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Stock-outs of essential medicines among community health workers (CHWs) in low- and middle-income countries (LMICs): a systematic literature review of the extent, reasons, and consequences
BACKGROUND: This paper explores the extent of community-level stock-out of essential medicines among community health workers (CHWs) in low- and middle-income countries (LMICs) and identifies the reasons for and consequences of essential medicine stock-outs. METHODS: A systematic review was conducte...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9287964/ https://www.ncbi.nlm.nih.gov/pubmed/35840965 http://dx.doi.org/10.1186/s12960-022-00755-8 |
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author | Olaniran, Abimbola Briggs, Jane Pradhan, Ami Bogue, Erin Schreiber, Benjamin Dini, Hannah Sarah Hurkchand, Hitesh Ballard, Madeleine |
author_facet | Olaniran, Abimbola Briggs, Jane Pradhan, Ami Bogue, Erin Schreiber, Benjamin Dini, Hannah Sarah Hurkchand, Hitesh Ballard, Madeleine |
author_sort | Olaniran, Abimbola |
collection | PubMed |
description | BACKGROUND: This paper explores the extent of community-level stock-out of essential medicines among community health workers (CHWs) in low- and middle-income countries (LMICs) and identifies the reasons for and consequences of essential medicine stock-outs. METHODS: A systematic review was conducted and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Five electronic databases were searched with a prespecified strategy and the grey literature examined, January 2006–March 2021. Papers containing information on (1) the percentage of CHWs stocked out or (2) reasons for stock-outs along the supply chain and consequences of stock-out were included and appraised for risk of bias. Outcomes were quantitative data on the extent of stock-out, summarized using descriptive statistics, and qualitative data regarding reasons for and consequences of stock-outs, analyzed using thematic content analysis and narrative synthesis. RESULTS: Two reviewers screened 1083 records; 78 evaluations were included. Over the last 15 years, CHWs experienced stock-outs of essential medicines nearly one third of the time and at a significantly (p < 0.01) higher rate than the health centers to which they are affiliated (28.93% [CI 95%: 28.79–29.07] vs 9.17% [CI 95%: 8.64–9.70], respectively). A comparison of the period 2006–2015 and 2016–2021 showed a significant (p < 0.01) increase in CHW stock-out level from 26.36% [CI 95%: 26.22–26.50] to 48.65% [CI 95%: 48.02–49.28] while that of health centers increased from 7.79% [95% CI 7.16–8.42] to 14.28% [95% CI 11.22–17.34]. Distribution barriers were the most cited reasons for stock-outs. Ultimately, patients were the most affected: stock-outs resulted in out-of-pocket expenses to buy unavailable medicines, poor adherence to medicine regimes, dissatisfaction, and low service utilization. CONCLUSIONS: Community-level stock-out of essential medicines constitutes a serious threat to achieving universal health coverage and equitable improvement of health outcomes. This paper suggests stock-outs are getting worse, and that there are particular barriers at the last mile. There is an urgent need to address the health and non-health system constraints that prevent the essential medicines procured for LMICs by international and national stakeholders from reaching the people who need them the most. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12960-022-00755-8. |
format | Online Article Text |
id | pubmed-9287964 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-92879642022-07-17 Stock-outs of essential medicines among community health workers (CHWs) in low- and middle-income countries (LMICs): a systematic literature review of the extent, reasons, and consequences Olaniran, Abimbola Briggs, Jane Pradhan, Ami Bogue, Erin Schreiber, Benjamin Dini, Hannah Sarah Hurkchand, Hitesh Ballard, Madeleine Hum Resour Health Research BACKGROUND: This paper explores the extent of community-level stock-out of essential medicines among community health workers (CHWs) in low- and middle-income countries (LMICs) and identifies the reasons for and consequences of essential medicine stock-outs. METHODS: A systematic review was conducted and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Five electronic databases were searched with a prespecified strategy and the grey literature examined, January 2006–March 2021. Papers containing information on (1) the percentage of CHWs stocked out or (2) reasons for stock-outs along the supply chain and consequences of stock-out were included and appraised for risk of bias. Outcomes were quantitative data on the extent of stock-out, summarized using descriptive statistics, and qualitative data regarding reasons for and consequences of stock-outs, analyzed using thematic content analysis and narrative synthesis. RESULTS: Two reviewers screened 1083 records; 78 evaluations were included. Over the last 15 years, CHWs experienced stock-outs of essential medicines nearly one third of the time and at a significantly (p < 0.01) higher rate than the health centers to which they are affiliated (28.93% [CI 95%: 28.79–29.07] vs 9.17% [CI 95%: 8.64–9.70], respectively). A comparison of the period 2006–2015 and 2016–2021 showed a significant (p < 0.01) increase in CHW stock-out level from 26.36% [CI 95%: 26.22–26.50] to 48.65% [CI 95%: 48.02–49.28] while that of health centers increased from 7.79% [95% CI 7.16–8.42] to 14.28% [95% CI 11.22–17.34]. Distribution barriers were the most cited reasons for stock-outs. Ultimately, patients were the most affected: stock-outs resulted in out-of-pocket expenses to buy unavailable medicines, poor adherence to medicine regimes, dissatisfaction, and low service utilization. CONCLUSIONS: Community-level stock-out of essential medicines constitutes a serious threat to achieving universal health coverage and equitable improvement of health outcomes. This paper suggests stock-outs are getting worse, and that there are particular barriers at the last mile. There is an urgent need to address the health and non-health system constraints that prevent the essential medicines procured for LMICs by international and national stakeholders from reaching the people who need them the most. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12960-022-00755-8. BioMed Central 2022-07-15 /pmc/articles/PMC9287964/ /pubmed/35840965 http://dx.doi.org/10.1186/s12960-022-00755-8 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Olaniran, Abimbola Briggs, Jane Pradhan, Ami Bogue, Erin Schreiber, Benjamin Dini, Hannah Sarah Hurkchand, Hitesh Ballard, Madeleine Stock-outs of essential medicines among community health workers (CHWs) in low- and middle-income countries (LMICs): a systematic literature review of the extent, reasons, and consequences |
title | Stock-outs of essential medicines among community health workers (CHWs) in low- and middle-income countries (LMICs): a systematic literature review of the extent, reasons, and consequences |
title_full | Stock-outs of essential medicines among community health workers (CHWs) in low- and middle-income countries (LMICs): a systematic literature review of the extent, reasons, and consequences |
title_fullStr | Stock-outs of essential medicines among community health workers (CHWs) in low- and middle-income countries (LMICs): a systematic literature review of the extent, reasons, and consequences |
title_full_unstemmed | Stock-outs of essential medicines among community health workers (CHWs) in low- and middle-income countries (LMICs): a systematic literature review of the extent, reasons, and consequences |
title_short | Stock-outs of essential medicines among community health workers (CHWs) in low- and middle-income countries (LMICs): a systematic literature review of the extent, reasons, and consequences |
title_sort | stock-outs of essential medicines among community health workers (chws) in low- and middle-income countries (lmics): a systematic literature review of the extent, reasons, and consequences |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9287964/ https://www.ncbi.nlm.nih.gov/pubmed/35840965 http://dx.doi.org/10.1186/s12960-022-00755-8 |
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