Table 2

Full list of references with drug availability implications from programmes

Author and yearLevelCountry/regionInterventionOutcome measureResults
Comprehensive drug system policies
Chaudhury et al (2005)15SubnationalIndiaEvaluation of a comprehensive drug policy in Delhi which included development of an Essential Drugs List, a centralised pooled procurement system and activities to promote rational drug usePercentage availability of key drugs (eg, amoxicillin, cloxacillin) before and after implementation of centralised pooled procurement systemKey drug availability increased from 40% to 70% before implementation of system to >90% after implementation
Centralised procurement/tendering
Tren et al (2009)12NationalKenyaRequirement by the Global Fund that Kenya purchase 75% of its annual order for first-line treatment of uncomplicated malaria (ALU) through an international open tenderAvailability of ALU after tender processOwing to tender process, which was delayed and which ended up purchasing drugs from a relatively new and unknown company, Kenya “was experiencing wide stock-outs of ALU and had to place emergency orders with the President's Malaria Initiative”
Supply chain management
Alayande et al (2016)30SubnationalNigeriaUNFPA-supported programme to increase distribution of contraceptives, which involved bimonthly meetings attended by reproductive health coordinators, family planning providers and representatives from the State health team to review commodity inventory and replenish stockAnnual average rate of contraceptive stock unavailabilityReduction from 30% in 2012 to 24.1% in 2013
Berger et al (2007)31SubnationalHaitiEvaluation of a web-based stock management system for rural clinicsReduction in stockouts (eg, for ARVs) from initial rollout of system to end of first yearStockouts reduced from 2.6% to 1.1% (p<0.001) in 1 year
Bukhari et al (2010)47NationalPakistanEvaluation of 12 guidelines focused on supply and management of essential medicines during emergenciesPer cent of donated medicine wasted during a disaster1.3% wastage per annum in Pakistan, compared to 20–70% in other benchmark disasters
Daff et al (2014)32SubnationalSenegalEvaluation of the IPM, which brings deliveries of drugs closer to clients in health facilitiesLevels of stockouts for four types of contraceptives: IUDs, implants, injectables and pillsStockouts for all four types of contraceptives reduced to 0% within 6 months from baseline of 14% for IUDs, 86% for implants, 57% for injectables and 57% for pills
Mikkelsen-Lopez et al (2014)11SubnationalTanzaniaEvaluation of a transition from a central ‘push’ system for drug delivery to a ‘pull’ ILSPercentage of unaccounted antihelminthics, antimalarials and ORS before and after system implementedUnaccounted for antimalarials decreased from 59.8% to 17.8% (p<0.05); unaccounted for antihelmintics decreased from 81.9% to 71.1% (p<0.05); unaccounted for ORS increased from 63.8% to 80.7% (p<0.05)
Namisango et al (2016)28SubnationalUgandamHealth application used to track supply chain and service delivery informationReduction in emergency orders after implementing the mHealth applicationReduction from five times per quarter to two times per quarter
Shieshia et al (2014)29SubnationalMalawiComparison of an EPT supply chain intervention, which focused on improving product flow and data flow, with an EM intervention, which focused on product flow, data flow and improving the effectiveness of the people by promoting team performanceMean percentage stockout rate over 18 months for six drugs (cotrimoxazole, LA 1×6, LA 2×6, ORS, paracetamol, and zinc)EM resulted in lower stockout rates for all six drugs (p<0.001 for all six drugs)
Steyn et al (2009)48SubnationalSouth AfricaComprehensive plan with ‘investments to upgrade the national drug distribution system at all levels of the healthcare system’, with particularly strict requirements to dispense ARV drugsAvailability of essential drugs and supplies for HIV care other than ARV medication (eg, antibiotics and anti-TB medications)At baseline, 8 of 15 essential HIV care items not available at all facilities, but 2 years after intervention, only 3 of 15 items not available at all facilities
Tumwine et al (2010)33SubnationalUgandaImplementation of a ‘pull system’ for ordering drugs at a rural hospital, in which health units had to determine the types and quantities of medicines and medical supplies neededMedian days out of stock for drugs, and average % days out-of-stock for drugs (eg, amoxicillin, diclofenac)Median out-of-stock days reduced from 94 to 24 (p<0.001); average % out-of-stock days reduced from 15.3% to 3.5% (p<0.001)
Knippenberg (1997)34SubnationalGuineaEvaluation of the Bamako Initiative—a RDFAvailability of vaccinesIncrease from 86% in 1991 to 100% 1 year later
Sabot et al (2009)37SubnationalTanzaniaEvaluation of impact of subsidy on ex-factory price of ACTs as a pilot to test the AMFm modelPer cent of shops stocking ACTsIncrease from 0% of shops stocking ACTs before pilot to 72.2% of shops stocking ACTs 1 year later (p<0.001)
Tougher et al (2012)36InternationalGhana, Kenya, Madagascar, Niger, Nigeria, Uganda, and Tanzania (and Zanzibar as a separate site)Evaluation of AMFm pilot, which included price reductions through negotiations on QAACTs, a buyer subsidy, and interventions to support AMFm implementationAchievement of a benchmark to show an increase of 20 percentage points from baseline to end point in the availability of QAACT among all outlets stocking antimalarial treatmentAll eight sites showed an increase in availability of QAACTs, and five of eight sites showed either a statistically significant chance of achieving the benchmark or a definitive demonstration of achieving the benchmark
Uzochukwu et al (2002)35SubnationalNigeriaEvaluation of the Bamako Initiative—a RDFNumber of essential drugs availableAverage of 35.4 essential drugs available in Bamako Initiative facilities, compared with 15.3 essential drugs in other facilities (p<0.05)
  • AMFm, Affordable Medicines Facility-malaria; ARV, antiretroviral treatment; EM, enhanced management; EPT, efficient product transport; ILS, Integrated Logistics System; IPM, Informed Push Distribution Model; QAACTs, quality-assured ACTs; RDF, revolving drug fund.