in-depth assessment of the medicines supply...

IN-DEPTHASSESSMENT OF THE MEDICINES SUPPLY SYSTEM IN TANZANIA

Published by the Ministry of Health and Social Welfare, Dar es salaam, Tanzania

© 2008 Ministry of Health and Social Welfare, Tanzania

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Acknowledgements/Disclaimer

This document has been produced with the financial assistance of the European Community and

the technical support of the World Health Organization. The views expressed herein are those of

the authors and can therefore in no way be taken to reflect the official opinion of the European

Community or the World Health Organization

IN-DEPTH ASSESSMENT OF THE MEDICINES SUPPLY SYSTEM IN TANZANIA4

IN-DEPTH ASSESSMENT OF THE MEDICINES SUPPLY SYSTEM IN TANZANIA i

TABLE OF CONTENTS

LIST OF FIGURES iiiLIST OF TABLES ivABBREVIATIONS vACKNOWLEDGEMENTS vi

1. EXECUTIVE SUMMARY 1

2. INTRODUCTION 2 2.1 Country Profile 2 2.2 Structure of National Health & Pharmaceutical System 2 2.3 Pharmaceutical services 3 2.4 Rationale of the assessment 4

3. STUDY DESIGN AND METHODOLOGY 5 3.1 Survey purpose 5 3.2 Methodology 5 3.2.1 Sampling and survey population 6 3.2.2 Training of the Survey Teams 7 3.2.3 Data collection 7 3.2.4 Data entry and analysis 7 3.2.5 Scope and limitation of the assessment 8

4.0 RESULTS AND ANALYSIS 9 4.1 Structure of medicines supply system in Tanzania 9 4.2 Categories of products managed at various level of care 9 4.3 Key medicines management functions at different levels of Health care 10 4.4 Customers at various levels of PSM 11 4.4.1 Turn over at MSD 12 4.5 Selection of Products 12 4.5.1 Availability of EML and STG 12 4. 5.2 Use of NEMLT in procurement 12 4.6 Quantification / Forecasting 13 4.7 Procurement 16 4.7.1 Sources of procured products at the Central Store 18 4.8. Ordering 20 4.9 Delivery 21 4.9.1 Indicators used for assessing products delivered 21 4.10. Storage/Stock Management 22 4.10.1 Adequate storage capacity 22 4.10.2 Storage conditions 23 4.10.3 Stock management techniques used 23 4.10.4 Availability of tracer products 24 4.10.5 Stock out days 25 4.10.6 Expiry of stocks 25 4.11. Distribution 26 4.11.1 Frequency of distribution for the various levels 26 4.11.2 Types, numbers and capacities of various means of transport 27 4.12 Quality Assurance system 28 4.12.1 The structures used for quality control 28 4.13 Rational Use 29 4.14 Financing 30 4.15 Information Management 32 4.16 Monitoring and evaluation 33 4.16.1 Performance Indicators 34 4.17 Human resource 35

IN-DEPTH ASSESSMENT OF THE MEDICINES SUPPLY SYSTEM IN TANZANIAii

5.0 DISCUSSIONS 36 5.1 Selection of products and order placement 36 5.2 Structure 37 5.3 Health facility Pharmacies 37 5.4 Procurement of medicines 37 5.5 Quantification of needs 38 5.6 Procurement methods 38 5.7 Products storage and stock management 39 5.8 Availability of medicines and medical supplies at Health Facilities 39 5.9 Quality Assurance system 40 5.10 The impact of Vertical Programs 40

6.0 CONCLUSION 41

7.0 RECOMMENDATIONS 43

8.0 RECOMMENDATIONS OF THE STAKEHOLDERS WORKSHOP 44

9.0 REFERENCES 50

10 ANNEXES 51

Annex 1: Data Collection Points 51Annex 2: List of names of Data Collectors for the Assessment 51Annex 3: List of Tracer Medicines 52

IN-DEPTH ASSESSMENT OF THE MEDICINES SUPPLY SYSTEM IN TANZANIA iii

LIST OF FIGURESFigure 1 Key medicines management functions

Figure 2 Supply functions performed by vertical programs

Figure 3 Reasons for non compliance with EML at facility level

Figure 4 Procurement methods and lead time

Figure 5 Procurement sources and their frequency of use

Figure 6 Percentage use of indicators for assessing products delivered

Figure 7 Percentage adequacy of storage capacity at all levels

Figure 8 Percentage median availability of 20 tracer medicines

Figure 9 Use of revenues collected at MSD

Figure 10 Activities carried out during supervision

Figure 11 Performance indicators regularly evaluated

Figure 12 Level of initial training offered to staff in procurement

Figure 13 Level of regular training offered to staff in procurement at health facilities

IN-DEPTH ASSESSMENT OF THE MEDICINES SUPPLY SYSTEM IN TANZANIAiv

LIST OF TABLESTable 1 General Health Indicators

Table 2 Levels of Health Service Delivery

Table 3 Facilities visited

Table 4 Formation of Zonal Stores

Table 5 Categories of products managed at various levels of care

Table 6 Customers at various levels of the procurement and supply management

Table 7 Total sales in USD and percentage mark up of MSD 04-06

Table 8 Reasons for non compliance with the NEMLIT in procurement

Table 9 Information used in quantification of needs

Table 10 Responsibilities and tools used in quantification

Table 11 Tendering methods, percentages of application and lead times in days

Table 12 Criteria considered when awarding contracts

Table 13 A summary of award contracts in USD for the year 2006

Table 14 Frequency of ordering

Table 15 Indicators used in measuring suppliers performance

Table 16 Volume of imports by central store in 2006

Table 17 Delivery types at all levels

Table 18 Adherence to storage conditions

Table 19 Adherence to stock management techniques

Table 20 Reasons for stock outs at all levels

Table 21 Causes of expiry of stocks

Table 22 Frequency of distributions

Table 23 The number and capacity of vehicles for distribution

Table 24 Criteria used to assure quality of products procured

Table 25 Standard operating procedures available at MSD

Table 26 Medicine information sources

Table 27 Amount of expenditure in USD and sources of funding

Table 28 Activities supported by donor funding

Table 29 Administration fees on selected category of products

Table 30 Type of information monitored regularly

Table 31 Processes monitored

Table 32 Professional category of staff and their function

Table 33 Areas needing improvement identified during a workshop to disseminate results of the

assessment

IN-DEPTH ASSESSMENT OF THE MEDICINES SUPPLY SYSTEM IN TANZANIA v

ABBREVIATIONSAIDS Acquired Immunodeficiency Syndrome

ARVs Anti-retrovirals

C & F Cost and Freight

CIF Cost Insurance and Freight

CPT Carriage Paid To

DDP Delivered Duty Paid

DDU Delivered Duty UnPaid

EML Essential Medicines List

FEFO First Expiry first Out

FIFO First In First Out

FOB Free on Board Vessel

GDP Gross Domestic Product

GOT Government of Tanzania

HF Health Facility

HIV Human Immunodeficiency Virus

HTC Hospital Therapeutic Committee

ILS Integrated Logistics System

MOHSW Ministry of Health and Social Welfare

MSD Medical Stores Department

NEDLIT National Essential Drugs List for Tanzania

NEMLIT National Essential Medicines List for Tanzania

NGO Non-Governmental Organization

OI Opportunistic Infection

PHF Primary Health Facility

PORALG Prime Minister’s Office Regional Administration and Local Government

PT Pharmacy Technicians

SOP Standard Operating Procedures

STG Standard Treatment Guidelines

TFDA Tanzania Food and Drugs Authority

WHO World Health Organization

IN-DEPTH ASSESSMENT OF THE MEDICINES SUPPLY SYSTEM IN TANZANIAvi

ACKNOWLEDGEMENTSThe Ministry of Health would like to express its gratitude to the World Health Organization (WHO) whose

financial support made it possible to conduct this survey. The Ministry would also like to acknowledge all

people who contributed their time and expertise to carry out this survey. In particular we would like to mention

the following: The Director for Hospital Services Ministry for Health, Dr Z. Berege; the Chief Pharmacist and

Assistant Director of Pharmaceutical Services, Mr Joseph Muhume and Mrs. A. Sillo for the administrative

support they offered during the assessment period and while preparing this report. Special thanks go to Ms

Rose Shija, the WHO Country Office Essential Medicines and Medicine Policy National Professional Officer

(EDM NPO) for her technical support throughout the whole process of the assessment.

The Ministry is also grateful to all health workers in the surveyed facilities for facilitating the data collection

process. The Ministry is grateful for the cooperation given by the Director General of MSD for setting aside

his time during interviews. The support extended by the entire management team of MSD and the individual

staff is highly appreciated.

The close cooperation and guidance received from the Regional Medical Officers and District Medical officers,

Regional and District Pharmacists of Dar es Salaam, Moshi, Mwanza, Tabora, Mbeya, and Mtwara regions

are highly appreciated. The Medical Directors of Bugando, K.C.MC, Mbeya and Muhimbili hospitals are

acknowledged for providing access to useful information pertaining to medicines supply in their hospitals.

Special gratitude is extended to staff of all sectors who volunteered to respond to the lengthy questionnaires

during the whole time of the survey.

