Abstract
BackgroundBetween 2007 and 2013, the Tanzanian public sector received 93.1 million doses of first-line anti-malarial artemisinin-based combination therapy (ACT) in the form of artemether-lumefantrine entirely supplied by funding partners. The introduction of a health facility ACT stock monitoring system using SMS technology by the National Malaria Control Programme in mid 2011 revealed a high frequency of stock-outs of ACT in primary care public health facilities. The objective of this study was to determine the pattern of availability of ACT and possible causes of observed stock-outs across public health facilities in Tanzania since mid-2011.MethodsData were collected weekly by the mobile phone reporting tool SMS for Life on ACT availability from over 5,000 public health facilities in Tanzania starting from September 2011 to December 2012. Stock data for all four age-dose levels of ACT across health facilities were summarized and supply of ACT at the national level was also documented.ResultsOver the period of 15 months, on average 29% of health facilities in Tanzania were completely stocked out of all four-age dose levels of the first-line anti-malarial with a median duration of total stock-out of six weeks. Patterns of total stock-out by region ranged from a low of 9% to a high of 52%. The ACT stock-outs were most likely caused by: a) insufficient ACT supplies entering Tanzania (e.g. in 2012 Tanzania received 10.9 million ACT doses compared with a forecast demand of 14.4 million doses); and b) irregular pattern of ACT supply (several months with no ACT stock).ConclusionThe reduced ACT availability and irregular pattern of supply were due to cumbersome bureaucratic processes and delays both within the country and from the main donor, the Global Fund to Fight AIDS, Tuberculosis and Malaria. Tanzania should invest in strengthening both the supply system and the health information system using mHealth solutions such as SMS for Life. This will continue to assist in tracking ACT availability across the country where all partners work towards more streamlined, demand driven and accountable procurement and supply chain systems.
Highlights
Between 2007 and 2013, the Tanzanian public sector received 93.1 million doses of first-line anti-malarial artemisinin-based combination therapy (ACT) in the form of artemether-lumefantrine entirely supplied by funding partners
Data on the availability of ACT were obtained from the Short Message Service (SMS) for Life reporting system [22], which was originally developed under a partnership consisting of the National Malaria Control Programme (NMCP), Roll Back Malaria, Novartis Pharma AG, Vodafone, IBM, Medicines for Malaria Venture, and the Swiss Agency for Development and Cooperation, and which is fully owned and operated by the Ministry of Health and Social Welfare (MoHSW) with support from the Global Fund
The peak total ACT stockout period was in the rainy season of April-May 2012, when total ACT stock-out rates reached 40%, implying that nearly half the country was totally stocked out of ACT in the public sector
Summary
Between 2007 and 2013, the Tanzanian public sector received 93.1 million doses of first-line anti-malarial artemisinin-based combination therapy (ACT) in the form of artemether-lumefantrine entirely supplied by funding partners. According to the latest Tanzania HIV/AIDS and Malaria Indicator Survey in 2011–12, the prevalence of malaria rapid diagnostic test (mRDT) -confirmed malaria in children under five was 9% [1]. At the end of 2006, Tanzania changed its policy on firstline anti-malarial treatment for uncomplicated malaria to the use of artemisinin-based combination therapy (ACT) artemether-lumefantrine (ALu) [2]; due to the high cost of ACT, Tanzania received USD 75 million from the Global Fund to Fight AIDS, Tuberculosis and Malaria ( referred to as the Global Fund) during its Round 4 disbursements in 2005 (continuing currently through Round 9) to purchase ACT for use in the public sector. Apart from ACT, other anti-malarials offered include sulphadoxine–pyrimethamine (SP), which is recommended only as intermittent preventive treatment during pregnancy, and quinine, which is a second-line treatment for cases contra-indicated for ACT, administered to pregnant women in their first trimester, or in cases of severe malaria not responding to first-line treatment [14]
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