Evaluation of an Auditable Pharmaceutical Transaction Services Program in Ethiopia: A Case Study Evaluation Design

Abstract

In Ethiopia the government created an auditable pharmaceutical transaction system (APTS) to prevent low availability and high expiration rate of drugs. However, nothing is known about the implementation status of APTS in the study area. Therefore, this study aimed to evaluate the implementation status of APTS program by dimensions (availability, compliance, and acceptability) at Debark primary Hospital, North West Ethiopia. A single case study design was used to evaluate the process of the APTS program. Availability, compliance, and acceptability (client satisfaction) dimensions were measured using four, seven, and seven indicators respectively. In this evaluation, 423 clients participated in exit interviews, 600 records were reviewed, and five key informants were interviewed. To identify the predictor variables with acceptability, we used a multivariable logistic regression analysis. Statistically significant variables were defined based on the adjusted odds ratio (AOR) with 95% confidence interval (CI), and a p-value of less than .05. Thematic analysis was used for qualitative data. The overall implementation of APTS was 70% measured by availability (70.9%), compliance (70.4%), and acceptability (68.5%) dimensions. Ergometrine maleate injection, fluconazole tablet, and functional computer were not available. Government employees (AOR: 0.31, 95% CI [0.12, 0.76]) and clients’ who had a one-time visit (AOR: 2, 95% CI [1.11, 3.55]) were factors associated with the satisfaction of clients. The overall APTS program implementation was good. Unavailability of some tracer drugs, and functional computer were the main gaps. Therefore the program needs some improvement to enhance the implementation of APTS program.