MEDICINES MANAGEMENT 

Access to medicines and their appropriate use must be a core focus for any effort to strengthen health systems and to advance universal health coverage. Medicines and health commodities are one of six health system building blocks. Yet medicines and health technologies do not lie in isolation from the other components of a health system. A health systems approach to medicines facilitates the understanding of the system’s integral relations and connections, allowing for innovative and contextual responses where needed.

 

The HPSS project situates medicines management against the full complexity of a health system, understanding how interventions in the pharmaceutical sector influence the rest of the health system and vice versa. Multiple  dynamics, factors and actors influence pharmaceutical and health sector governance. HPSS, by appreciating the interplay among health system components, embeds and addresses medicines management and interventions in a system’s perspective. Therefore, HPSS -within its scope and mandate- endeavors to map out, analyze, and collaborate in the area of health financing, governance, service delivery and human resources.

The challenge: providing equitable, affordable access to rationally used medicines and medical supplies

Our strategy: addressing medicines challenges using a systems approach

SYSTEM THINKING
NATIONAL POLICY FRAMEWORK

The policy and legal framework for the management of medicine in Tanzania provides guidance for the sector and is based on the National Health Policy, the National Medicines Policy (NMP) and its Masterplan, the National Essential Medicines List (NEML) and the regularly revised National Standard Treatment Guidelines (STG).

The ruling party manifesto emphasizes the constant availability of all essential health commodities. Big Results Now (2015-2020) targets ensuring 100% health commodities stock availability. The National Public Private Partnership Policy promotes public-private partnerships in the pharmaceutical sector. HSSP IV emphasises the importance of well-stocked health facilities in terms of medicines, supplies and staff. Specifically, the plan aims at strengthening the management of medicines and health products and their supply systems at all levels.

HPSS supports the Government of Tanzania in realizing these objectives.

OUR THEORY OF CHANGE
STRATEGY TO STRENGTHEN MEDICINE MANAGEMENT 

HPSS applies a multi-leveled strategy to strengthen the supply side of health care

  • A Prime Vendor System (Jazia PVS) as a complementary procurement pathway for continuous medicine supply.

  • Clinical training in the management of main illnesses in primary health care

  • Support of the Ministry of Health, Community Development, Gender, Elderly and Children in the revision of national Standard Treatment Guidelines

  • A process of peer coaching for supply management that is funded through the district’s own resources 

  • An accredited one-year certificate course for vocational training of pharmaceutical Dispensers in rural areas in collaboration with St. John’s University of Tanzania

  • Implementation of a medicine and financial audit system to increase accountability and transparency

  • Capacity building of health care workers in supply chain management with a focus on the national Integrated Logistic system (ILS) and eILMS

ACHIEVEMENTS IN MEDICINES SUPPLY AND MANAGEMENT

During Phase 1 and 2 (2011 to 2019), HPSS strengthened the management of medicines and health supplies and related services so that vulnerable people can access the health care they need. 

  • Improved availability of essential medicines: from 53% in October 2011 to over 90% in July 2019 in the three pilot regions

  • Clinical staff of all Dodoma region facilities trained in new STG (400 clinicians)

  • More transparency and accountability in procurement and payment procedures related to medicines

  • Increased human resources for health: The Dispenser course with St. John’s University mitigates shortage in rural areas with 668 students enrolled, 466 completed and 388 graduated as of end of 2019

  • The Jazia PVS complements the national Medical Stores Department (MSD) and successfully engages the private sector

  • National roll-out of Jazia PVS in all regions of mainland Tanzania and 32’123 staff trained at all levels

 Jazia PRIME VENDOR SYSTEM

Medical Stores Department (MSD) is the backbone for public medicines supply in Tanzania. But they face challenges in filling orders of health facilities. The supply gap of more than 40% stemming from the out-of-stock situation and low order fulfillment rates for supplies by MSD needs to be complemented by medicines from other sources.

Districts may purchase from private suppliers in case of stock-out at MSD upon its approval. However, this procedure is lacking consistency and transparency, is bureaucratic and uneconomic, and it prolongs lead-time for delivery of supplies.

To tackle the problem of medicine stock-outs the Dodoma Regional Administration and Local Government (RALG) decided to pilot a new strategy establishing a Public-Private Partnership (PPP) with a private sector pharmaceutical supplier.

This unique Prime Vendor System (PVS) has the objective to ensure that health facilities have the medicines and medical supplies to meet the needs of the people. The PPP supplements the regular gover­nment supply with additional supplies from a single vendor in a pooled regional approach. All complementary purchases from health facilities are consolidated at the district level and forwarded to the Prime Vendor.

In principle, the PVS established in Dodoma region serves as a “one stop shop” intended to alleviate opportunity costs previously incurred by health facilities when they have to search for alternative sources of supplies they could not obtain from MSD.

PV supplies are of assured efficacy, safety and quality in accordance with MoHCDGEC and Tanzania Medicines & Medical Devices Authority  (TMDA) standards.

Filling the supply gap - our strategy
Jazia PVS in a nutshell
  • Complements Medical Stores Department (MSD)

  • Public-private partnership (PPP) 

  • Fixed prices and comparable to MSD 

  • Medicines of assured quality, safety and efficacy

  • Funds from health facility own sources, responding to fiscal decentralization 

  • A system and not just a vendor

  • Sustainable and not a parallel system

  • Transparency and accountability enhanced

  • Based on  government policies and within regional structures

  • Significant increase in availability of medicines 

  • Improved access to medicines for patients

MEDICINE MANGEMENT