The use of the database and the modules developed to capture information in a structured manner posed quite

a challenge. The efforts and the enthusiasm experienced in using this software have been overwhelming. We

thank Mr. James Annan the Temporary Advisor from the Ministry of Health Ghana for his support on the use of

the data analysis software. We also thank Mrs Helen Tata and Mrs Magali Babaley from WHO Headquarters

who coordinated and facilitated the data analysts and principal investigators training in Ghana.

Lastly but not least, the valuable work done by the data collectors who devoted their time and commitment

to collect the data for this survey is acknowledged. These include: Prof. Dr. M. Justin-Temu, Dr. M. Jande,

Dr. G. Rimoy, Mr F. Nicolaus, Mr. A. Malisa, Mr. N. Mhadu, Ms. C. Muzaga, Ms. C. Magege, Mr. E. Ngaimisi,

Mr. W. Shango and Ms. R. Tumbo. Not forgetting Mr. C. Makwaya and Mr. H. Mchunga who compiled and

analyzed the data. We thank the entire Tanzanian Team who has demonstrated exceptional skills and ability

of team spirit and skills. It is our hope that this spirit of support and cooperation will be the modus operandi

for future works and assignments.

Finally, the Ministry of Health and Social Welfare wishes to acknowledge Mr. C. Msemo for coordinating this

assessment.

IN-DEPTH ASSESSMENT OF THE MEDICINES SUPPLY SYSTEM IN TANZANIA 1

1. EXECUTIVE SUMMARYA well functioning medicines supply management system is vital in assuring an un-interrupted supply of

essential medicines that are efficacious and of good quality, physically and financially accessible and used

rationally. Carrying out an in-depth assessment of the system provides information for targeted interventions

in strengthening the system. In the light of the above, WHO supported Tanzania mainland in August 2007 to

undertake an in-depth assessment of the supply management systems of essential medicines and medical

supplies in the public health. The survey was carried out using the WHO draft tool for the in-depth assessment

of the medicines supply management system (June 2007 version).

The Medical Store Department which is the structure responsible for procurement and distribution at the

national level is a semi- autonomous, public, non-for-profit organization created in 1993. It operates a self

sustaining revolving drug fund with 8 zonal stores. Data from the study found that stock availability of twenty

(20) tracer medicines was at an average of 79% at the dates of evaluation in the Zonal Stores. The stock out

situation measured by the number of days the item has been out of stock in a year ranged between one (1)

and one hundred eighty three (183) days. Lead times for delivery by sea on the average were long taking up

to 8 months. In addition the time used to clear products from the port to the central warehouse was also long.

Stock management techniques also were found to be weak except for traceability of batches (though this had

been rated poor by the TFDA in previous quality inspections) and the definition of minimum stock levels. This

could have contributed highly on the number of expired medicines and supplies which was found to be 3.7%

of sales for the year for 2006 at the central store.

The assessment also found that, most facilities studied had a functioning Pharmacy system (88.9%) and

kept Essential Medicines (92.9%). However, in most of the Pharmacies, a general inadequacy of storage

space, storage equipment and facilities for controlling temperatures were found. For example only 33% of

Pharmacies reported to have adequate storage capacity, only 52% had facilities for cold storage and only

22% had adequate storage equipment. Important parameters in stock management such as maximum and

minimum levels of stock were not determined in almost all facilities. The assessment showed the level of

stock management in almost all of the Pharmacies needed to be improved. Although availability of tracer

medicines was high at health facilities, the same facilities also presented a considerable number of stock-out

days. Some medicines were out of stock for 4 months.

Tanzania has about 640 registered Pharmacists, 352 Pharmacy Technicians (PT) and 312 Pharmacy

Assistants. With more than 5400 health facilities in the country, it is evident that there are inadequate

pharmaceutical human resources at health facilities, districts and regions.

The assessment also found that there were more areas in the health facilities management systems that

required improvement. This was in comparison with how the supply chain management was managed in the

regional, central and national levels. The assessment showed that there were challenges with regards to the

quantification processes and staff interviewed did not have a unified system for determining what to order

from the Central Store. The forecasting ability was still low, and Health facility staff (78%) affirmed that very

minimal initiatives were in place to provide continuous training. Only 11% of facilities used data on donation

supplied by partners. Results showed that only 33% facilities procured exclusively from MSD, the national

procurement agent while 45% procured from other sources.

At the Medical Stores Department (MSD), procurement was done predominantly through a competitive tender

system, and the medicine price survey conducted in 2004 indicated that the medicines procurement prices

were below the international reference prices with an overall medicines availability of 72 %.


2. INTRODUCTION

2.1 Country Profile

The United Republic of Tanzania is a union of between Tanganyika (Tanzania Mainland) and Zanzibar. It

has a total Area of 945,000 square kilometers, of which 883,000 square kilometers are land; 881,000 square

kilometers in the mainland and 2,000 square kilometers in Zanzibar. Projections for 2009 indicate Tanzania’s

total population of 41.9 millions, of which 44.4% (18.6 million) are children under 15 years. The population

of

Zanzibar is estimated to be 1.2 million (63 % in Unguja and 37% in Pemba Island)1.

The country’s economy is based mainly on agriculture and tourism, which accounts for 75-78% of the total

export earnings, yet meet only one third of Tanzanians imports.

Table 1: General and health indicators2

Estimated Population July 2008 37,990,5563

Estimated % Population living under the poverty line of 1 USD 57.8%

Life expectancy at birth (M/F) years , 2008 Male 51.4 yrs

Female 53.6 yrs

Under five mortality per 1000 live births 112

Infant mortality per 1000 live births 68

HIV prevalence rate among adults 5.8

Per capita public health spending in US$, 2001. 6

% of the population within 5 km of a facility, 2005 70

% of population within 10 km of a facility, 2005. 90

Medicines budget 2002, US$, million 18.3

Medicines budget 2007, US$, million 28.5

2.2 Structure of National Health & Pharmaceutical System

The health system in Tanzania has two major components; the public and the private sector. The public share

is 56%; the private share is 44% (which includes Faith Based Organizations (NGOs) 30% and private for

profit 14 %). The system works at four levels; the community, the ward where there is a dispensary and a

health centre at the division level. As one moves further there is the district and regional hospitals at district

and regional levels respectively. At the zonal and national levels, are the consultant/ referral hospitals.

1Population and Housing Census General Report, Central Census Office, National Bureau of Statistics. 20032Source UN population division (http://esa.un.org/unpp)


Table 2: Levels of Health Service Delivery

Level Type of health

facility

Service

population

Remarks

Country National Hospital,

MSD, Private

wholesalers

36 million There is only one national hospital, serves

36 million because it offers some specialized

services not generally available in other

consultant hospitals

Zone Consultant Hospital,

ZMS

8 million Serve as the referral centre for the hospitals

in the surrounding regions in the zone.

There are four consultant hospitals in total

including the national hospital

Region Regional Hospital,

Pharmacy

1-1.5 million 17 regional hospitals

District District Hospital,

Pharmacy

250-500,000 A number of NGO hospitals function as

designated district hospitals (DDH). More

than one hospital may be available in

each district, usually run by NGOs (219

hospitals)

Division Health centre 50-100,000 481 health centers

Ward/ Village Dispensary, Medical

stores

5-10,000 More than one dispensary may be available

in a ward (4679)Community Health post, ADDO 2-5,000

Currently in Tanzania there are a total of 5,379 health facilities geographically distributed so that 70% of the

population is within 5 km of a facility and 90% is within 10 km as at the end of 20053.

Administratively, the health system is largely decentralized. The MoHSW has direct responsibility for the referral

and regional hospitals, and regulatory power over all health facilities. The district facilities are independently

run by the Prime Minister’s Office Regional Administration and Local Government (PORALG).

2.3 Pharmaceutical services

In improving the Pharmaceutical sector, the government endorsed the first National Drug Policy, the Standard

Treatment Guidelines (STG) and the National Essential Drug List for Tanzania (NEDLIT) in 1991. The STG

and NEDLIT were later revised in 1997. These documents are crucial in medicine quantification, procurement

and supply to achieve therapeutically better outcomes to the patients, a most important objective of all health

care systems. The Ministry of Health and Social Welfare is currently in the process of revising the NEDLIT,

STG and the NDP and has produced drafts in 2007.

The overall objectives of the NDP are to make available to all Tanzanians at all times safe, efficacious and

quality essential medicines at affordable price to an individual and the community, when these are needed

to prevent, cure or reduce illness and suffering. The NDP set up a master plan for Pharmaceutical sector

to further improve the sector between 1992 and 2000, with clear objectives, strategies, time frame and

budget required to achieve development in key areas of the pharmaceutical sector. It provides a framework

to coordinate activities by the various actors in the pharmaceutical sector: the public, private and mission

sectors, donors and other interested parties.

3 MOH&SW, Second Health Sector Strategic Plan (HSSP), July2003-June 2008, April 2003


Implementation of the NDP Pharmaceutical Master plan is coordinated by the Pharmaceutical Services Unit

(PSU) at Ministry of Health (MOH&SW). Some of the key roles of the PSU are to:

• Ensure that MSD performs according to the MSD Act of 1993

• Ensure that adequate funds to procure drugs and medical supplies are provided to MSD

• Assist health facilities with capacity to quantify drugs requirements

• Establish effective strategies for improving rational drugs use

• In collaboration with TFDA ensure the quality of medicines

• Establish effective drug management and monitoring systems at health facility level and reduce drug waste

and pilferage

• Ensure an appropriate allocation of resources to health facilities for drugs that takes into account equity,

patient load, morbidity and drug needs.

