scholarly journals Acceptability of a Prime Vendor System in Public Healthcare Facilities in Tanzania

2020 ◽  
Author(s):  
August Kuwawenaruwa ◽  
Fabrizio Tediosi ◽  
Emmy Metta ◽  
Brigit Obrist ◽  
Karin Wiedenmayer ◽  
...  
Keyword(s):  
Supply Chain ◽  
Low Income ◽  
Critical Factor ◽  
Essential Medicines ◽  
Public Healthcare ◽  
Framework Analysis ◽  
Group Discussions ◽  
Pharmaceutical Supply Chain ◽  
Middle Income ◽  
Vendor System

Background: Pharmaceutical supply chain management in low- and middle-income countries has received substantial attention to address the shortage of medicines at peripheral facilities. The focus has been on health system interventions, including the establishment of public-private partnerships (PPPs). In 2014, the United Republic of Tanzania began implementing the Jazia prime vendor system (Jazia PVS) with a contracted private wholesale supplier to complement the national medicines supply chain in public facilities. Few studies have investigated the acceptability of such a prime vendor system. This study analyses factors that contributed to the acceptability of Jazia PVS introduced in Tanzania. We used qualitative analytical methods to study experiences of Jazia PVS implementers in 4 districts in mid-2018. Methods: Data were drawn from 14 focus group discussions (FGDs), 7 group discussions (GDs) and 30 in-depth interviews (IDIs) with a range of actors involved in Jazia PVS. The study analysed 7 acceptability dimensions as defined in the acceptability framework by Sekhon et al. Framework analysis was adopted to summarise the results using a deductive and an inductive approach. Results: The findings show that participants’ acceptability of Jazia PVS was influenced by the increased availability of essential medicines at the facilities, higher order fulfilment rates, and timely delivery of the consignment. Furthermore, acceptability was also influenced by the good reputation of the prime vendor, close collaboration with district managers, and participants’ understanding that the prime vendor was meant to complement the existing supply chain. Intervention coherence, experienced opportunity cost and intervention burden, affective attitude and self-efficacy were also important in explaining the acceptability of the Jazia PVS. Conclusion: In conclusion, the most critical factor contributing to the acceptability of the Jazia PVS was the perceived effectiveness of the system in achieving its intended purpose. Districts purchasing directly from the prime vendor have a policy based on the possibility to increase availability of essential medicines at peripheral facilities in a low income setting; however, it is crucial to select a reputable and competent vendor, as well as to abide by the contractual agreements.

scholarly journals Cost and cost drivers associated with setting-up a prime vendor system to complement the national medicines supply chain in Tanzania

2020 ◽  
Vol 5 (9) ◽  
pp. e002681
Author(s):  
August Kuwawenaruwa ◽  
Kaspar Wyss ◽  
Karin Wiedenmayer ◽  
Fabrizio Tediosi
Keyword(s):  
Supply Chain ◽  
Low Income ◽  
Public Healthcare ◽  
Cost Drivers ◽  
Complementary Medicines ◽  
Management Interventions ◽  
Financial Costs ◽  
Start Up ◽  
The Cost ◽  
Vendor System

IntroductionEconomic analysis of supply chain management interventions to improve the availability of healthcare commodities at healthcare facilities is important in generating evidence for decision-makers. The current study assesses the cost and cost drivers for setting-up a public-private partnership programme in Tanzania in which all public healthcare facility orders for complementary medicines are pooled at the district level, and then purchased from one contracted supplier, the prime vendor (referred to as ‘Jazia Prime Vendor System’ (Jazia PVS)).MethodsFinancial and economic costs of Jazia PVS were collected retrospectively and using the ingredients approach. The financial costs were spread over the implementation period of January 2014–July 2019. In addition, we estimated the financial rollout costs of Jazia PVS to the other 23 regions in the country over 2 years (2018–2019). A multivariate sensitivity analysis was conducted on the estimates.ResultsJazia PVS start-up and recurrent financial costs amounted to US$2 170 989.74 and US$709 302.32, respectively. The main cost drivers were costs for short-term experts, training of staff and healthcare workers and the Jazia PVS technical and board management activities. The start-up financial cost per facility was US$2819.47 and cost per capita was US$0.37.ConclusionIn conclusion, the study provides useful information on the cost and cost drivers for setting-up a complementary pharmaceutical supply system to complement an existing system in low-income settings. Despite the substantial costs incurred in the initial investment and operations of the Jazia PVS, the new framework is effective in achieving the desired purpose of improving availability of healthcare commodities.

