Assessment of availability, price, expiry, stock-outs and storage conditions for key medicines in the public, NGO and private pharmacies in Moshi

Abstract

Background Despite significant progress in increasing access to essential medicines in low- and middle income countries during the past decades, many of the health services used by the poor still lack adequate supplies of basic medicines. Drug shortages and medicine prices continue to undermine the performance of health systems throughout the developing world. It was important to carry out this study in Moshi as previous studies had not covered this town, and hence results of this study would assist in comparing and complimenting the previous studies. Objective Assessment of availability, price, expiry, stock-outs and storage conditions for key medicines in the public, NGO and private pharmacies in Moshi Methodology The survey was conducted in public, NGO and private pharmacies in Moshi town using the WHO Operational Package for Monitoring and Assessing the Pharmaceutical Situation in Countries (2007 version). The package contained tools necessary for the survey (modified to suit our local pharmaceutical system). The indicators to measure the degree to which public, NGO and private retail facilities are achieving the strategic pharmaceutical objectives of improved availability, reasonable price and appropriate storage conditions of medicines were used. These included: availability of key medicines in public, NGO and private pharmacies, price of key medicines in public, NGO and private pharmacies, presence of expired medicines in public, NGO and private pharmacies, adequacy of storage conditions and handling of medicines in public, NGO and private pharmacies. Results The survey revealed that only one (1) of the public health facilities had less than 30% of the 33 selected key medicines available at the pharmacy while ten (10) public health facilities had availability of medicines ranging from 30% to 80%. In the private retail pharmacies, four (4) had availability of medicines ranging from 50% to 80% while eleven (11) pharmacies had availability of medicines of more than 80%. In the NGO facilities, seven (7) facilities had more than 80% of availability of key medicines while three (3) facilities had availabilities between 50% and 80%. Excluding four (4) public health facilities and one (1) private pharmacy which happened to have one expired medicine each on their shelves, all other thirty two (32) facilities did not have expired medicines on their dispensing shelves. Prices in the NGO’s were approximately 1.87 times higher than those in the public health facilities. Prices in the NGO’s were approximately 1.36 times higher than in the private retail pharmacies. Prices in the private retail pharmacies were approximately 1.48 times higher than those in the public health facilities. The median stock-out days per year was 117 days (ranging from 0 to 135 days) for medicines in the public health facilities. Five facilities out of the eleven surveyed did not have proper records to enable calculation of stock-out days of medicines for at least six months. The average percentage storage condition scores in the main drug stores of Public health facilities, NGO health facilities and private retail pharmacies were 44.5%, 45.8% and 69% respectively while that in the Dispensing rooms was 52.6%, 70.8% and 89% respectively. Conclusion The low overall availability of medicines in the public health facilities forces the population to purchase prescribed medicines from the private sectors where they are available, but are expensive. Frequent and lengthy stock-out periods of essential medicines in the public health facilities also raises concerns about the functionality of the current Integrated Logistics System (ILS) adopted by the MOHSW, forecasting of the medicine requirements and appropriate delivery of medicines to the end users by the Medical Stores Department (MSD) Tanzania. Adequate storage conditions and handling of medicines in the Main drug stores of public and NGO health facilities were dissatisfactory while that in the Dispensing rooms were satisfactory in both kinds of health facilities. As for the private retail pharmacies, the average storage condition in the Main drug stores was satisfactory while that in the Dispensing rooms was very satisfactory. Price of medicines in the public sector where cheapest amongst all other sectors while price fluctuations were observed in all sectors. Expired medicines happened to be more of a problem in the public health facilities and this raises concerns over appropriate regulation and inspection by the MOHSW. Recommendations Key medicines should be given priority during selection and procurement. Pharmacy and Therapeutic committees should prepare and update the list regularly based on the primary, secondary and tertiary health facility levels. Facilities should strengthen Drug Revolving Fund program through NHIF at the hospitals in order to sustain constant availability of essential medicines. While lowering price in the private and NGO sector is a long term goal, a new financing approach at the hospitals by using Drug Revolving Funds through the NHIF might be a solution. There is need for improvement in policies on medicine pricing and individual medicine prices where there is evidence of excessive prices. A system of MRP (Maximum retail price), as that used in other countries like India, can be beneficial whereby all the private medicine outlets cannot sell a particular medicine above that price. In that way, price fluctuations, vast differences in price and affordability to end users will improve. Prices on medicines and availability should be regularly and widely disseminated. Surveillance on availability, cost and price components should regularly be conducted by the relevant authorities so as to develop reliable information on medicine prices and availability to be used by the government, insurance funds and health facilities.