Chemotherapy supply chain management, safe-handling and disposal in Ethiopia: the case of Tikur Anbessa specialized hospital

Abstract

Optimal chemotherapy management is substandard in low and middle-income countries. We aimed to identify major gaps to design interventional strategies for improved chemotherapy management at Tikur Anbessa Specialized Hospital (TASH), Ethiopia. This study was conducted using an observational checklist, open-ended questions, record review, and key informant interviews of department heads and focal persons at TASH. Findings were categorized into specific themes that developed. Chemotherapy represented 60.2% of the hospital medication budget. Drug utilization was quantified via monthly consumption documentation and forecasting. However, unreliable data resulted in frequent stockouts (unavailability of the item when it is needed) of chemotherapy with only 67.8% availability. Thirteen healthcare personnel (9 nurses, 2 pharmacists and 2 hospital cleaners) were interviewed: all clinical staff but neither of hospital cleaners believed that they were at risk of hazardous agents. Challenges identified included inadequate and frequent stockouts (unavailability of the item when it is needed) of personal protective equipment, lack of standardized guidelines for chemotherapy handling, admixture, and disposal, lack of designated preparation rooms, and lack of training. All nine nurses handled chemotherapy admixtures despite only two nurses previously receiving in-service training. Most of the participants had never witnessed the disposal of anticancer drugs. Prompted by the results of this study, a dialogue was initiated among members of TASH, the American Cancer Society and the University of North Carolina to implement action-oriented projects to address the gaps identified at TASH. These gaps directly and indirectly affect care and treatment outcomes of patients at a large cancer center. Collaborations with well-resourced centers are potential models for improving chemotherapy management.

Keywords:

• Access
• chemotherapy
• disposal
• Ethiopia
• safe-handling

Acknowledgements

We express our gratitude to College of Health Sciences management for the study facilitation and permission, and data collectors for their kind support. We also would like to extend our appreciation to Prof. Jennifer Geel (Pediatric Oncology, Wits University, Donald Gordon Medical Center) who reviewed and edited this manuscript to enhance the quality of the work and Dr. Jaques Van Heerden (Consultant Paediatric Oncology, Universitair Kinderziekenhuis Antwerpen) for guidance on this manuscript writing.

Author’s contributions

All authors conceptualized, drafted and wrote the manuscript. All authors critically reviewed and authorized the final manuscript.

Disclosure statement

The authors declare that they have no conflicts of interest.

Additional information

Funding

No funding was received for this research.