scholarly journals Price, availability and affordability of medicines

2014 ◽  
Vol 6 (1) ◽  
Author(s):  
Brenda S. Mhlanga ◽  
Fatima Suleman
Keyword(s):  
Supply Chain ◽  
Public Sector ◽  
Low Income ◽  
Essential Medicines ◽  
World Health ◽  
Middle Income ◽  
Originator Brand ◽  
Private And Public ◽  
Daily Wage ◽  
Health Organization

Background: Medicines play an important role in healthcare, but prices can be a barrier to patient care. Few studies have looked at the prices of essential medicines in low- and middle-income countries in terms of patient affordability.Aim: To determine the prices, availability and affordability of medicines along the supply chain in Swaziland.Setting: Private- and public-sector facilities in Manzini, Swaziland.Methods: The standardised methodology designed by the World Health Organization and Health Action International was used to survey 16 chronic disease medicines. Data were collected in one administrative area in 10 private retail pharmacies and 10 public health facilities. Originator brand (OB) and lowest-priced generic equivalent (LPG) medicines were monitored and these prices were then compared with international reference prices (IRPs). Affordability was calculated in terms of the daily wage of the lowest-paid unskilled government worker.Results: Mean availability was 68% in the public sector. Private sector OB medicines were priced 32.4 times higher than IRPs, whilst LPGs were 7.32 times higher. OBs cost473% more than LPGs. The total cumulative mark-ups for individual medicines range from 190.99% – 440.27%. The largest contributor to add-on cost was the retail mark-up (31% – 53%). Standard treatment with originator brands cost more than a day’s wage.Conclusion: Various policy measures such as introducing price capping at all levels of the medicine supply chain, may increase the availability, whilst at the same time reducing the prices of essential medicines for the low income population.

scholarly journals Solving the problem of access to cardiovascular medicines: revolving fund pharmacy models in rural western Kenya

2020 ◽  
Vol 5 (11) ◽  
pp. e003116
Author(s):  
Dan N Tran ◽  
Imran Manji ◽  
Benson Njuguna ◽  
Jemima Kamano ◽  
Jeremiah Laktabai ◽  
...  
Keyword(s):  
Supply Chain ◽  
Low Income ◽  
Essential Medicines ◽  
Chain Model ◽  
Important Lesson ◽  
Middle Income ◽  
Western Kenya ◽  
Middle Income Countries ◽  
Advantages And Disadvantages ◽  
The Past

Availability of medicines for treatment of cardiovascular disease (CVD) is low in low-income and middle-income countries (LMIC). Supply chain models to improve the availability of quality CVD medicines in LMIC communities are urgently required. Our team established contextualised revolving fund pharmacies (RFPs) in rural western Kenya, whereby an initial stock of essential medicines was obtained through donations or purchase and then sold at a small mark-up price sufficient to replenish drug stock and ensure sustainability. In response to different contexts and levels of the public health system in Kenya (eg, primary versus tertiary), we developed and implemented three contextualised models of RFPs over the past decade, creating a network of 72 RFPs across western Kenya, that supplied 22 categories of CVD medicines and increased availability of essential CVD medications from <30% to 90% or higher. In one representative year, we were able to successfully supply 5 793 981 units of CVD and diabetes medicines to patients in western Kenya. The estimated programme running cost was US$6.5–25 per patient, serving as a useful benchmark for public governments to invest in medication supply chain systems in LMICs going forward. One important lesson that we have learnt from implementing three different RFP models over the past 10 years has been that each model has its own advantages and disadvantages, and we must continue to stay nimble and modify as needed to determine the optimal supply chain model while ensuring consistent access to essential CVD medications for patients living in these settings.

