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Original research
Cost and cost drivers associated with setting-up a prime vendor system to complement the national medicines supply chain in Tanzania
  1. August Kuwawenaruwa1,2,3,
  2. Kaspar Wyss2,3,
  3. Karin Wiedenmayer2,3,4,
  4. Fabrizio Tediosi2,3
  1. 1Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania
  2. 2University of Basel, Basel, Switzerland
  3. 3Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland
  4. 4Health Promotion and System Strengthening (HPSS) project, Dodoma, United Republic of Tanzania
  1. Correspondence to August Kuwawenaruwa; ajoachim{at}ihi.or.tz

Abstract

Introduction Economic analysis of supply chain management interventions to improve the availability of healthcare commodities at healthcare facilities is important in generating evidence for decision-makers. The current study assesses the cost and cost drivers for setting-up a public-private partnership programme in Tanzania in which all public healthcare facility orders for complementary medicines are pooled at the district level, and then purchased from one contracted supplier, the prime vendor (referred to as ‘Jazia Prime Vendor System’ (Jazia PVS)).

Methods Financial and economic costs of Jazia PVS were collected retrospectively and using the ingredients approach. The financial costs were spread over the implementation period of January 2014–July 2019. In addition, we estimated the financial rollout costs of Jazia PVS to the other 23 regions in the country over 2 years (2018–2019). A multivariate sensitivity analysis was conducted on the estimates.

Results Jazia PVS start-up and recurrent financial costs amounted to US$2 170 989.74 and US$709 302.32, respectively. The main cost drivers were costs for short-term experts, training of staff and healthcare workers and the Jazia PVS technical and board management activities. The start-up financial cost per facility was US$2819.47 and cost per capita was US$0.37.

Conclusion In conclusion, the study provides useful information on the cost and cost drivers for setting-up a complementary pharmaceutical supply system to complement an existing system in low-income settings. Despite the substantial costs incurred in the initial investment and operations of the Jazia PVS, the new framework is effective in achieving the desired purpose of improving availability of healthcare commodities.

  • health economics
  • health systems
  • health systems evaluation
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjgh-2020-002681

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    Footnotes

    • Handling editor Seye Abimbola

    • Twitter @fabrizio2570

    • Contributors AK and FT conceptualised the study. AK participated in data analysis, interpretation of data and drafted the manuscript; KWi participated in interpretation and contextualisation of results. KWy and FT contributed to interpretation of results and in writing the manuscript. All authors have critically reviewed the manuscript and approved the final version.

    • Funding This manuscript is an output from the project: Health Systems Governance for an Inclusive and Sustainable Social Health Protection in Ghana and Tanzania funded by the Swiss Programme for Research on Global Issues for Development (r4d programme, phase I). The project involves a consortium of five partners: Swiss Tropical and Public Health Institute, ETH Zurich, University of Applied Sciences and Arts of Southern Switzerland (SUPSI), Ifakara Health Institute Tanzania and University of Ghana.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Ethics approval The permission to conduct the study was obtained from the institutional review board (IHI/IRB/No. 21-2017), and the National Institute for Medical Research, ethics review board (NIMR/HQ/R.8a/Vol. IX/2720). Endorsement letters were obtained from the President's Office Regional Administration and Local Government offices (Ref No. AB.307/323/02/69), respective regional and districts health managers. All study participants were thoroughly informed about the study, and written consent was obtained from all study participants. Confidentiality of the participant’s information was assured at all times, and data anonymity was considered during data collection and analysis.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.