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Empirical Framework for Point-of-Care Diagnostics Supply Chain Management for Accessibility and Sustainability of Diagnostic Services in Ghana's Primary Health Care Clinics

Kuupiel, Desmond, PhD*†; Bawontuo, Vitalis, PhD†‡; Donkoh, Addai, PhD§; Drain, Paul K., MD∥¶**; Mashamba-Thompson, Tivani P., PhD*

doi: 10.1097/POC.0000000000000186
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Achievement of universal health coverage may be a mirage if supply chain management challenges of point-of-care (POC) diagnostics are not addressed to ensure accessibility and sustainability of POC diagnostic services in rural primary health care (PHC) clinics. Many patients accessing health care services in rural PHC clinics are likely to be undiagnosed and treated only based on syndromic management, due to stock-outs of POC tests. This potentially may result in complications such as wrong treatment, drug resistant to some infections, increased morbidities and mortalities, and many others. Public health activities for priority diseases such as tuberculosis, malaria, and human immunodeficiency virus, as well as maternal health services, may be affected. We have proposed an empirical model framework for POC diagnostics supply chain management to ensure accessibility and sustainability of POC diagnostic service in PHC clinics in Ghana based on evidence generated from our primary studies nested in a broader doctoral study entitled “Assessing the Accessibility of Antenatal Clinic Point-of-Care Diagnostic Services in Rural Ghana.” Prior to the development of this model framework, we conducted a literature review to identify the barriers and challenges of POC diagnostic services in low- and middle-income countries. We also conducted a cross-sectional survey to assess the accessibility of pregnancy-related POC diagnostic tests for maternal health care in the Upper East Region, Ghana. Finally, we conducted a formalized audit of the supply chain management of POC diagnostic tests also in the Upper East Region to investigate causes of deficiencies.

From the *Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa;

Research for Sustainable Development Consult and

Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani;

§Procurement and Supply Directorate, Ghana Health Service, Accra, Ghana; and

International Clinical Research Center, Department of Global Health,

Division of Infectious Diseases, Department of Medicine, and

**Department of Epidemiology, University of Washington, Seattle, WA.

Reprints: Desmond Kuupiel, PhD, 2nd Floor George Campbell Building, Department of Public Health Medicine, University of KwaZulu-Natal, Howard College Campus, Durban, 4001, South Africa. E-mail: desmondkuupiel98@hotmail.com.

This study was funded by University of KwaZulu-Natal College of Health Science Scholarship. This project was also supported by research project number BE565/17.

The authors declare no conflict of interest.

Authors' Contributions: D.K., T.P.M.-T., and V.B. conceptualized the study, and D.K. wrote the first draft. D.K. was the principal investigator for the project; T.P.M.-T. and V.B. were supervisors. A.D. and P.K.D. were collaborators. All authors contributed to the writing and editing of the article and approved the final version.

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