scholarly journals Towards understanding global patterns of antimicrobial use and resistance in neonatal sepsis: insights from the NeoAMR network

2019 ◽  
Vol 105 (1) ◽  
pp. 26-31 ◽  
Author(s):  
Grace Li ◽  
Julia Anna Bielicki ◽  
A S M Nawshad Uddin Ahmed ◽  
Mohammad Shahidul Islam ◽  
Eitan Naaman Berezin ◽  
...  
Keyword(s):  
Low Income ◽  
Neonatal Sepsis ◽  
Carbapenem Resistance ◽  
Essential Medicines ◽  
Research Network ◽  
Clinical Practices ◽  
Middle Income ◽  
Admission Rates ◽  
Resistance Patterns ◽  
Resistance Rates

ObjectiveTo gain an understanding of the variation in available resources and clinical practices between neonatal units (NNUs) in the low-income and middle-income country (LMIC) setting to inform the design of an observational study on the burden of unit-level antimicrobial resistance (AMR).DesignA web-based survey using a REDCap database was circulated to NNUs participating in the Neonatal AMR research network. The survey included questions about NNU funding structure, size, admission rates, access to supportive therapies, empirical antimicrobial guidelines and period prevalence of neonatal blood culture isolates and their resistance patterns.Setting39 NNUs from 12 countries.PatientsAny neonate admitted to one of the participating NNUs.InterventionsThis was an observational cohort study.ResultsThe number of live births per unit ranged from 513 to 27 700 over the 12-month study period, with the number of neonatal cots ranging from 12 to 110. The proportion of preterm admissions <32 weeks ranged from 0% to 19%, and the majority of units (26/39, 66%) use Essential Medicines List ‘Access’ antimicrobials as their first-line treatment in neonatal sepsis. Cephalosporin resistance rates in Gram-negative isolates ranged from 26% to 84%, and carbapenem resistance rates ranged from 0% to 81%. Glycopeptide resistance rates among Gram-positive isolates ranged from 0% to 45%.ConclusionAMR is already a significant issue in NNUs worldwide. The apparent burden of AMR in a given NNU in the LMIC setting can be influenced by a range of factors which will vary substantially between NNUs. These variations must be considered when designing interventions to improve neonatal mortality globally.

Right Idea, Wrong Result—Canada's Access to Medicines Regime

2008 ◽  
Vol 34 (4) ◽  
pp. 567-584 ◽  
Author(s):  
Paige E. Goodwin
Keyword(s):  
Low Income ◽  
Essential Medicine ◽  
Developed Countries ◽  
Access To Medicines ◽  
Production Costs ◽  
Essential Medicines ◽  
World Health ◽  
Low Income Countries ◽  
Brand Name ◽  
Middle Income

In 2007, an estimated 33.2 million people were living with HIV, 2.5 million had become infected, and 2.1 million died from the virus. The majority of infected individuals reside in Africa, where in some countries as many as 33.4% of adults have HIV. In developed countries, effective drug therapies have reduced AIDS-related deaths by over seventy percent each year. These drugs have been so effective that over the last two years the global number of individuals dying from AIDS-related illness has actually declined. These therapies, however, are currently sold for $10,000 USD a year, a purchase price that is not feasible for low income countries where the annual health expenditure may be only $29 per person. A lack of essential medicine is not only a problem for those suffering from AIDS. Low and middle-income countries are disproportionately burdened by many additional chronic and infectious illnesses. The World Health Organization (“WHO”) estimates that one third of the world's population cannot regularly access essential medicines. The WHO cites the high cost of drugs as one of the major hurdles countries face in obtaining access to medication. However, the high cost of these brand-name medications does not reflect their minimal production costs. Drug manufacturers can produce generic versions of these drugs for as little as 1/30th of the cost of their brand-name counterparts.

