Perceived Satisfaction of Public Health Facilities’ with the Quality of Logistics Service Provided by Pharmaceutical Fund and Supply Agency Bahirdar Hub, Northwest Ethiopia: Descriptive Study

Background

Most scholars describe logistics services as the most critical elements that can help to achieve substantial customer satisfaction; however, managing the quality of logistics services is a difficult task [1]. Logistics is the process of planning, implementing, and controlling procedures for the safe and successful transport and storage of goods, and related information, from the point of origin to the point of consumption [2, 3]. Usually, logistics management practices include inbound and outbound transportation management, fleet management, warehousing, material processing, order processing, inventory control, and supply and demand planning [3, 4]. The rapid development of the logistics system will help to increase the distribution of goods within a short timeframe and the economic growth rate [5]. Recently, the basic definition of logistics service management has changed in two main ways: shifting from ‘attention to the internal impact of success (e.g., internal efficiency including labor productivity and profits) to external consequences’ (e.g., consumer satisfaction) and changing from ‘focusing on the system to focusing on the process as part of the supply chain” [6]. The logistics service involves practices used to handle customer feedback and enhance customer satisfaction [7, 8]. Dimensions of the quality of the logistics service that can be measured from a customer satisfaction perspective include the reporting and requisition procedure, capability of the staff, quality of the information, management of order discrepancies, product availability, service accuracy, timeliness, and product delivery condition [1].

The main metric for healthcare logistics services is customer satisfaction, and it is positively linked to the quality of the pharmaceutical logistics service [9]. The health logistics system is responsible for ensuring that every patient can access and use quality healthcare supplies [4]. Providing a complete healthcare service necessitates the availability of quality, safe, effective, and affordable medicines and supplies in adequate quantities at all times [10]. Despite this reality, Ethiopia’s pharmaceutical logistics system has had many issues in the past, including inaccessibility, unaffordability, poor storage and inventory management, and unreasonable use [11, 12, 13, 14]. In 2004, a national review of the performance of the existing public health pharmaceutical logistics system was conducted and several shortcomings and challenges were discovered. To solve these problems in public health facilities, the Pharmaceuticals Fund and the Supply Agency (PFSA) was established in 2007 by Proclamation No. 553/2007 based on the Pharmaceutical Logistics Master Plan (PLMP) [15, 16]. The agency is mandated to provide all public health facilities with affordable and high-quality pharmaceuticals in a sustainable way and to ensure rational use. Therefore, an integrated pharmaceutical logistics system (IPLS) has been developed and implemented since 2010 to execute its mandate effectively and efficiently [12, 14, 15]. IPLS is the primary mechanism by which all public health facilities found in Ethiopia get pharmaceuticals to fulfill the six rights of the logistics system through the implementation of effective, efficient, and easy-to-use systems [4, 14]. An assessment of various customer satisfaction metrics for the quality of logistics services in the health care system is necessary for continuous service improvement and the achievement of the best clinical outcome. Besides, assessing the logistics service quality from the customer perspective is usually more comprehensive [17, 18]. This study was therefore attempted to investigate the satisfaction of public health facilities in the quality of logistics services received from PFSA Bahirdar hub.

Methods

A descriptive research design was used to assess the level of satisfaction public health facilities with the quality of logistics service received from the PFSA Bahirdar hub. This study was conducted in public health facilities located in the West Gojjam zone, one of the most densely populated areas in the State of Amhara, Ethiopia. The capital city of this zone is Finoteselam town, which is 174 km from Bahirdar and 481 km from Addis Ababa. An estimated 2.2 million inhabitants live in this region. In the study area, there were 130 health centers and 6 primary hospitals. The data collection was carried out from 28 April/20, 2019 to – 20 June/2019.

All public health facilities in the West Gojjam zone were the study populations of this study. These public health facilities were all health centers, primary and general hospitals located in the study area. Public health facilities, getting pharmaceutical products from PFSA Bahirdar hub as the main supplier and started providing healthcare services at least 6 months before the data collection period and were included in this study. Besides, the pharmacy managers and pharmaceutical store managers who worked in their public health facilities for less than 6 months and were not on duty during the data collection period were excluded from this study.

All hospitals in the study area were selected purposively and simple random sampling with a lottery method was used to pick health centers from the sampling frame, which was prepared based on the inclusion criteria. Under the Logistics Indicators Assessment Tool (LIAT) of the USAID Delivery Project, a minimum of 15% of healthcare institutions within the study area is recommended for the determination of samples [19]. However, all hospitals and 20% of health centers located in the West Gojjam zone have been selected for this research. A total of 32 health facilities (i.e. 6 hospitals and 26 health centers) have been chosen for this research since a total of 130 health centers have been found in this area, taking 20 percent of them into account. The pharmacy head and a pharmaceutical store manager (both were pharmacists) in each selected public health were chosen purposively to fille the questionnaire. Therefore, a total of 64 participants were selected for data collection.

