IN-DEPTH ASSESSMENT OF THE MEDICINES SUPPLY SYSTEM …

1 :6;6@A?F <3 .;1 A.;G.;6. IN-DEPTH . ASSESSMENT OF THE. MEDICINES SUPPLY . SYSTEM IN TANZANIA. Published by the Ministry of Health and Social Welfare, Dar es salaam, Tanzania 2008 Ministry of Health and Social Welfare, Tanzania Printed by: Jamana Printers Limited, Dar es Salaam, Tanzania Any part of this document may be reproduced in any form without the prior permission of the publisher provided that this is not for profit and that due acknowledgement is given. Any reproduction for profit must be made with the prior permission of the publisher Copies may be obtained from: The Permanent Secretary, Ministry of Health and Social Welfare, PO Box 9083, Dar es Salaam Tel: 255 22 2120261.

2 Fax: 255 22 2139951. Acknowledgements/Disclaimer This document has been produced with the financial assistance of the European Community and the technical support of the World Health Organization. The views expressed herein are those of the authors and can therefore in no way be taken to reflect the official opinion of the European Community or the World Health Organization 4 IN-DEPTH ASSESSMENT OF THE MEDICINES SUPPLY SYSTEM IN TANZANIA. IN-DEPTH ASSESSMENT OF THE MEDICINES SUPPLY SYSTEM IN TANZANIA. i TABLE OF CONTENTS. LIST OF FIGURES iii LIST OF TABLES iv ABBREVIATIONS v ACKNOWLEDGEMENTS vi 1.

3 EXECUTIVE SUMMARY 1. 2. INTRODUCTION 2. Country Profile 2. Structure of National Health & Pharmaceutical SYSTEM 2. Pharmaceutical services 3. Rationale of the ASSESSMENT 4. 3. STUDY DESIGN AND METHODOLOGY 5. Survey purpose 5. Methodology 5. Sampling and survey population 6. Training of the Survey Teams 7. Data collection 7. Data entry and analysis 7. Scope and limitation of the ASSESSMENT 8. RESULTS AND ANALYSIS 9. Structure of MEDICINES SUPPLY SYSTEM in Tanzania 9. Categories of products managed at various level of care 9. Key MEDICINES management functions at different levels of Health care 10.

4 Customers at various levels of PSM 11. Turn over at MSD 12. Selection of Products 12. Availability of EML and STG 12. 4. Use of NEMLT in procurement 12. Quantification / Forecasting 13. Procurement 16. Sources of procured products at the Central Store 18. Ordering 20. Delivery 21. Indicators used for assessing products delivered 21. Storage/Stock Management 22. Adequate storage capacity 22. Storage conditions 23. Stock management techniques used 23. Availability of tracer products 24. Stock out days 25. Expiry of stocks 25. Distribution 26. Frequency of distribution for the various levels 26.

5 Types, numbers and capacities of various means of transport 27. Quality Assurance SYSTEM 28. The structures used for quality control 28. Rational Use 29. Financing 30. Information Management 32. Monitoring and evaluation 33. Performance Indicators 34. Human resource 35. ii IN-DEPTH ASSESSMENT OF THE MEDICINES SUPPLY SYSTEM IN TANZANIA. DISCUSSIONS 36. Selection of products and order placement 36. Structure 37. Health facility Pharmacies 37. Procurement of MEDICINES 37. Quantification of needs 38. Procurement methods 38. Products storage and stock management 39. Availability of MEDICINES and medical supplies at Health Facilities 39.

