Abstract
Objective: Assess whether reform in the Tanzanian medicines delivery system from a central ‘push’ kit system to a decentralized ‘pull’ Integrated Logistics System (ILS) has improved medicines accountability. Methods: Rufiji District in Tanzania was used as a case study. Data on medicines ordered and patients seen were compiled from routine information at six public health facilities in 1999 under the kit system and in 2009 under the ILS. Three medicines were included for comparison: an antimalarial, anthelmintic and oral rehydration salts (ORS). Results: The quality of the 2009 data was hampered by incorrect quantification calculations for orders, especially for antimalarials. Between the periods 1999 and 2009, the percent of unaccounted antimalarials fell from 60 to 18%, while the percent of unaccounted anthelmintic medicines went from 82 to 71%. Accounting for ORS, on the other hand, did not improve as the unaccounted amounts increased from 64 to 81% during the same period. Conclusions: The ILS has not adequately addressed accountability concerns seen under the kit system due to a combination of governance and system-design challenges. These quantification weaknesses are likely to have contributed to the frequent periods of antimalarial stock-out experienced in Tanzania since 2009. We propose regular reconciliation between the health information system and the medicines delivery system, thereby improving visibility and guiding interventions to increase the availability of essential medicines.
Highlights
The effective delivery of medicines requires integration and coordination of the entire health system
Reconciliation of medicines supply under the ‘push’ system, 1999 The 1999 results illustrate that the summary health information reported under the MTUHA was accurate, with less than 1% difference in total outpatient numbers compared with the information collected from the patient ledgers
The availability of medicines at health facilities is a critical element of service delivery quality, without which the districts will be seriously limited in their ability to provide adequate health care
Summary
The effective delivery of medicines requires integration and coordination of the entire health system. Essential drug program (EDP) kit (‘push’ system) 1983–2008 Despite the various waves of decentralization experienced in Tanzania during the early 1990s, medicines and other supplies were still centrally provided (‘push’) as standard, pre-packed EDP ‘kits’ to all health facilities (excluding hospitals) from the Medical Stores Department (MSD). The MSD is the national semi-autonomous, non-profit department under the Ministry of Health and Social Welfare (MoHSW), responsible for the procurement and delivery of medicines to public and Non-Governmental Organization health facilities. Each kit was designed to last a month, and as they were procured pre-packed from both international and national suppliers (Euro Health Group, 2007a) the MSD only had to manage up to four variants (Center for Pharmaceutical Management, 2003). Medicines were selected based on a combination of the National Essential
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