The questionnaire used to assess satisfaction with quality logistics services was taken from the questions that were examined and validated by various related literature [1]. Respondents were asked to gauge their satisfaction level as well as to express their overall verdict using a 5-point quantitative scale of the form: highly satisfied, satisfied, neutral, dissatisfied, and highly dissatisfied. The questionnaire had thirty-three questions grouped into two parts. Thirty-three questions in the questionnaire were grouped into two sections. There were three questions in the first section and it was supposed to collect demographic information regarding public health facilities. In the second part, twenty-nine questions, prepared with a five-point Likert scale, were asked to determine the extent of satisfaction with the questions prepared to assess the level of satisfaction with the quality of the logistics services received.

The data were collected through the administration and collection of the questionnaires under the supervision of the data collector. The data were checked for completeness and then entered into Epi Data software. After data cleaning was done, the data were analyzed with the Statistical Package for Social Science (SPSS) programs version 20. Frequency distribution, arithmetic means, standard deviation (S.D), and percentages were computed.

The quality of the data was ensured by properly preparing and pretesting the questionnaires. A pretest was conducted on 5 percent of the total sample size (i.e., 2 public health facilities) and an acceptable adjustment of the questionnaires was made to increase the reliability and accuracy of the data collection instruments. Cronbach’s alpha was estimated to measure the reliability of the final questionnaires used for data collection and was 0.953. The accuracy of the data was also ensured by proper categorization and coding of the questionnaires, giving instructions to respondents about the questionnaires, and evaluation of the completeness of the filled questionnaires before analysis.

The variables measured by this research include procedure, contact, information, discrepancy, availability, accuracy, timeliness, and condition of delivery. Procedures: refers to the effectiveness and easiness of the reporting and ordering procedures used by PFSA Bahirdar hub, as well as the flexibility of the procedures in the event of demand changes. Contact: it is related to the expertise and willingness of PFSA Bahirdar hub staff to solve product or service issues. It also explores the efforts made by contact workers to understand specific business situations and their overall conduct. Information: This refers to the accuracy, availability, and completeness of the logistics-related information issued by the PFSA Bahirdar hub. Discrepancies: It examines the efforts of the PFSA Bahirdar hub to correct and respond to errors in requisition, as well as the appropriateness of the reporting process. Availability: It refers to the availability of requested pharmaceutical products at the PFSA Bahirdar hub and it also refers to the handling of a variety of pharmaceutical products in response to the unexpected demand increase. Accuracy: it refers to whether the pharmaceutical product meets both the specifications and technical requirements of the order, as well as the frequency of delivery of incorrect products or incorrect amounts from PFSA Bahirdar hub. Timeliness: It refers to the PFSA Bahirdar hub speed to process orders, and the time taken between order requests and receipts. Condition: It examines the effort of the PFSA Bahirdar hub to supply customers with actual damage-free pharmaceutical products and accurate distribution documents.

According to the National Research Ethical Review Guideline of Ethiopia, where the purpose of the study is to examine government programs designed to provide the public service and where information has been collected by the investigator in such a way that it is impossible to identify the study participants, it is exempted from ethical review [20]. Before starting data collection, verbal consent was obtained from all respondents, and confidentiality of the information was assured to them. Since the study involves no more than minimal risk to participants, verbal informed consent is acceptable under the National Research Ethical Review Guideline [20].

Discussion

Assessing customer satisfaction is one of the critical mechanisms for advancing the efficiency of various approaches to logistics in the health care system [21]. Therefore, this study focused on measuring the satisfaction of public health facilities with the logistics services they were receiving from the PFSA Bahirdar hub.

This study discovered that the majority of the respondents (64.1%) were neither satisfied nor dissatisfied with the overall quality of logistics services provided by the PFSA Bahirdar hub. This suggests that the satisfaction level was in the middle of the 5-Likert scale. However, 29.6% of the respondents expressed that they were satisfied with the overall quality of the logistics service they received. The remaining 4.7% and 1.6% of the respondents reported being dissatisfied and very dissatisfied, respectively. Therefore, more than 70.4% of the total participants were not pleased with the overall quality of logistics services they received from the PFSA Bahirdar hub, which has a tremendous effect on the quality of basic healthcare services being provided by the public health facilities.

The logistics service dimension with the second-highest overall mean value reported in this study was the reporting and requisition “procedure” employed by PFSA Bahirdar hub for serving public health facilities, with a mean value of 3.501. This shows that the PFSA Bahirdar hub employed effective and user-friendly procedures for reporting information and placing the order, and the procedure set out by PFSA Bahirdar hub was versatile to accommodate the unexpected variance in demand. The use of effective and efficient retrieval procedures by medical suppliers has notable effects on the customer’s satisfaction and the quality of services provided by healthcare organizations, thereby reducing procurement costs and distribution of goods [22, 23].

The “contact” (staff) of the PFSA Bahirdar hub was the dimension with the fourth-highest overall mean value. It was one of the dimensions with a mean value very close to the midpoint of the 5-Likert scale (mean=3.0), with a mean value of 3.388. It suggests that the customers of the PFSA Bahirdar hub were not significantly pleased with the knowledge and behavior of the staff, therefore, PFSA Bahirdar hub should take appropriate measurements, e.g., providing training to its staff, to improve their knowledge and attitude. This finding was somewhat lower than the finding of a study conducted in India and Palestine [24, 25]. A study done in Indonesia concludes that employee knowledge and behavior can directly affect customer satisfaction and fidelity [26].

