Abstract
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.
Highlights
Pharmaceutical supply chains have received substantial attention,[4] focusing on health system interventions such as those for redesigning and optimising the public sector pharmaceutical supply chain,[4,5,6,7] including increasing financial resources allocated to the supply chain, introduction of incentives for staff to act effectively,[8,9,10] staff training to improve pharmaceutical supply chain management skills,[11,12] improvement of the supply chain process and procurement procedure such as centralising/decentralising purchasing of drugs, improvement of health information management systems to monitor and inform purchases, as well as infrastructure improvement and communication.[13,14,15]
In this study we adopt a definition of acceptability as defined by Sekhon et al, ‘a multi-faceted construct that reflects the extent to which individuals, as well as institutions affected by an intervention directly or indirectly, consider it to be suitable, based on their expectations, or experienced reasoning and emotional reactions to such intervention.’[23]. Sekhon et al gave specific dimensions to be considered when analysing the acceptability of interventions in the context of health systems.[22,23]
We found that experienced intervention burden and lower opportunity costs related to the previous system influenced the acceptability of the Jazia PVS
Summary
The pharmaceutical supply chain in low- and middleincome countries faces multiple challenges, such as the existence of falsified medicines, underfunding, affordability, weak transparency, weak mechanisms of accountability, and inefficiencies in medical prescriptions to the patients.[1,2,3] pharmaceutical supply chains have received substantial attention,[4] focusing on health system interventions such as those for redesigning and optimising the public sector pharmaceutical supply chain,[4,5,6,7] including increasing financial resources allocated to the supply chain, introduction of incentives for staff to act effectively,[8,9,10] staff training to improve pharmaceutical supply chain management skills,[11,12] improvement of the supply chain process and procurement procedure such as centralising/decentralising purchasing of drugs, improvement of health information management systems to monitor and inform purchases, as well as infrastructure improvement and communication.[13,14,15] Another policy introduced in several countries is the establishment of public-private partnerships (PPPs)[5,13] to complement existing medicines supply chain systems.[4,16,17] PPPs have been reported to increase the availability of essential medicines in peripheral areas in low-income settings[18,19,20,21] to improve order fulfilment rates, to control drug costs, and to increase satisfaction among programme users.[20]The successful deployment of new devices, interventions, or PPPs within the health system usually requires high acceptability by both implementers and beneficiaries of the intervention.[15,22,23,24] The degree of acceptance by beneficiaries affects the successful implementation of the PPP, and the effectiveness of the intervention.[25]. Individual affective attitude and intervention coherence in terms of ease of use, safety and reliability contribute to the acceptability of an intervention.[28,29]
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