6 Quality Assurance SYSTEM 40. The impact of Vertical Programs 40. CONCLUSION 41. RECOMMENDATIONS 43. RECOMMENDATIONS OF THE STAKEHOLDERS WORKSHOP 44. REFERENCES 50. 10 ANNEXES 51. Annex 1: Data Collection Points 51. Annex 2: List of names of Data Collectors for the ASSESSMENT 51. Annex 3: List of Tracer MEDICINES 52. IN-DEPTH ASSESSMENT OF THE MEDICINES SUPPLY SYSTEM IN TANZANIA. iii LIST OF FIGURES. Figure 1 Key MEDICINES management functions Figure 2 SUPPLY functions performed by vertical programs Figure 3 Reasons for non compliance with EML at facility level Figure 4 Procurement methods and lead time Figure 5 Procurement sources and their frequency of use Figure 6 Percentage use of indicators for assessing products delivered Figure 7 Percentage adequacy of storage capacity at all levels Figure 8 Percentage median availability of 20 tracer MEDICINES Figure 9 Use of revenues collected at MSD.

7 Figure 10 Activities carried out during supervision Figure 11 Performance indicators regularly evaluated Figure 12 Level of initial training offered to staff in procurement Figure 13 Level of regular training offered to staff in procurement at health facilities iv IN-DEPTH ASSESSMENT OF THE MEDICINES SUPPLY SYSTEM IN TANZANIA. LIST OF TABLES. Table 1 General Health Indicators Table 2 Levels of Health Service Delivery Table 3 Facilities visited Table 4 Formation of Zonal Stores Table 5 Categories of products managed at various levels of care Table 6 Customers at various levels of the procurement and SUPPLY management Table 7 Total sales in USD and percentage mark up of MSD 04-06.

8 Table 8 Reasons for non compliance with the NEMLIT in procurement Table 9 Information used in quantification of needs Table 10 Responsibilities and tools used in quantification Table 11 Tendering methods, percentages of application and lead times in days Table 12 Criteria considered when awarding contracts Table 13 A summary of award contracts in USD for the year 2006. Table 14 Frequency of ordering Table 15 Indicators used in measuring suppliers performance Table 16 Volume of imports by central store in 2006. Table 17 Delivery types at all levels Table 18 Adherence to storage conditions Table 19 Adherence to stock management techniques Table 20 Reasons for stock outs at all levels Table 21 Causes of expiry of stocks Table 22 Frequency of distributions Table 23 The number and capacity of vehicles for distribution Table 24 Criteria used to assure quality of products procured Table 25 Standard operating procedures available at MSD.

9 Table 26 Medicine information sources Table 27 Amount of expenditure in USD and sources of funding Table 28 Activities supported by donor funding Table 29 Administration fees on selected category of products Table 30 Type of information monitored regularly Table 31 Processes monitored Table 32 Professional category of staff and their function Table 33 Areas needing improvement identified during a workshop to disseminate results of the ASSESSMENT IN-DEPTH ASSESSMENT OF THE MEDICINES SUPPLY SYSTEM IN TANZANIA. v ABBREVIATIONS. AIDS Acquired Immunodeficiency Syndrome ARVs Anti-retrovirals C&F Cost and Freight CIF Cost Insurance and Freight CPT Carriage Paid To DDP Delivered Duty Paid DDU Delivered Duty UnPaid EML Essential MEDICINES List FEFO First Expiry first Out FIFO First In First Out FOB Free on Board Vessel GDP Gross Domestic Product GOT Government of Tanzania HF Health Facility HIV Human Immunodeficiency Virus HTC Hospital Therapeutic Committee ILS Integrated Logistics SYSTEM MOHSW Ministry of Health and Social Welfare MSD Medical Stores Department NEDLIT National Essential Drugs List for

10 Tanzania NEMLIT National Essential MEDICINES List for Tanzania NGO Non-Governmental Organization OI Opportunistic Infection PHF Primary Health Facility PORALG Prime Minister's Office Regional Administration and Local Government PT Pharmacy Technicians SOP Standard Operating Procedures STG Standard Treatment Guidelines TFDA Tanzania Food and Drugs Authority WHO World Health Organization vi IN-DEPTH ASSESSMENT OF THE MEDICINES SUPPLY SYSTEM IN TANZANIA. ACKNOWLEDGEMENTS. The Ministry of Health would like to express its gratitude to the World Health Organization (WHO) whose financial support made it possible to conduct this survey.