Abstract
BackgroundMany households in sub-Saharan Africa utilize the private sector as a primary source of treatment for malaria episodes. Expanding access to effective treatment in private drug shops may help reduce incidence of severe disease and mortality. This research leveraged a longitudinal survey of stocking of subsidized artemisinin combination therapies (ACTs), an effective anti-malarial, in Accredited Drug Dispensing Outlets (ADDOs) in two regions of Tanzania. This provided a unique opportunity to explore shop and market level determinants of product diffusion in a developing country retail market.Methods356 ADDOs in the Rukwa and Mtwara regions of Tanzania were surveyed at seven points between Feb 2011 and May 2012. Shop level audits were used to measure the availability of subsidized ACTs at each shop. Data on market and shop level factors were collected during the survey and also extracted from GIS layers. Regression and network based methodologies were used. Shops classified as early and late adopters, following Rogers’ model of product diffusion, were compared. The Bass model of product diffusion was applied to determine whether shops stocked ACTs out of a need to imitate market competitors or a desire to satisfy customer needs.ResultsFollowing the introduction of a subsidy for ACTs, stocking increased from 12% to nearly 80% over the seven survey rounds. Stocking was influenced by higher numbers of proximal shops and clinics, larger customer traffic and the presence of a licensed pharmacist. Early adopters were characterized by a larger percentage of customers seeking care for malaria, a larger catchment and sourcing from specific wholesalers/suppliers. The Bass model of product diffusion indicated that shops were adopting products in response to competitor behavior, rather than customer demand.ConclusionsDecisions to stock new pharmaceutical products in Tanzanian ADDOs are influenced by a combination of factors related to both market competition and customer demand, but are particularly influenced by the behavior of competing shops. Efforts to expand access to new pharmaceutical products in developing country markets could benefit from initial targeting of high profile shops in competitive markets and wholesale suppliers to encourage faster product diffusion across all drug retailers.
Highlights
Many households in sub-Saharan Africa utilize the private sector as a primary source of treatment for malaria episodes
Though the first shipment of Affordable Medicines Facility – Malaria (AMFm) artemisinin combination therapy (ACT) arrived in Tanzania in November 2010 [32], distribution in the private sector did not occur until several weeks later
Surveyors noted whether AMFm co-paid ACTs were being stocked on the day of the survey and recorded retail prices
Summary
Many households in sub-Saharan Africa utilize the private sector as a primary source of treatment for malaria episodes. This research leveraged a longitudinal survey of stocking of subsidized artemisinin combination therapies (ACTs), an effective anti-malarial, in Accredited Drug Dispensing Outlets (ADDOs) in two regions of Tanzania This provided a unique opportunity to explore shop and market level determinants of product diffusion in a developing country retail market. Drug stock outs and lengthy travel times have all been noted as barriers to improving access to effective medications in public sector health facilities [2,3,4,5] It is no wonder, that the private sector is typically the first choice in treating common health conditions such as malaria and diarrhea [6]. Expanding access to safe and effective medications, along with basic diagnostics for common conditions such as rapid diagnostic tests (RDTs) for malaria, in privately owned drug shops might allow households to receive proper treatment for life threatening diseases earlier, reducing the chance of severe disease and mortality
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