Identification of Factors Leading to Unfit Medical Products and Other Health Commodities, Disposal Management and Related Perceived Consequences to Health Supply Chain in Rwanda. Case of Rwanda Medical Supply Ltd and Medical & Allied Service Solutions Ltd
Authors: - F.K Kotana , - J. Sezihiga , - V. Habyalimana 
Published: November 2024

Abstract
Background
Unfit medical products, especially poor quality / damaged / expired / and phased out (no longer accepted for use) are among health challenges that need careful attention and adequate management in developing countries health supply chains, including Rwanda. Not only does medical wastage affect the public health in general, but also it affects financial capabilities. Actually, according to the Management Science for Health, countries on average spend about 25% of their total health expenditure on medicines, and a significant part of the funds expended on critical drugs is wasted.
Objectives
The main objective of this study is to identify the factors leading to unfit medical products and related perceived consequences to the supply chain management in Rwanda.
Specific Objectives
I.	To identify the most commonly found unfit medical products in RMS and MEDIASOL.
II.	Explore factors contributing to unfit medico-pharmaceuticals in RMS and MEDIASOL.
III.	To explore perceived consequences of unfit medical products to the supply chain management in RMS and MEDIASOL.
IV.	To explore the disposal methods of unfit pharmaceuticals management in RMS and MEDIASOL
Methods
The mixed method research design used, data were collected from 20 key informant by doing interview, A questionnaire containing open questions was used and cross-sectional study were used both focusing on identify the most commonly found unfit medical products in RMS and their management, then the shared data were transcribed and translated by the researchers. Main ideas from each Key informant were merged under each theme and sub themes by reading and then rereading to identify common words, phrases and perceptions that were coded. Quantitative data were coded and analyzed using SPSS and EXCEL software.
Results
The study found that the most common unfit medico-pharmaceuticals are the laboratory commodities, malaria commodities and program products including quinine, and Haloperidol retard 50mg/ml injection and Insulin combinations, the study indicated that the Lack of local manufacturers of pharmaceutical products according to market needs; Change of medical products protocols; Minimum shelf life not specified while ordering the products; and Lack of accurate data to facilitate quantification were highlighted by the respondents as the main factors leading to unfit medicinal products. And the study found that the total unfit products were 3% of the average annual loss in unfit medicinal products compared to the total stock.

The study recommended that further research should be done on this topic especially by exploring effective mechanisms and strategies to mitigate the wastage of medical products and other health commodities in Rwanda.
Conclusions
Medical products are critical for preserving lives in morbid diseases, yet they can get unfit from their intended use for different identified reasons in this study as presented in the summary of factors leading to unfit medical products. Those factors are for example the: Low consumption rate of some products; Sudden change of medical treatment protocols; Procurements without specific minimum required shelf life of products at arrival; etc. Then, were identified twenty-three (23) common unfit products also presented in the results, as well as the perceived consequences of unfit medical products to the supply chain; and three main applied disposal methods are incineration, plastic materials recycling and reuse of unfit products for other purposes. Future studies are needed to explore this important topic more broadly and come up with sustainable strategies to properly manage the medical products throughout the entire supply chain