The dimension with the third-highest overall mean value was logistics-related “information” provided by PFSA Bahirdar hub, with a mean value of 3.411. Although it is larger than the midpoint of the 5-Likert scale continuum, it is still close to the midpoint, therefore, the PFSA Bahirdar hub should make a significant effort to improve the availability, accuracy, and completeness of the information it provides to customers. The result of a study done in Singapore, with a mean value of 3.85, is almost similar to this study. Accessibility of quality information at the right time and place is important to ensure the continuous operation of the logistics process and is crucial to fostering trust among its customers [27].

Order “discrepancy” was the quality of the logistics services dimension with the sixth-highest overall mean value reported in this study and it was 3.144. This result is almost close to the midpoint of the 5-Likert scale, which is 3.0. It indicates that the respondents were not pleased with the procedure that is being used by the PFSA Bahirdar hub to manage the order discrepancy coming from the customer, and the effort of PFSA Bahirdar hub to communicate with customers.

The dimension of quality of logistics services with the least mean score was the availability of pharmaceuticals (mean =2.875). This indicates that the availability of pharmaceuticals at the PFSA Bahirdar hub was not adequate to satisfy the demand of its customers, which are public health facilities. Besides, it implies that due to frequent drug shortages at public health facilities have been compromising the quality of the health care service. This finding was lower than studies done in India and Palestine with a mean of 3. 66 and 3.75, respectively [24, 28]. However, this finding is consistent with the conclusion of a study done in Ethiopia, India, and China [29, 30, 31]. Ideally, frequent medicine stockout can happen due to inaccurate demand forecasting, limited government budget allocation, or inefficient budget utilization [32].

The “accuracy” of the overall logistics services provided by the PFSA Bahirdar hub is the dimension with the fifth-highest overall mean value, which is 3.336 and it is almost near to the midpoint of the 5-Likert scale that is 3.0. This demonstrates that the PFSA Bahirdar hub was delivering incorrect quantities and obsolete or near-expiry pharmaceuticals to their customers. This result agreed with studies done in Malaysia and Palestine [25, 27].

The quality of logistics service’s dimension with the seventh-highest overall mean value was the “timeliness” of logistics services, being provided by PFSA Bahirdar hub, with a mean value of 3.051. This value is at the midpoint of the 5-Likert continuum (mean-3.0) and it was lower than the finding of studies done in Singapore and Malaysia [18, 27]. Moreover, this finding indicates that respondents were not happy with the length of the lead-time of pharmaceutical delivery from the PFSA Bahirdar hub. Having a logistics system with a speedy customer request fulfillment rate for shortening the lead time is the key to improve customer satisfaction, especially for customers like health care providers [33]. Pharmaceuticals are the key to provide basic health care services; therefore, they must be delivered at the right time to the right places [34].

Among the quality of logistics service dimensions assessed in this study, the “condition” of pharmaceutical delivery was the one with the highest overall mean value compared to the other dimensions (mean=3.740). This suggests that the effort made by the PFSA Bahirdar hub to distribute damage-free pharmaceutical products and correct delivery documents was satisfactory relative to other logistics activities. The finding of a study done in India, with a mean value of 4.30, was slightly higher than this finding [24]. Pharmaceuticals can be damaged and become impotent or unsafe during transport if they are exposed to temperature or humidity beyond their specified range. Therefore, distributors have to make an appropriate effort to protect the pharmaceuticals, since it has an impact on both the quality and quantity of the product supplied to the health care providers [35].

Some of the limitations of this study include that it assessed only the public health satisfaction with the quality of logistics services, but it would be more comprehensive if the study evaluated which factors significantly affect satisfaction. Besides, this research assessed only the satisfaction of public health facilities, but it would be more complete if the research evaluated the factors that substantially affect satisfaction.

Conclusions and Recommendations

This study found out that the perceived satisfaction of public health facilities with the condition of pharmaceutical delivery received the highest mean score compared to the other seven dimensions, followed by procedure flexibility and effectiveness, information quality, staff quality, accuracy, order discrepancy handling, timeliness, and product availability sequentially. Besides, the pharmaceutical product availability was the dimension of quality of the logistics service with the least mean score. In general, the overall perceived satisfaction of public health facilities with the quality of logistics service given by Bahirdar PFSA hub was in the middle of the continuum, with the mean score nearly close to the 5-Likert scale midpoint.

PFSA Bahirdar hub must advance the availability and variety of pharmaceutical products required by its customers because it is the quality of the logistics service dimension with the least level of satisfaction. PFSA Bahirdar hub should attempt to minimize the lead time when replenishing their customer purchase orders as much as possible and announce as soon as possible the discrepancy they discovered from the purchase order submitted by clients.

Acknowledgments

We are thankful to the staff of public health facilities located in the western Gojjam zone for their cooperation and support in providing the requisite data and willingness to provide information through interviews. We would also like to thank all data collectors, as this study would not have been successful without their constructive cooperation.