Provision of medicines and medical supplies in Tanzania is through the public non-for-profit system (56%)

and private-for-profit sector (44%). All public facilities receive their supply shares by either using allocated

financial budgets or draw supplies for use against established budget ceilings.

The total medicine budget disbursed for the public sector for the year 2000, 2001 and 2002 and 2007 in US$

was 14.1million, 16.2 million, 18.3 million, 28.5million respectively. The budget for year 2007/08 was US$

28.46 million. Although the budget has been increasing every year this however is not enough to meet the

national medicine needs.

The Tanzania Food and Drugs Authority (TFDA) is responsible for the regulation of medicines and conducts

inspections of the private and public drugs outlets in Tanzania.

Tanzania has about 640 registered Pharmacists, 352 Pharmacy Technicians (PT) and 312 pharmacy

Assistants4. The Pharmacy Council is responsible for regulating the pharmacy profession and for registering

the pharmaceutical personnel in the country.

2.4 Rationale of the assessment

The increase of scope of activities within the past few years has seen an increase in the number of partners

involved in the procurement and supply management of essential medicines, especially those for priority

diseases such as HIV/AIDS, TB and malaria. This increase in roles and upsurge in funding from both the

government and partners to service the health facilities have affected the way the central supply system

operates as it puts more demands for reporting, coordination and accountability with all stakeholders and in

particular funding agencies. These challenges have spilled over to health facilities where parallel reporting is

also still needed despite the inadequate human resources.

It is against this background that Tanzania decided to do an in-depth assessment of procurement and supply

management system as well as mapping of the partner’s coordination within the procurement and supply

management system.

4Source –Pharmacy Council


3. STUDY DESIGN AND METHODOLOGY

3.1 Survey purpose

The objective of this assessment was to carry out an in-depth assessment of the country medicine supply

management systems and also the financial flows for essential medicines and medical supplies. Subsequently

it aims at providing a situation analysis of the strengths and weaknesses of existing medicines supply systems

and to propose recommendations and strategies on how to improve them.

Specific objectives were:

To undertake an in-depth assessment of medicines financing and financial flows for the existing

systems for procurement and distribution of essential medicines including medicines for HIV/AIDS,

TB, malaria, opportunistic infections, contraceptives, vaccines, condoms, HIV/AIDS test kits, medical

devices and laboratory products.

To identify and analyse at each level of the medicines supply management cycle (selection,

procurement, distribution, and use), the actors involved in each category of product.

To determine the strengths and weaknesses of existing medicines supply systems and to propose

recommendations and strategies on how to improve them.

To disseminate results to stakeholders to help develop a coordinated, coherent and efficient national

medicines supply plan or strategy.

3.2 Methodology

The assessment focused mainly on the Public health facilities’ medicines supply system. The survey was

carried out using the WHO draft tool for the in-depth assessment of the medicines supply management

systems (June 2007 version). The survey tool consisted of questionnaires for the following level of health

care:

Questionnaire N° 2 Ministry of health

Questionnaire N° 3 Priority disease programs

Questionnaire N° 4 Central Medical Stores

Questionnaire N° 5 District stores

Questionnaire N° 6 Health facilities

For each level, the questionnaire addressed medicines supply management issues around:

Structure

Selection

Quantification

Procurement

Ordering

Storage & stock management

Distribution

Quality assurance

Rational use

Resource allocation0

Information management

Monitoring and evaluation, and

Human resource


3.2.1 Sampling and survey population

The assessment assessed the procurement and supply management systems in six geographical areas

representing the Eastern, Western, Central, Northern, and Southern parts of Tanzania. Dar es Salaam was

purposely chosen as the capital city of Tanzania mainland and the other five administrative regions also

purposely chosen were Mwanza, Tabora, Moshi, Mbeya and Mtwara.

The criteria for selection of the sites was based on the intensity of the health service activities carried out,

the geographical and economical distribution and the presence of a comprehensive health system structure,

comprised of primary, secondary and tertiary levels of health care. Presence of a functioning medical store

and operating distribution system was a prerequisite.

The areas are economically different with Dar es salaam and Mwanza being more economically vibrant

followed by Mbeya and Moshi. Tabora and Mtwara represented the least developed regions.

Dar es Salaam region is the commercial capital of Tanzania. Mwanza city is on the shores of Lake Victoria

and is economically vibrant with activities such as mining, fishing industries and farming. Mbeya is an

agricultural town with increasing trade activities along its borders with Zambia and Malawi. Moshi on the

other hand is an emerging tourist center. Its economy is dependent on the service industry, tourism and

agriculture of cash crops for export. Tabora and Mtwara represent the economically unstable regions with

some activities of subsistent farming as their major source of income.

The selected sites took into account the six Medical Stores Zonal branches of Mwanza, Tabora, Mbeya,

Mtwara, Moshi and Dar es Salaam. The Ministry of Health and Social Welfare (MOHSW) provided the list of

health facilities. Those closest to the regions/ districts and zonal medical stores were chosen for the survey.

Since the sampling was representative, the results can be generalized to the country.

In each region, the following units were surveyed:

At the central level:

The Medical Store Department as well as the following vertical programs were surveyed:

1 Eye Care Services

2 National TB& Leprosy

3 National Malaria Control

4 National Aids Control

5 Reproductive and Child Health

6 Extended Program on Immunization

At the Regional level, a total of five zonal medical stores and twenty seven Health facilities were surveyed

as follows:


Table 3: Facilities visited

AREA MTWARA MBEYA TABORA MOSHI MWANZA DAR ES

SALAAM

Type of facility

Regional Store or Zonal Medical

Store

1 1 1 1 1 1

Referral Hospital 0 1 0 1 1 1

Regional Hospital 1 1 1 1 1 0

District Hospital 1 1 1 0 1 1

Health Center 1 0 2 1 1 1

Dispensary 1 2 0 2 1 1

Sub Total 5 6 5 6 6 5

Grand Total 33

3.2.2 Training of the Survey Teams

The survey team comprised of numbers 12 data collectors, one data analysts and a coordinator. The data

collectors consisted of pharmaceutical staff from the public as well as the private sectors as well as members

from the academia.

The training of data collectors took place in Dar e s Salaam, Tanzania from 25th -27th July 2007. A field test

of the data collection instrument was carried out at the training location. After the training, each region was

assigned a team of two data collectors.

Later on, three data analysts from Tanzania participated at a three day workshop on data entry and analysis

that was organized by WHO in Accra- Ghana from 21st – 23rd August 2007. The training equipped the

participants with basic knowledge on handling the software programs.

3.2.3 Data collection

Data was collected from health facilities in the six regions between 30th July 2007 and 3rd August 2007. Face

to face interviews using structured questionnaires were used to collect data and information.

The coordinator for the assessment and two data collectors gathered information on policy issues affecting

the medicines supply management system at the ministry of health level and vertical disease programs.

3.2.4 Data entry and analysis

Data collected for all sites surveyed was entered into a software and analysed by the data analysts. To

ensure accuracy of the data, the national Coordinator counterchecked all data entered against the original

filled-in questionnaires. During this exercise, data entry errors were corrected. Where there were technical

problems in correcting data entry errors, communication to the Software Engineer commissioned by WHO in

Accra was made via email.


3.2.5 Scope and limitation of the assessment

The findings of the assessment are limited to the questionnaire tool used to collect information and data.

Some data could not be obtained. For example, the financing and funding flows of the health facilities could

not be captured with precision, since most of the facilities do not control any funds and staff interviewed had

no direct access to information and records of the budgets for their health facilities. Most of the financial

information is kept at the Administration office and in Accounts sections and time was not adequate to gather

the information from those other sources. The Health centers and Dispensaries in particular were not able

to provide adequate information on funding since they receive medicines and medical supplies against an

allocated budget line which is managed by the Medical Stores Department.


4.0 RESULTS AND ANALYSIS

4.1 Structure of medicines supply system in Tanzania

The Medical Stores Department, created in 1993, is a semi-autonomous unit under the ministry of health. It

operates a self sustaining revolving drug fund and its main customers are the Zonal Medical Stores which

supply products to regional and districts hospitals, health centers and dispensaries. The Central store and

the zonal stores together form an institution known as the Medical Stores Department, which has a governing

Board of Trustees. This Board appoints directors of MSD. A management committee comprising of all directors

meets regularly to discuss issues pertaining to the management of the organization.

The five zonal stores visited (see table below) reported to not having independent Boards but rather had

management committees comprising of stores managers, warehouse officers and accountants and other

professionals. Each store operated a separate Bank Account that serves as a collection account for earnings

on sales as well as for servicing the operational business.

Table 4: Formation of Zonal Stores

Name of the store Name of region Distance in Km from

the MSD

Date of creation

MWANZA MWANZA 1164 JULY 1994

TABORA TABORA 1023 JULY 1994

MTWARA MTWARA 580 JULY 1994

MBEYA MBEYA 850 JULY 1998

MOSHI KILIMANJARO 562 JULY 2000

All health facilities visited had pharmacy sections which are under the leadership of the Medical Officer in

Charge.

