Abstract
BackgroundInternational policy towards access to essential medicines in Africa has focused until recently on international procurement of large volumes of medicines, mainly from Indian manufacturers, and their import and distribution. This emphasis is now being challenged by renewed policy interest in the potential benefits of local pharmaceutical production and supply. However, there is a shortage of evidence on the role of locally produced medicines in African markets, and on potential benefits of local production for access to medicines. This article contributes to filling that gap.MethodsThis article uses WHO/HAI data from Tanzania for 2006 and 2009 on prices and sources of a set of tracer essential medicines. It employs innovative graphical methods of analysis alongside conventional statistical testing.ResultsMedicines produced in Tanzania were equally likely to be found in rural and in urban areas. Imported medicines, especially those imported from countries other than Kenya (mainly from India) displayed 'urban bias’: that is, they were significantly more likely to be available in urban than in rural areas. This finding holds across the range of sample medicines studied, and cannot be explained by price differences alone. While different private distribution networks for essential medicines may provide part of the explanation, this cannot explain why the urban bias in availability of imported medicines is also found in the public sector.ConclusionsThe findings suggest that enhanced local production may improve rural access to medicines. The potential benefits of local production and scope for their improvement are an important field for further research, and indicate a key policy area in which economic development and health care objectives may reinforce each other.
Highlights
Over the last decade, there has been a huge increase in international funding for access to essential medicines, with a particular focus on HIV, TB and malaria in Sub-Saharan Africa [1,2,3,4]
The main sources of the findings presented in this article are the World Health Organization (WHO)/Health International Action (HAI) medicines surveys conducted each year in Tanzania during 2006-2009b
Recognising the high levels of commercialisation and charging within the Tanzanian health system [30,31,32,33,34], we explore in this article the extent to which our findings on urban bias in imported medicines distribution may be explained by lesser purchasing power in rural areas
Summary
We present systematically the findings from the WHO/HAI survey data for 2006. It confirms the general drop in availability of Tanzanian medicines in the later year. This does not offer a complete explanation, since urban bias in public sector availability of imported medicines is observed for most medicines in this data set, whether import-only or available from both local manufacturers and importers Another explanatory factor may be that urban facilities are more likely than rural facilities to raise and retain fees which can be used for medicines purchases to fill gaps in supply. The decline may be in part the result of the switch from local production to imports of first line anti-malarials, previously a major product for several Tanzanian manufacturers, but this is unlikely to be the full explanation
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