In London School of Hygiene and Tropical Medicine. London: University of London.

Stanback J, Otterness C, Bekiita M, Nakazyiza O, Mbonye AK: (2011). Injected with Controversy: Sales and Administration of Injectable Contraceptives in Drug Shops in Uganda. Int Perspect Sex Reprod Health 2011, 37(1):24-29

Tashobya, C. K., Ssengooba, F & Valeria Oliveira Cruz (2006). Health Systems Reforms in Uganda: processes and outputs. Health Systems Development Programme, London School of Hygiene & Tropical Medicine, UK. ISBN: 0 902657 77 1

The World Medicines Situation 2011 – Storage and Supply Chain Management
(2011; 22 pages)

UBoS (2009). National Service Delivery Survey Report, 2008, Kampala, Uganda.

Uganda Bureau of Statistics: Uganda in Figures 2013. Kampala; 2013.

[http://www.ubos.org/index.php?st=page&id=9&p=Publications]

United Nations High Commissioner for Refugees; (2006). Drug management manual 2006 Geneva: Office of the United Nations High Commissioner for Refugees; 2006

New Vision (Mar 21, 2009). Drug shortage hits Uganda. Article by Ben Okiror

United States Agency for International Development (USAID) Office of the Inspector General. 2010. Audit of USAID/Uganda’s PEPFAR-funded Activities for the Prevention of Transmission of HIV. Washington, DC: USAID.

USAID (2012). Computerizing Logistics Management Information Systems a Program Manager’s Guide. OCTOBER 2012 this publication was produced for review by the U.S. Agency for International Development. It was prepared by the USAID | DELIVER PROJECT, Task Order 4.

USAID Deliver Project. (2008). Strengthening Laboratory Logistics Systems: Country Experience. USAID Deliver Project. Copyright © 2008 by John Snow, Inc. All Rights Reserved.

Wafula FN, & Goodman CA: Are interventions for improving the qualitative of serviced provided by specialized drug shops effective in sub-Saharan Africa? A systematic review of the literature. Int J Qual Health Care 2010, 22(4):316-323

WHO (2011). The World Medicines Situation 2011: Global Health Trends: Global Burden Of Disease And Pharmaceutical Needs. WHO, Geneva. Written by Kaplan W and Mathers, C. 3rd edition. http://www.who.int/medicines/areas/policy/world_medicines_situation/en/

WHO (2014). Logistics Management and Information System (LMIS)

Wilbur, S., Raja, S and Bonita B.B (2000); Uganda Logistics System for Public Health Commodities; An assessment Report (2000), FPLM Project, Arlington Va.

World Health Organization (2004). “Equitable access to essential medicines: a framework for collective action.”

APPENDICES

Appendix 1: INFORMED CONSENT FORM

Title of the proposed study: A study of the factors affecting the performance of logistics management information systems in lira district.

Investigators: 

1. AGUMA DANIEL (Pharmacy department Lira regional referral hospital)
2. KAMBA PAKOYO FADHIRU (Pharmacy Department Makerere University)
3. BUSH HERBERT AGUMA (Pharmacy Department Makerere University)

Study sponsor:Self Background and rationale for the study:

The world mainly developing countries is faced with health problems ranging from pestilence, poor and inadequate health facilities, lack of logistics for effective and efficient health service delivery, lack of health service providers and many others (Manso, Annan & Anane, 2013). However, it is the aim of every country to achieve SDG 3 which is to ensure healthy lives and promote well-being for all at all ages (UNDP, 2015). This can only be achieved if adequate supply of logistics are in place for efficient and effective service delivery. In turn, for adequate logistics, an efficient LMIS is vital to guide decision makers (UHSC, 2015). For developing countries especially in Africa such as Uganda, designing an effective and sustainable supply chain system and LMIS for medicines and other health commodities is important and can be complex (Manso et al 2013).

It is the aim of this study to determine and examine the factors responsible for the performance of LMIS in Lira district.

Purpose:This study is being conducted for the award of a Master of Science Degree in Pharmaceuticals and Health Supplies management at Makerere University. Procedures:The study will involve responding to a questioner which will be administered by the investigator. The information will be obtained through interview, observation and LMIS tool review. Study area and participantsThe study will be conducted in selected Public Health facilities in Lira district. Participants will be selected purposively for their knowledge in the subject matter.  