4.2 Categories of products managed at various level of care

The table below shows the category of products managed at each level. It can be seen that not all products

are managed by all the facilities. For HIV products for example, only 48% health facilities reported to manage

them.


Table 5: Category of products managed at various levels.

Category of products LEVEL

Central Medical

Store

Zonal Stores H e a l t h

Facilities

Essential Medicines 100% 100% 92.6%

Antimalarial 100% 100% 96.3%

Condoms 100% 100% 55.6%

Contraceptives 100% 100% 51.9%

HIV/AIDS Medicines 100% 100% 48.1%

Medical Supplies 100% 100% 85.2%

Medicines for OI 100% 100% 66.7%

Pediatric Formulations for HIV and Malaria 100% 100% 51.9%

Reagents for blood safety 100% 100% 51.9%

TB medicines 100% 75% 66.7%

Vaccines 100% 100% 55.6%

4.3 Key medicines management functions at different levels of Health care

The following key medicines supply management functions were observed at the different levels as follows:

Figure 1: Key medicines management Functions

The functions of the MSD include all the activities in the medicines supply management cycle except

dispensing. This ranges from the selection of a list of medicines for its catalog from the National Essential

Medicines list, to procurement, storage and distribution to its customers. The zonal stores conduct the same

activities as at MSD with the exception of procurement of medicines and medical supplies. At the health

facility levels, the various functions performed at the pharmacy are depicted in figure above. The pharmacy

departments at referral and national hospitals also have wider roles and some reported that they offered

trainings to lower pharmaceutical cadres and other health professionals and are involved in preparation of

basic pharmaceuticals for hospital use. Those secondary and tertiary health facilities are also responsible

for the selection (of products for their facilities from the NEMLIT), quantification, ordering, warehousing of


medicines and medical supplies. Vertical programs also performed some of supply management functions

as shown below:

Figure 2: Supply functions performed by vertical programs

The figure above illustrates involvement of the vertical disease programs in the medicines supply management

system in Tanzania. As part of the health sector reforms in the country, the procurement and supply

management activities of the vertical programs are supposed to be integrated within the one system of the

MOHSW used for all medicines.

4.4 Customers at various levels of PSM

With regards to customers of the stores, the Central Store serves all Zonal Stores as well as the national

hospital and some facilities in Dar es Salaam. The zonal stores are geographically distributed to provide

medicines and supplies closest to the population. The Table below shows the customers of MSD and its

Zones.

Table 6: Customers at the various level of the supply system

Customers LEVEL

Central Medical Store Zonal Stores Health Facilities

District Facilities 100% 100% No responses

District warehouses 100% 50% -

Faith-based HF 100% 100% -

Health Facilities 100% 100% -

NGOs 100% 50% -

Patients 100% 0% -

Private pharmacy 0% 0% -

Regional health facilities 100% 75% -

Schools - 25% -

Armed Forces - 25% -

Responsibility of programmes

0%20%40%60%80%

100%

Pro

du

ctse

lect

ion

Dis

trib

uti

on

Qu

anti

fica

tio

no

f n

eed

s

War

eho

usi

ng

Dis

trib

uti

on

Sto

rag

e

% o

f p

rog

ram

mes

th

at p

erfo

rm

fun

ctio

n


The MSD and its zones therefore supply products to health facilities at the central level i.e. national referral

hospitals, regional health facilities, district health facilities, health centers and dispensaries, faith based health

facilities, approved non-governmental organizations, armed forces, schools and other training institutions

that have medical services within their establishment. However, health facilities do not supply to any lower

levels.

4.4.1 Turnover at MSD

The figure below states the total sales and percentage mark-up at the MSD in three consecutive years:

Table 7: Total sales in Us Dollar and percentage mark-up of MSD 2004-2006

Year 2004 2005 2006

Turnover in US$ of the MSD 38,417,481 52,000,000 86,980,000

% mark-up of total sale 17% 17% 15.5%

The Zonal stores and health facility pharmacies do not sell products but rather distribute further the products

to lower levels.

4.5 Selection of Products

Selection of products is done in accordance to the National Essential Medicines List for Tanzania (NEMLIT).

The selection of products for the National Essential Medicines List for Tanzania (NEMLIT) is done at the level

of ministry of health. The MSD further selects a list of medicines and medical supplies for its price catalogue.

Facilities use MSD price catalogue as a guide to place orders with MSD.

4.5.1 Availability of EML and STG

The draft 2007 revised version of NEMLT was available at the MSD. There were no treatment guidelines

found except those for tuberculosis the version last reviewed in 2005/06.

The draft EML was available in 80% of the Zonal stores. There were no STGs found in Zonal Stores.

With respect to health facility pharmacies, 38% only had the EML, and the ones in use were last revised in

2006 and were in a draft form.

4. 5.2 Use of NEMLT in procurement

Results showed that at the MSD, procurement of essential medicines is not limited to the EML. It was

reported that there are medicines for tertiary care procured under request of health institutions offering care

and management. Reasons for non compliance with the NEMLIT are as follows:

Table 8: Reasons for non-compliance with the NEMLT in procurement

Reasons for procuring out of the EML Ranking of priority

(No 1 is the most important and 3 the

least)

a. The prescribers do not agree with the STG 1

b. The EML does not address local needs or demand 2

c. The products on the EML are not available from the suppliers

(CMS, regional warehouse, district warehouse…)

3


Reasons for Non compliance with EML at facility level

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

Limitin

g is n

ot de

fined

in ph

arma.

.

EML d

oes n

ot ad

dres

s loc

al ne

ed ..

EML n

ot re

vised

and n

ot co

nform

...

Last

vers

ion of

EML

not a

vaila

ble

Pres

cribe

rs no

t fam

iliar w

ith S

TGs

Presc

riber

do n

ot ag

ree

with S

TGs

Produ

cts fr

om E

ML no

t ava

ilable

% of facilities

Similarly at the health facility level, only about 52% of facilities procured medicines within the EML. The

main reasons for non compliance are that the EML does not address local needs (33% of facilities) and that

products from EML are not available (22%). Other reasons are shown in Figure below:

Figure 3: Non compliance with EML at facility level

4.6 Quantification / Forecasting

At the Central Medical Store there is a special committee responsible for forecasting and quantification

of essential medicines. Other category of products such as HIV/AIDS medicines, anti-malarias etc. are

forecasted and quantified by their respective vertical programs. At the health facilities it was found that seven

health facilities out of twenty seven conducted quantification exercises on an annual basis; four indicated that

they do not do quantification while sixteen did not respond to the question.


The information used in the quantification at the different levels is shown in the table below:

Table 9: Information used in the quantification of needs

Information Used LEVEL

Central Medical

Store

Zonal Medical

Stores

Health Facilities Program

1st Consolidating

distribution data

(100%)

Consolidating

distribution data

(100%)

Dispenser

to user data

(77.8%)

Demographic data

(83.33%)

2nd Consolidating

decentralized

forecasts (100%)

Expiry dates of

stock on hand

(100%)

Stock on hand at

all level (59.3%)

Consolidating

decentralized

forecasts

(66.67%)

3rd Donations provided

by partners/donors

(100%)

Stock out

duration (75%)

Available finance

(51.9%)

Standard

Treatment

Guidelines

(66.67%)

4th Seasonal and

regional variations

(100%)

Available finance

(50%)

Standard

Treatment

guidelines

(51.9%)

Dispenser to user

data (66.67%)

5th Standard Treatment

guidelines (100%)

Consolidating

decentralized

forecasts (50%)

Demographic

data (51.9%)

6th Stock on hand at all

level (100%)

Seasonal

and regional

variations (50%)

7th Expiry dates of stock

on hand (100%)

Stock on hand at

all level (50%)

The following factors were important in determining quantification needs: Consumption or distribution pattern,

available finances and stock on hand as well as expiry dates of stock at hand, all of which are widely used

across all the four levels. At the CMS, other information is also used, such as donations, Standard Treatment

Guidelines and Seasonal variations. Zonal stores also took into account available finances and seasonal

variation, while health facilities do consider available finances and standard treatment guidelines as well as

demographic data. The latter data are also commonly used at program level.

The table below explains the various categories of staff involved in the quantification of different categories of

products at different levels. The table also shows the tools used in quantification and forecasting of medicines.

With regards to this, the Central Medical Store uses an Enterprise Resource Planning (ERP) tool (Orion) in

the quantification of essential medicines and medical supplies. Quantification of needs for medicines and

medical supplies is performed once in a year. The medical store has a procurement plan developed by the

procurement management unit of the department. The plan includes medicines and supplies financed by

partners.


As for health facilities, quantification of needs is done manually. Use of computer programs is much less

common and excel is the most used program.