scholarly journals Implementing pharmaceutical track-and-trace systems: a realist review

2021 ◽  
Vol 6 (Suppl 3) ◽  
pp. e003755
Author(s):  
Joeke Kootstra ◽  
Tineke Kleinhout-Vliek
Keyword(s):  
Supply Chain ◽  
Implementation Process ◽  
Realist Review ◽  
Medical Product ◽  
Pharmaceutical Supply Chain ◽  
Middle Income ◽  
Middle Income Countries ◽  
Point Of Entry ◽  
Falsified Medicines ◽  
The Government

IntroductionOne way to prevent falsified medical products from entering the regulated pharmaceutical supply chain is to implement a pharmaceutical track-and-trace system (PTTS). Such systems in the most extensive versions generally mandate a scan at every point of contact with the medical product: from the point of entry to dispensation. There have been several attempts to implement such systems; for example, a ‘full’ PTTS in Turkey and the more pared-down version offered by the European Union’s Falsified Medicines Directive and Delegated Act. This study aims to identify facilitators and barriers to implementing (elements of) a PTTS, with the Turkish system used as a benchmark.MethodsWe conducted a ‘realist’ review, which synthesises literature and aims to establish how a specific technology works, for whom, under which circumstances. We searched Embase, Medline Ovid, Web of Science, Cochrane Central and Google Scholar databases, yielding 2,790 scholarly articles. We selected 21 for review.ResultsImplementation of PTTS elements has been attempted in different compositions in several primarily high-income and middle-income countries. Factors that affected implementation included stakeholders like the government and supply chain actors, the coordination between them, and their awareness, knowledge, and skills, as well as regulation and legislation, monetary investments, and technical and digital requirements.ConclusionThe interplay between contextual factors is crucial for successful PTTS implementation. Specifically, the findings indicate that aligning the incentives for all actors and allowing for adjustments in a continuous implementation process will likely facilitate implementation.

scholarly journals A Network Maturity Mapping Tool for Demand-Driven Supply Chain Management: A Case for the Public Healthcare Sector

2021 ◽  
Vol 13 (21) ◽  
pp. 11988
Author(s):  
Munyaradzi Bvuchete ◽  
Sara Saartjie Grobbelaar ◽  
Joubert van Eeden
Keyword(s):  
Supply Chain ◽  
Supply Chain Management ◽  
Healthcare Sector ◽  
Public Healthcare ◽  
Healthcare Industry ◽  
Framework Analysis ◽  
Chain Management ◽  
The Public ◽  
Mapping Tool ◽  
Public Healthcare Sector

The healthcare supply chain is a complex adaptive ecosystem that facilitates the delivery of health products to the end patient in a cost-effective way. However, low forecast accuracy and high demand volatility in healthcare supply chains have resulted in an increase in stockouts, operational inefficiencies, poor health outcomes, and a significant increase in supply chain costs. To cope with these challenges, organisations are trying to adopt demand-driven supply chain management (DDSCM) operating practices which have been established in other sectors such as the telecommunications, fruit, and flower industries. However, previous studies have not considered these practices in the healthcare industry, and hence no methodologies exist that support the implementation of these practices in this context. Moreover, current studies present cases where the focus has been on improving and expanding individual organisational performance, but no supply chain network-level studies exist on the healthcare industry. Therefore, this paper provides a network-level analysis when addressing DDSCM in the healthcare industry. A grounded theory-based approach coupled with a conceptual framework analysis process was used to leverage a systematized literature review methodology with the development of a network maturity mapping tool for DDSCM which was validated in the public healthcare sector.

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