Knowledge Is Not Enough: A Comparative, Inferential Analysis of Pharmaceutical Supply Chain Knowledge and Practice across Demographic and Institutional Strata in South-South Nigeria

Abstract

Descriptive surveys of pharmaceutical supply chain knowledge and practice in Nigeria have typically reported findings as unadjusted percentages, without testing whether the differences observed between states, professions, sectors or practice settings are statistically distinguishable from chance. This study re-analysed data from a 2015 cross-sectional survey of 150 health professionals in Rivers, Bayelsa, Akwa-Ibom and Cross River States, South-South Nigeria, applying inferential statistics to compare a composite knowledge score, derived from thirteen supply-chain knowledge items, and six discrete procurement and forecasting practices, across state, gender, sector of employment, area of practice and profession. Composite knowledge scores differed significantly by profession (Kruskal-Wallis H=18.10, df=4, p=0.001), with pharmacists (mean 11.67, SD 2.36) and store-keeping personnel (mean 11.55, SD 1.04) scoring appreciably higher than nurses (mean 9.48, SD 4.04) and purchasing-and-supply staff (mean 9.43, SD 3.21), but did not differ significantly by state (p=0.079), gender (p=0.083), sector of employment (p=0.456) or area of practice (p=0.624). In sharp contrast, every one of six procurement channels examined — tenders, local purchase order, direct purchase, suppliers/retailers, wholesalers and medical representatives — varied significantly by state (all p<0.001), while none varied significantly by sector of employment (all p>0.24). Two of four forecasting information sources (stock-on-hand data and dispensed-to-user data) also varied significantly by state (p=0.037 and p=0.017 respectively) but not by sector. These findings indicate that knowledge of supply chain concepts is differentiated principally along professional-training lines, whereas the specific channels through which procurement and forecasting are actually operationalised are differentiated principally along geographic lines — a knowledge-practice divergence that has implications for how capacity-building interventions in the region should be targeted.