Table 10: Responsibilities & tools use in quantification

Level of Care Category of products Responsible staff Tool used

MSD Essential medicines Forecast Committee Orion

Programs HIV/AIDS Team comprising JSI, NACP, Clinton

Foundation

Excel

Paediatric formulations

for HIV/AIDS and

Malaria

Team comprising JSI, NACP, Clinton

Foundation

Excel

OI Team comprising JSI, NACP, Clinton

Foundation

TB Supplies Officer MS Access

Malaria Excel

Vaccines UNICEF None

Reagents for blood

safety including HIV/

AIDS

'Team comprising JSI, NACP, Clinton

Foundation

Excel

Condoms Supplies Officer Excel, Papiline

Contraceptives Supplies Officer Papiline

Zonal stores Essential medicines,

Antimalarials,

Area managers, pharmacist and

warehouse officers

Support Manual

Condoms, Area managers, pharmacist and

warehouse officers, Program Manager

Support Manual

Contraceptives Pharmacist, Area manager, nurse,

warehouse officer, Program Manager

Support Manual

HIV/AIDS medicines Area managers, pharmacist and

warehouse officers, Program Manager

Support Manual

Medical supplies Area managers, pharmacist, warehouse

officers and nurses,

Medical

Supplies

OI National AIDS Control Programme,

pharmacists, manager

Support Manual

Paediatric Formulations

HIV and Malaria

National AIDS Control Programme,

warehouse officers, pharmacist,

manager

Support Manual

Reagents Advanced Diploma in Medical Laboratory

Technology, National AIDS Control

Programme, Pharmacist

TB medicines TB and Leprosy Coordinator, Medical

doctor, pharmacist

Vaccines Medical doctor, environmental health

officer, pharmacist, manager.


Level of Care Category of products Responsible staff Tool used

Health

Facilities

Essential Medicines Hospital pharmacist, Clinical Officer,

Health Facility in charge, Medical Doctor,

pharmaceutical assistant, AMO, Supply

Officer.

Excel, Support

Manual, Manual

ledger book

Antimalarial Hospital pharmacist, Clinical Officer,

Nurse Assistant

Excel, Support

Manual

Condoms Peer educator, Medical doctor, Regional

AIDS Coordinator, Head of general Store,

Nursing Officer, RCH Coordinator, MCH,

Clinical Officer

Support Manual

Contraceptives Peer educator, Medical Doctor, MCHCO,

Nurse, Nursing officer, RCH coordinator,

MCH, Clinical Officer

Support Manual

HIV/AIDS Medicines Hospital Pharmacist, Excel, Support

Manual

Medical Supplies Hospital Pharmacist, Supplies officer,

Pharmaceutical technician, AMO, Head

of Facility, Clinical Officer

Support Manual

OI Hospital Pharmacist, Clinical Officer Support Manual

Paediatric Formulations

HIV and Malaria

Hospital Pharmacist, Support Manual

Reagents Laboratory technologist, Hospital

therapeutic committee

TB medicines Regional TB coordinator, Medical Doctor,

District TB and leprosy coordinator,

Clinical Officer

Support Manual

Vaccines Hospital Pharmacist, Health officer,

Nursing Officer, RCH coordinator,

Regional Cold chain coordinator, District

cold chain coordinator

Support Manual

The assessment also found that only six out of twenty seven facilities reported to have procurement and

supply management plans. Copies of the plans were provided, however in all of them the procurement plan

did not include medicines and supplies financed by partners. All facilities with the procurement plan affirmed

that they had a committee for the development of the plan.

4.7 Procurement

At the Central Store, procurement of essential medicines and all other categories of products are procured

by the MSD Tender Board. The tender board membership is comprised of people with different qualifications

including, Pharmacists, Financial experts, Material Management staff and Logisticians.

The area managers are responsible for procurement at the zonal levels, while at the health facility level,

different people procure medicines. This could be the supplies officer, Nursing Officer, Head of Facility,

Pharmacist or RCH coordinator depending on the facility in question.


The most common tendering methods include the following:

Table 11: Tendering methods percentages of application and lead times in days

Central Medical Store Health Facilities

Average

lead time

Average

lead time

Responsible for procurement Tender

Board

Supplies officer, Nursing

Officer, Head of Facility,

Pharmacist, RCH

coordinator

Procurement Methods

International Competitive Bidding 80% 150 0%

National Competitive Bidding 100% 45 3.7% 75

Negotiated Tender 0% 30 3.7% 90

Selective Bidding 10% 90 3.7%

Direct Procurement 2% 18 22% 16.7

Shopping 3% 7 -

For the central medical stores, lead times for the procurement are further graphically displayed below:

Figure 4: Procurement Methods and Lead Times

As can be seen, procurement through international competitive bidding is the slowest procurement method

as it has a lead time of 150 days. Selective bidding is also slow (90 days), while direct procurement and

shopping are the fastest methods (respectively 18 and 7 days).

Lead time for procurement CMS

020406080

100120140160

Intern

ational

Compe

ti tive

Bidding

National

Compe

titive

Bidding

Negotia

ted T

ende

r

Selecti

ve Bidd

ing

Direct

Procurem

ent

Shopp

ing

Length in days


The Central Store applies the following Incoterms during procurement ie CIF, DDP, FOB, DDU and CPT/

C&F.

The Medical Store Department reported that it considered all the criteria in the questionnaire when awarding

contracts. There is a technical committee responsible for analyzing tenders; the award of tenders is made by

its tender board. The results of the tender are publicly declared before participating bidders. Results of the

tender are only read out during the opening of bids, but are not published. The frequency of procurement is

once a year but there is in between emergency purchases that follow the same procedures.

At the Health Facility level, the criteria in the questionnaire are not widely used. The most commonly used

criteria are price (19% of facilities), performance of supplier (15%) and quality of product (11%). It was

found that SOP documents for call of tenders were used in few facilities (3.7%) and the rest had none. Pre-

selection of suppliers was practiced by 11% only of the facilities surveyed. Most procurement of medicines

done by health facilities sources supplies from within the country as such INCOTERMS are not applied in

purchase contracts.

Table 12: Criteria Considered when awarding contracts

Criteria Central Medical Store Health Facilities

1st National preference Price (18.5%)

2nd Performance of Supplier Performance of supplier (14.8%)

3rd Price Quality of product (11.1%)

4th Quality of product

5th Stated delivery time

6th Supplier terms of payment

4.7.1 Sources of procured products at the Central Store

At CMS, the greatest percentage of expenditure is for products purchased from International Suppliers.

In particular, international suppliers account for all the expenditure on antimalarial and vaccines. Local

manufactures account for the largest share of essential medicines, while international manufactures provide

the greatest part of HIV medicines. Local distributors account for the largest shares of medical supplies,

medicines for opportunistic infections and reagents.


Procurement sources

33%

45%

22%

Exclusively from MSDOther sources

No response

Table 13: A summary of award Contracts in US $ for the year 2006

Category of Products

Sources of Procurement

International

supplier

US$

International

manufacturer

US$

Local

Distributor

US$

Local

Manufacturer

US$

Others

Specify

US$

Essential Medicines 5,163,633 2,237,051 11,774,583

HIV/AIDS medicines 2,547,538 68,347

Antimalarials 14,865,324.26

TB medicines

Medicines for opportunistic

infections

959,674.94

Pediatric formulations for

HIV/AIDS and malaria

Vaccines 269,364

Contraceptives 1,565,950 912,012

Condoms 967,050

Medical supplies 5,185,089 7,680,927 1,529,303

Reagents for blood safety

including HIV test kits

187,541

With regards to health facilities, results show that only 33% of them procure products exclusively from the

MSD which is the national procurement agent. Some health facilities however, procure medicines and

supplies from other sources as indicated below:

Figure 5: Procurement sources and their frequency of use


4.8. Ordering

Ordering at CMS is strictly performed on an annual basis, while zonal stores order according to their needs. As

for Health Facilities, about half of them place their orders every three months, while the rest order according

to needs. Not many responses were obtained from programs, but annual ordering and ordering according to

needs seem to be the most common options

Table 14: Frequency of Ordering

Frequency CMS ZMS HF Program

Quarterly 0% 0% 44.4% 0%

Semi-annual 0% 0% 0% 0%

Annual 100% 0% 0% 16.7%

According to the needs 0% 100% 44.4% 16.7%

For the Central store, the average lead time for deliveries is 5-8 months by sea and 90 -120 days by air and

within 90 days by land. The central Store is 80 km, 3 km and 700 km from the airport, sea port and border

respectively. The average time taken to remove products from the port, airport and border is 21 days, 7 days

and 3 days respectively. The main problems encountered during the customs clearance of products are:

a) From the sea port - lengthy clearing and customs procedures

b) From the airport - lengthy inspection time and

c) At the border points - lengthy documentation processes.

The average time it takes to transport products to the central Store from the sea port and airport is one hour

while from the border is one day.

Performance of the supplier is measured using the following performance indicators:

Table 15: Indicators used in measuring Suppliers` performance

Performance Indicators Rel. Freq.

Products delivered conform to order 70

Respect of storage conditions 56

Quality of service after sales 30

Respect of agreed delivery time schedule 30

Damages and losses 4

Volume of supplies handled by the Central Store in the year 2006 is as follows:

Table 16: Volume of Imports by Central Store in 2006

Volume of Imports in 2006

Number of 40 feet

containers

Number of 20 feet

containers

Volume in m3 for the

maritime or surface

shipping

Volume in m3 by

airfreight

70 115 600 350


The Zonal stores however, place their orders with the Central store according to needs. There is an internal

policy of replenishing their stocks fortnightly. All products are delivered by the Central Store to the zones.

