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Purpose: To assess the impact of the 'Pull' system on the availability and reduction of expiry of essential medicines and medical supplies and to determine factors affecting their availability in Kilembe Hospital, Uganda. Methods: Records of 27 essential medicines and 11 medical supplies were reviewed over two-year periods in the Push (2000 - 2001) and Pull system (2004 - 2005). Key informant interviews were conducted. The data were analyzed using STATA version 8. Comparison of availability was effected using Wilcoxon signed rank tests. Results: The median number of days out-of-stock for drugs and medical supplies was 94 versus 24 (p < 0.001) and 8 versus 0 (p < 0.39) for the Push and Pull systems, respectively. The mean percentage days out-of-stock in the two periods was 15.3 % versus 3.5 % (p < 0.001) and 1.8 % versus 1.3 % (p = 0.34) for drugs and medical supplies, respectively. Expired drugs were worth USD 1584 (25 items) in 2000/2001 and USD 1307 (13 items) in 2004/2005. Factors contributing to availability of supplies were inadequate training, lack of transport and inadequate funding. Conclusion: The Pull system improved availability of essential medicines and reduced the volume of expiries. Availability of funds, transport, staff training and supervision should be addressed for maximal benefits. [ABSTRACT FROM AUTHOR]