Risks/Discomforts:There is minimal risk in providing information for this study and confidentiality will be ensured to further minimise the risk to the respondents. Benefits:No monitory benefit will be got from participating in this study. The results of the study however will be disseminated to stakeholders whose actions might indirectly or directly benefit participants. Alternatives:Participation in the study is not mandatory and participants can opt out at any stage during the study.  Cost:The participant will not incur any costs during the course of this study or after its completion. In the event of the occurrence of costs, the investigator will incur or reimburse any costs incurred. Compensation for participation in the study:The participants will be interviewed at their work stations as such a modest safari day allowance SDA of fifty thousand Uganda shillings (UGX 50,000) will be provided for the time committed by the respondent. Reimbursement: Questions:In the event that you have any questions about the study at a later date, please contact

1. AGUMA DANIEL (Pharmacy department Lira regional referral hospital)

Phone: +256773085939/+256704815448

Email address: agumadaniel@gmail.com

Questions about participants rights:If you have any questions regarding your welfare and rights as a research participant, you can have their queries addressed toThe SHSIRB chairperson Dr. Paul Kutyabami-+256 772404970 or +256 0200903786)  Feedback on study findings and progress of the studyThe results of this study and any other findings will be shared with you at the facility level. Statement of voluntariness:Participation in this proposed study is voluntary and participants may join on their own free will. Participants also have a right to withdraw from the study at any time without penalty. Approval of the research studyThis study has been approved by the Institutional Review Board of Makerere University School of Health Sciences Research and Ethics Committee.

Confidentiality

The results of this study will be kept strictly confidential, and used only for research purposes. My identity will be concealed in as far as the law allows. My name will not appear anywhere on the coded forms with the information. Paper and computer records will be kept under lock and key and with password protection respectively.

The interviewer has discussed this information with me and offered to answer my questions. For any further questions, I may contact the Chairperson of the School of Health Sciences Research and Ethics Committee (MakSHSREC) on (+256) 772-404970 / (+256) 0200903786 / or Uganda National Council of Sciences and Technology. Tel: (+256)-041-4705500).

STATEMENT OF CONSENT

………………………………………………………………… has described to me what is going to be done, the risks, the benefits involved and my rights regarding this study. I understand that my decision to participate in this study will not alter my usual medical care. In the use of this information, my identity will be concealed. I am aware that I may withdraw at any time. I understand that by signing this form, I do not waive any of my legal rights but merely indicate that I have been informed about the research study in which I am voluntarily agreeing to participate. A copy of this form will be provided to me.

Name……………….Signature/thumbprint of participant ……………………..Age..……………

Date (DD/MM/YY)……………………………

Name……………………………………..Signature of Interviewer …………………………. Date (DD/MM/YY)…………………………

Appendix 2: Data collection tools

LMIS Data Quality

Table 5. LMIS Data Quality: Usable Stock on Hand at Time of Most Recent LMIS Report

Column:

1. Will be pre-populated with the same products as in table 1.
2. Whether or not the product is managed at this facility, answer Y for yes or N if no.
3. Check if the bin cards and RRF are available, answer Y for yes or N for no.
4. Get the most recent RRF report showing the selected products, and record the stock on hand from the RRF report in column 3.
5. Write the quantity of usable stock on hand from the bin card from the time of the selected RRF report.
6. Note the reasons for any discrepancy.

KEY INFORMANT

LOCATION………………………………………

INVESTIGATORT………………………………

DATE OF VISIT…………………………………..

Does the law require a pharmacist / pharmaceutical technician to be present during hours of

Operation facility?

Yes                         No                                                   Don’t know

Is a pharmacist / Pharm Tech present at the time of the visit?                  Yes                              No

Assessment

1       complies with the law (items 1 and 2 are both Yes)

2       does not comply with the law (item 1 Yes and item 2 No)

Who is carrying out Logistics responsibilities during the time of visit? (Check all that apply)

Others (specify)

The core indicators measure the most important information needed to understand the pharmaceutical situation in the facility.

Appendix 3: List of data collectors to be used

LOCATION………………………………………

INVESTIGATORT………………………………

DATE OF VISIT…………………………………..

Appendix 4: List of sampled health facilities to be visited.

LOCATION………………………………………

INVESTIGATOR………………………………

DATE OF VISIT…………………………………..

Appendix 5: Budget

Appendix 6: Time frame