Average lead time to receive products ordered from a higher level is fourteen (14) days.

4.9 Delivery

At zonal stores most of the deliveries are performed by the supplier, while at the health facilities level, it is

quite common for facilities to collect items themselves (48% of facilities do so).

Table 17: Delivery types at all levels

CMS ZMS HF

Delivery

By the supplier - 100% 59.3%

Collected by the store - 25% 48.1%

Delivered by office of DMO 4%

4.9.1 Indicators used for assessing products delivered

The CMS uses all the indicators which were given in the questionnaire. Zonal stores and health facilities

however tend to use product conformity to order and respect of storage conditions, but they are less likely

to use quality of service after sales and respect of agreed delivery time schedule as indicators for quality

delivery of products. In general, Health Facilities are less likely to assess products delivered than CMS and

zonal stores.

Figure 6: Percentage use of indicators for assessing product delivered

Indicators used for assessing product delivered

0%

20%

40%

60%

80%

100%

120%

Product conforms to order

Quality of services after sales

Respect of agreed delivery time

schedule

Respect of storage conditions

CMS ZMS HF


4.10. Storage/Stock Management

4.10.1 Adequate storage capacity

Storage capacity at the Central Store in Dar es Salaam in year 2006 was 20,000 cubic meters. This amount of

storage space was considered adequate for storing forecasted quantities of medicines and medical supplies.

The store had clearly demarcated areas as shown below:

Storage area Yes

Reception of products a

Quarantine of products a

Storage of dangerous products a

Product requiring cold chain <8°C a

Main storage a

Products returned from customers a

Expired/damaged products a

Delivery of products a

Products from various partners(programs) a

The storage capacities in cubic meters of the following Zonal stores are: Mwanza (1305), Mbeya (10660),

Mtwara (11000), Tabora (526) and Moshi (5051). Only half of zonal stores reported to have adequate storage

capacity. Also some of the stores however had clearly demarcated areas as shown below:

Storage area Yes (%)

Reception of products 60

Quarantine of products 0

Storage of dangerous products 80

Product requiring cold chain <8°C 100

Main storage 100

Products returned from customers 40

Expired/damaged products 60

Delivery of products 20

Products from various partners(programs) 60

In the facility pharmacies however, storage space was found to be 622.85 cubic meters. The storage space

for forecasted quantities of medicines and medical supplies was inadequate and this was affirmed by 56% of

facilities surveyed. Only 33 % of the health facilities had adequate storage space. Pharmacies that had a

separate and demarcated area for delivery of products were only 33%. Expired stocks did have a separate

storage space in only 41% of the pharmacies. Most pharmacies (71%) had a main storage place. As regards

products requiring cold storage of between < 80C, only 52% of the pharmacies had the facilities. Also it

was found that products from various partners and programs had no separate storage space. This was a

challenge for most pharmacies (63%). Products returned from customers had no separate place for their

storage and this was affirmed by (77%) of the pharmacies. Reception of products, quarantine and storage of


dangerous products were evaluated to be 33%, 30% and 37% respectively in the pharmacies evaluated. The

other storage parameters are generally good in most of the facilities studied as indicated below:

Figure 7: Percentage adequacy of storage capacity at all levels

Adequacy of storage capacity

0%

50%

33%

0%

10%

20%

30%

40%

50%

60%

CMS ZONAL HF

Facility with adequatecapacity

4.10.2 Storage conditions

Storage conditions seemed to be excellent at the CMS since they satisfied all the criteria included in the

questionnaire. Conditions were also extremely good at zonal stores, where all the criteria were satisfied by all

stores. Only one zonal store – Mtwara reported shortage of storage equipment. As regards health facilities,

the storage conditions were less good than in the two previous levels. The main problems encountered at the

facility level included inadequate storage equipment (only 22% have adequate equipment) and temperature

control (only 33% of facilities have cold chain storage with chart and only 41% have some method to control

temperature.

Table 18: Adherence to storage conditions

Indicator CMS ZMS HF

Adequate Storage equipment 100% 75% 22.2%

Area is free from moisture 100% 100% 88.9%

No direct sunlight on products 100% 100% 85.2%

Products no on the floor 100% 100% 63%

Products stored in a systematic way 100% 100% 55.6%

Security measures to avoid burglary 100% 100% 81.5%

Storage equipment available 100% 100% 70.4%

Doors with adequate locks and keys 100% 100% 92.6%

Windows can be opened 100% 100% 77.8%

Method to control temperature 100% 100% 40.7%

Cold chain storage with chart 100% 100% 33.3%

No evidence of pest 100% 100% 63%

4.10.3 Stock management techniques used

At the CMS the maximum level was defined and the ‘first expires, first out rule’ was respected; traceability of


batches was also assured. At zonal stores the ‘first expires, first out’ rule was always followed, stock cards

were usually available and the traceability of batches was assured in the majority of stores. As for health

facilities, the ‘first expires, first out’ rule was usually followed by the majority (89%) and stock.

Table 19: Adherence to stock management techniques

Technique CMS ZMS HF Program

Maximum stock level defined 0% 25% 25.9% -

Minimum stock level defined 100% 25% 29.6% -

Other method 0% 25% 14.8% -

Specific tools exist for products financed by partners 0% 0% 11.1% -

Stock cards available 0% 75% 74.1% -

Stocks renewed on scheduled dates 0% 50% 44.4% -

First expires, first out 100% 100% 88.9% 16.7%

Replenishing when minimum level is reached 0% 25% 37% -

Traceability of batches assured 100% 75% 40.7% -

Inventory controls were conducted once a year during the stock taking session. However, there were

perpetual inventory controls counts made periodically as deemed necessary. But there were no regular

inventory controls in most health facilities.

4.10.4 Availability of tracer products

Median availability for 20 tracer medicines in the zonal stores was found to be 82.5%, while that value for

the health facilities was 88.9%

Figure 8: Percentage median availability of tracer medicines

Availability of 20 tracer medicines

78.00%

80.00%

82.00%

84.00%

86.00%

88.00%

90.00%

Zonal Medical Stores Health Facilities

Median Availability


4.10.5 Stock out days

Although availability of tracer medicines was high at health facilities, the same facilities also presented a

considerable number of stock-out days. Some medicines were out of stock for 4 months. In fact, the median

number of stock-out for the 20 tracer medicines was 135.6. Conversely, the median number of stock-out days

for zonal stores was 0, as there were no stock-out days for more than half of the medicines considered.

Main causes of stock out

The main causes of stock out at CMS were delays in delivery, errors in forecasting and maximum and

minimum not regularly updated. At zonal stores, delays in delivery was the most commonly cited cause of

stock-out (75%) together with quantities delivered not in conformity with quantity ordered. Error in forecasting

also played a part at zonal stores. As for health facilities, the main causes of stock-out were unavailability of

funds and non conformity of quantities delivered to orders (41%). Delays in delivery and errors in forecast

were also not uncommon at the Health Facilities.

Table 20: Reasons for stock outs at all levels

Cause CMS ZMS HF

1st Delay in delivery Delay in delivery (75%) Funds not available for the

order (40.7%)

2nd Error in forecast Quantities delivered not

in conformity with quantity

ordered (75%)

Quantities delivered not in

conformity with quantity ordered

(40.7%)

3rd Maximum and minimum

not regularly updated

Errors in forecast (50%) Delay in delivery (33.3%)

Error in forecast (33.3%)

4.10.6 Expiry of stocks

The amount of medicines and supplies that expired in 2006 at the central store was 3.7% of sales for the year.

Percentage of the products that expired at the stores were reported by only three stores mainly Mwanza,

Mbeya and Moshi and the value of expired products varied from 0.02-6% of annual sales for the year.

Not many data were obtained on the percentage of product expired in 2006 in health facilities but

something can be said on the main causes of expiring.


Table 21: Causes for expiry of stocks

CMS ZMS HF

% of products expired in 2006 3.7% 0.02-6% -

Main causes of expiring

1st Non respect of the

rule “first expired,

first out”

Short expiring products

provided by central store

(50%)

Errors in forecast

(37%)

2nd Modification of the

STG in the course of

the financial year

Error in the forecasts

(25%)

None compliance

to the STG by

prescribers (22.2%)

3rd Error in the

forecasts

Modification of the STG in

the course of the financial

year (25%)

Donations (14.8%)

Donations from

partners are not

limited to EML

No stock control (25%)

Unqualified staff (25%)

Supplies in excess of

orders (25%)

4.11. Distribution

4.11.1 Frequency of distribution for the various levels

The frequency of distribution of products at both the CMS and the zonal stores vary from time to time but

also distribute upon requests from their customers. Programs however tend to distribute every three or six

months.

Table 22: Frequency of distribution

Frequency of

distribution

CMS ZMS Program

Upon request 100% for hospitals and

approved NGOS

75% for hospitals and approved

NGOS

16.7%

Weekly 0% 0% 0%

Twice a month 100% for Zonal stores 0% 0%

Monthly 100% for dispensaries/HC

under Kit system

50% for dispensaries/HC under

Kit system

0%

Quarterly 100% for dispensaries/HC

under indent system

25% for dispensaries/HC under

indent system

50%

Every two months - 25% dispensaries/HC under

Kit system (due to seasonal

variations)

0%

Twice a year - - 33.3%


4.11.2 Types, numbers and capacities of various means of transport

The Central Store uses its own transport fleet but compliments it with the hired private fleet from private

companies and their service is considered satisfactory. Supply orders are generally delivered within the

deadlines. The zonal stores also use their own fleet of vehicles for the distribution of supplies to the districts

and to some facilities that request such service. They do not use private vehicles.

