Assessment of medicines price, availability and distribution in the centralised and decentralised procurement systems in Dar es salaam region

Abstract

Background: Medicines procurement processes in the public health facilities (PHFs) in Tanzania are characterized by two main procurement systems, the centralized and decentralized procurement systems. Policy for medicines procurement is in favour of the centralized procurement system, managed by the Medical Stores Department (MSD). Despite much effort of improving the access of medicines in the public health facilities, prices of medicines have remained substantially high for individuals to afford. Objective: The main objective of the survey was to assess medicines procurement price, availability and distribution of medicines in the centralized and decentralized procurement systems in the public health facilities in Dar es Salaam region. Methods: The study was an explorative cross-sectional survey that applies both quantitative and qualitative approaches to determine medicine procurement price of the centralized and decentralized systems, investigate the medicines availability in the selected public hospitals and asses the efficiency of distribution systems. Results: The result shows that median percentage availability of medicines in the hospital was 72.5 %. Overall median percentage availability of each individual medicine in the surveyed hospitals was 71.4%. The average median stock-out days per year was 97.2. The median decentralize, centralised and international reference prices were, Tshs 122.5, 77.7 and 63.35 respectively. MPR of the decentralized to international reference prices, centralized to international reference prices, and the decentralized to centralize procurement prices, the ratios were, 1.92, 1.1, and 1.85 respectively. Conclusion: Findings of the study revealed that, availability of medicines is fairly high in public hospitals during day of data collection but high stock out for the past six months of review. There is no statistical significant difference in median prices across all procurement systems. However, there was statistical significance difference in MPRs of medicines procurement prices across the categories. The centralized procurement prices were reasonably cheaper compared to decentralized and international reference prices. Low order fulfilment rate in the centralized procurement and high supplier procurement lead time in the decentralized procurement systems are the factor contributing to the fairly high availability and stock out of medicines in the public hospitals.