Three Zonal stores mainly Mbeya, Tabora and Moshi (60%) reported that there is adequate transport to

distribute medicines and medical supplies while two others Mwanza and Mtwara stores (40%) said it is

inadequate. It was reported by 60% of the zonal stores that orders are delivered to customers within the

deadlines. The three main problems encountered during delivery/pick-up of medicines and medical supplies

in ranking order are:

Climatic problems1

Poor condition of vehicles2

Poor road network3

At the Zonal Stores there is a specific distribution system financed by partners for commodities such as HIV/

AIDS medicines, Pediatric HIV/AIDS and malaria medicines, TB and Leprosy medicines, Contraceptives and

Vaccines.

Some health facilities had means of transport for collecting and distributing medicines. Only seven (25%) of

health facilities had adequate means of transport for collection and distribution of medicines. The three main

challenges seen during collection of supplies from medical stores to health facilities in ranking order are:

(1) Lack of vehicles

(2) High cost of transportation and

(3) Poor condition of vehicles where there is one.

Table 23: The number and capacity of transport for distribution

Type of car Central Store Zonal HF HF

Number (Total

capacity)

Mwanza Mbeya Mtwara Tabora m3

Scania 24 (732m3) 2(10 ton) 2 (10

ton)

1(168CBM) 2 (10

ton)

1 (10 m3)

Isuzu CVR 2 (36 m3)

Mitsubishi canter 3 (24m3) 2 (4 m3)

Land cruiser pickup 2 (8m3) 2(2.25 ton) 1(78 CBM) 1(2.25

ton)

1 (1 m3)

Pick up van 1 (10

ton)

1 (140

CBM)

2 (2.5 m3)

Toyota escudo 1 (0.6 m3)

Toyota station wagon 1 (1 m3)

Toyota minibus 1 (3 m3)

Toyota Pick up 2 (2 m3)

Motorbike 1 (0.5 m3)


4.12 Quality Assurance system

All the criteria for assuring quality of products procured that were put into the questionnaire were used by

the CMS. For example all categories of medicines had been registered with the Tanzania Foods and drugs

Authority (TFDA). Conversely, quality assurance was much less common at the Facility and Zonal level,

where only a minority of stores controlled quality of products.

Table 24: Criteria used to assure quality of products procured

Criteria used CMS ZMS HF Program

Products from pre-selected suppliers 100% - 18.5% 16.7%

Products pre-qualified by WHO 100% - 14.8% -

Products registered in a country with high pharmaceutical regulation

(ICP/ICH)

100% - 7.4% -

Products registered in the country 100% 25% 22.2% 16.7%

4.12.1 The structures used for quality control

The central store has a mini lab facility that compliments the quality assurance system in place. The National

quality control laboratory operating under the drug regulatory authority (TFDA) performs the regular controls

and in exceptional cases an external laboratory may be contracted to perform quality checks. There is no

sub-regional quality control lab that is used.

As a quality control measure, samples of various batches are taken for analysis. The percentage of batch

failure could not be ascertained during the assessment, but it was revealed that the commonest parameter

that causes failure was deviation in weight and disintegration time of some hard dosages.

Pharmaceutical inspection by the regulatory authority has been performed in the last three years. The

positive remarks given were presence of a good storage and system flow in the facility whereas batch

tracking was rated poorly.


The medical store has written procedure for the following processes:

Table 25: Standard operating procedures available at MSD

Processes Yes No

Selection of the products a

Quantification of needs a

Placing of order a

Reception a

Storage a

Stock management a

Inventory control a

Destruction of expired/damaged products a

Returned products a

Redistribution of products in overstock a

Distribution a

Dispensing a

Quality assurance a

Financial management a

Monitoring/evaluation/supervision a

Recruitment of personnel a

With regards to the zonal stores, samples of each batch were not systematically taken up for analysis. In

situations where the samples from facilities are drawn, the TFDA mini lab at the zonal centers are used to do

the screening tests, and then taken further for quality analysis at the National quality control laboratory. In

three years before 2006 only one (1) facility out of twenty one (21) facilities had a pharmaceutical inspection

conducted. The facilities visited had no written SOP’s.

4.13 Rational Use

Pharmaceutical information available in the Central Store is as shown below:

Table 26: Medicine Information sources

Information Sources Yes No

British National Formulary a

Donation Guidelines a

Essential Medicines List a

Internet a

Manufacturers information a

Martindale a

National Formulary a

Standard Treatment Guidelines a


4.14 Financing

Table 27 below shows the amount of expenditure in US $ and sources of financing for various category of

medicines and medical supplies.

Table: 27 Amount of expenditure in US $ and sources of financing

Category of Products

Sources of

Funds

2006

Expenditure

US$

2007

Budget

US$

%

budget

2007

Type of

financing

Essential Medicines Government 17,060,000 16,424,218 Drug

Revolving

HIV/AIDS medicines Global Fund,

Govt, CIDA,

SIDA

2,615,885 12,748,000 77.6 Grant

Antimalarial Global Fund 14,865,324 20,344,000 123.8 Grant

TB medicines - - -

Medicines for opportunistic

infections

Global Fund 959,674 2,881,000 17.5 Grant

Pediatric formulations for HIV/

AIDS and malaria

- - -

Vaccines Government 289,364 390,625 2.37 GRANT

Contraceptives Government 2,345,080 11,253,000 68.5 GRANT

Condoms Global Fund 967,050 1,848,000 11.25 GRANT

Medical supplies Global Fund 13,456,304 GRANT

Reagents for blood safety

including HIV test kits

Government 187,541 5,475,000 33.33 GRANT

During the year 2006 adequate financing was available for procurement of all categories of medicines and

medical supplies shown above. In Tanzania the government allocates 1.3% of the budget of medicines and

medical supplies for distribution and storage management purposes.

Vertical disease programs provide funding as seen in the table 28 below:

Table 28: Activities supported by Donor funding

Activities financed

Name

GFATM CDC CIDA

Yes No % Yes No % Yes No %

Warehousing/storage modernization a a a

Medicines distribution (vehicle…) a a a

Staff training a a

The government’s allocation supplements the real costs of storage and distribution. CIDA offered its support

in training MSD staff, distribution and rehabilitating and modernization of one of the MSD warehouses.


The administration fee added to all essential medicines and medical supplies is 10% while that for the other

category of products is 8% of the procurement price.

Table 29: Administration fees on selected category of products

Category of Products % Administration fee

Essential Medicines 10

HIV/AIDS medicines 8

Antimalarial 8

TB medicines 8

Medicines for opportunistic infections 8

Pediatric formulations for HIV/AIDS and malaria 8

Vaccines 10

Contraceptives 8

Condoms 8

Medical supplies 10

Reagents for blood safety including HIV test kits 8

Customers to medical stores may pay by way of pre-payment method or upon delivery of products and on

cash basis. The revenue generated from the revolving fund is deposited in accounts of the medical store at

commercial banks.

The revenues collected are ploughed back to manage the operations of the store in the following manner:

Figure 10: Use of Revenues at MSD

Use of Revenue collected

86%

6%8%

Procurement of medicinesStaff salary Running cost

The revenue allocated for stock replenishment is always available.

The Zonal stores have no other funding source besides the budget allocation from the Central Store. Every

Zonal store has within its annual budget a budget line for storage and distribution. Customers to zonal

medical stores may pay by way of pre-payment method or upon delivery of products and on cash basis.

The revenue generated from the revolving fund is deposited in accounts of the zonal store at commercial

banks.


4.15 Information Management

The medical stores operate a computerized management system. The information for quantification of needs

is available in the management information system. The table 30 contains the type of information monitored

regularly.

Table 30: Type of Information monitored regularly

Information monitored Yes

Quantities received a

Average monthly consumption a

Expired medicines a

Stock on hand a

Expiry dates a

Purchase orders a

Others such as sales report, emergency procurement, special procurement a

Reports on medicines management information system are available and they are used by the Medical

Stores Management, Program Managers and the Ministry of Health and Social Welfare officials. Reports are

sometimes sent to partners upon request. The reports are always available in real time.

The following processes can be monitored using the Information management system in place at the Central

Store.

Table 31: Processes monitored

Process Yes

Quantification a

Purchase (Call for tender …) a

Ordering a

Stock management a

Distribution a

Financial management a


Information used for quantification of needs is available in the information management system. The following

logistic information is monitored regularly at the zonal stores.

Process Yes Rel. Freq

Quantities received a 100

Expiry a 100

Stock on hand a 100

Expiry dates a 100

Average monthly consumption a 80

Damages a 20

Purchase orders a 20

Expired medicines a 20

At the zonal stores there are reports on medicines management information system. Reports are submitted to the central Store management and Heads of health facilities. Reports are distributed on a quarterly basis and they are delivered in time.

The Muhimbili National Hospital has a management information system for medicines by the name of JEEVA and they use it for quantification, Ordering, Stock management and distribution. There is no specific management system for products financed by partners.

4.16 Monitoring and evaluationThe medical store carries out supervision visits to her customers on a quarterly basis and as need arises. During supervision visits at CMS, there is no checking of stock cards, no financial monitoring and no training takes place. Checking cards is also not done at the zonal level and zonal stores are unlikely to have physical inventory performed during supervision visits. As for programs, no financial monitoring take place and training also is uncommon.

For the CMS, The schedules for supervision are normally respected. Other supervisory visits are carried out by either PSU staff of the MOH&SW or supervisors from regional or district health management teams. The vertical programs have a monitoring and evaluation component within their plan of activities.

The figure below is a summary of the activities carried out during supervision by all levels:

Figure 11: Activities carried out during supervision


At the CMS level, stock out rate, percentage of expiry, percentage of late deliveries and percentage of

products not in conformity are regularly evaluated. At the zonal level, the majority (75%) regularly measure

stock out rate and percentage of incomplete delivery. As regards facilities, performance indicators are less

evaluated. In fact, the most commonly measured is stock out rate, but only 40% of facilities evaluate. Not

many data are available on Programs, but it can be said that the most commonly measured indicators are

the number of stock out days and the percentage of expiry.

Figure 12: Performance indicators regularly evaluated

4.16.1 Performance Indicators

The assessment identified the following as key performance indicators for regular evaluation of a facility

Pharmacy.

Indicator Rel Freq. Rank order

Stock out rate 41 1

Number of stock out days 37 2

% of Expiry 33 3

% of incomplete delivery 22 4

% of late delivery 22 5

% of non conformity to order placed 3.7 6

There are no specific tools for monitoring procurement of products financed by partners.


4.17 Human resource

The table below shows the professional category of staff, their functions, and numbers and whether they are

adequate to fulfill procurement and supply management roles at the medical stores.

Table 32: Professional category of staff and their functions

Professional category Functions Numbers Adequate Civil

servant

Yes Not Yes

Pharmacist Procurement

Specialists

5 a a

Nurse Quality Assurance 1 a a

Computer specialist 3 a

Administrative officer 2 a

Lab. Technologist Quality Assurance 1 a a

Materials Management staff Purchasing 15 a a

At the Central store and regional stores of MSD staff involved in procurement and supply management

receive initial training whereas in the health facilities they are offered training while on their job placement and

regular and continuous training is offered but on a lesser scale as shown in the figures below:

Fig 13: Level of initial training offered to staff in Procurement

Fig 14: Level of regular training offered to staff in Procurement at Health facilities

Initial training offered to staff in Procurement in Health facilities

44%

15%

41% YesNoNo comment

Regular continuos training conducted to staff in Procurement in Health facilities

15%

78%

7.40%

YesNo

No comment


5.0 DISCUSSIONS

5.1 Selection of products and order placement

The process of selection of medicines and medical supplies in Tanzania is done at four levels in the health

delivery system. The lowest level where selection of drugs is done is at a dispensary or health centre where

indent or ILS mode of ordering is operational. The second level is at Hospital level, where the hospital

management has the responsibility of selecting and placing orders. The third level is at the regional stores

where the area manager selects products from the MSD catalogue that he/she would like to stock at his area

of work. The fourth level is at the National level where PSU is responsible for selection of EML. At these

levels selection of products is made from the list of essential medicines currently in use.

The delay in the review of the EML at the central level obviously would have an impact on the medicines

procured by MSD as well as medicines available in health facilities. This would explain why MSD`s procurement

is not limited to the EML. The reasons given i.e. prescribers do not agree with STG and EML does not

address local needs or demands shows that the timely review of the EML is very important not only for the

procurement and supply system but also in the correct management of patients. The assessment also found

that the NEMLIT and STG were not available at the MSD.

All drug ordering, supervision and access to supplementary financing for drugs starts and ends with the

DMO Office, as far as the PHFs are concerned. Furthermore, many DMOs perceive themselves as active

players in the process of drug ordering at the District Hospitals (DHs) and some actually work in the hospitals

in a clinical capacity due to staff shortages. Since the DMOs have a huge range of duties to perform, their

priorities for drug delivery is bound to influence the efficiency of drug delivery and drug availability (i.e. they

are often stretched in having to manage the district (PHFs) and the hospital). In this assessment for example

only 4% of health facilities for example reported to have their products delivered by the office of the DMO

in spite of the fact that districts are supposed to have frequent distribution and supervision schedules for all

health facilities.

The Area Managers of a Zonal Medical Store (Regional Store) using their experience, past sales trends and

distribution figures generate forecast data that they use to determine quantities to order from the central

store. The manager acts cautiously when placing orders with the central store avoiding possible losses

resulting from expiry of products. In so doing only those items that have a well established demand forecast

are ordered. However since drug management techniques eg determination of minimum and maximum stock

levels have not being integrated into the procurement and supplies management system from all levels,

levels of expired medicines are high, stock out levels and durations are long.

The level of stock availability at a regional store is influenced by various factors that take place at the central

store. Some of which are inadequate stock to distribute to regional stores, lack of transport, long tendering

procedures, supplier performance, uneconomical order quantities, computer system hang-ups and at times

lack of due diligence on the part of central store staff among other issues. The many factors mentioned

invariably affect the availability of medicines and medical supplies at the health facilities as well.

It has been reported that there are supplier performance indicators used by the Central Store. One of the

indicators measure how the agreed delivery time schedule is respected by suppliers. This indicator was

ranked fourth in the order of priority after products conforming to order (1), respect of storage conditions (2)

and quality of service after sales (3) respectively. It is nonetheless important to explore the impact caused by


supplier delays in delivering the products beyond the agreed time schedule. Furthermore, it is desirable to

know whether there is a tool in the ERP software of MSD that is active and able to capture this information.

It is strongly felt that delays in delivering supplies beyond the contracted dates contributes to stock outs at

both the Zonal stores and Health facilities level.

Another factor that affects the availability of stock at regional and health facilities include the time taken by

the central store in completing sales entry after the products have been physically delivered to the regional

store. This has been identified as a systemic challenge where sales to customers can only be done when

a complete entry in the computerized management system is completed. The presence and use of the

computerized system in MSD operation should in principle eradicate all the noted shortfalls in ordering since

one can see the whole country’s stock from a single workstation. Follow-ups of the orders and deliveries can

then be made through phone calls and e-mails. Lack of adequate stock of essential medicines and supplies

at regional and central stores of MSD remain a challenge to date. A closer look as to why there is no vivid

improvement in this area merits a separate assessment.

Tanzania has about 640 registered, 352 Pharmacy Technicians (PT) and 312 Pharmacy Assistants. There is

a serious lack of pharmaceutical human resources at health facilities, districts and regions. Even if posts are

available in rural areas, it is very difficult to find pharmacy professionals willing to fill them. Moves are being

made to increase the number of Pharmacy Technicians, but it is not clear if this alone will have any impact

on the staffing problems

5.2 Structure

Results show that the MSD and its zonal stores perform all its core functions which are quantification of

needs, ordering, warehousing and distribution. Other functions include stock management, and providing

customer services

The medical stores serve health facilities at the central level i.e. national referral hospitals, regional health

facilities, District health facilities, health centers and dispensaries, faith based health facilities, approved non-

governmental organizations.

MSD has 8 zonal stores which each serves 2 to 4 regions. Distances from the MSD to the Zonal stores differ

and some stores e.g. Mwanza and Tabora have almost twice the distance to MSD compared to other zones

despite the fact that these stores serve the large populations in the country. While geographical equality with

regards to the distribution of the stores may have been achieved, equity in access to medicines has not.

5.3 Health facility Pharmacies

All health facilities visited have pharmacy sections whose core functions are to manage pharmaceutical stock

and supplies and dispense medicines and medical supplies to in and out patients. Most facility pharmacies

keep all essential medicines including anti-malaria medicines and those for opportunistic infections. However,

in most health center and dispensaries, they do not have stocks of HIV medicines for both adults and children,

reagents for blood safety including HIV test kits and no anti-Tuberculosis medicines. These medicines are

found at the level of District hospitals and above.

5.4 Procurement of medicines

Procurement of Essential medicines was found not to be limited to the EML. This is understandable for

referral and regional hospitals where medicines for tertiary care can be procured under request of the


health institutions offering specialized care and management of their patients. It was however cited that

some prescribers do not agree with what is in the current edition of the STG. Only in 38% of health facility

pharmacies there were EML, and the ones in use were last revised in 2006 and were in a draft form. Fifty

two (52%) of facility pharmacies did not have any EML. This situation calls for fast printing and distribution of

the revised STG and Essential Medicines List. There is also a need for more efforts to teach the concept of

essential medicines not only to pharmacists but to all health care workers.

5.5 Quantification of needs

The Central medical Store and its zones use an Enterprise Resource Planning (ERP) tool (Orion) in the

quantification of essential medicines and medical supplies. Quantification for needs of medicines and

medical supplies is performed once in a year. The quantities determined forms the basis for the development

of Tenders that are advertised at different periods of the year in accordance to the Procurement and Supply

plan developed by a procurement management unit of the department. The plan includes medicines and

supplies financed by partners. The function of forecasting and quantification of needs of medicines managed

under Vertical programs is performed by Program Managers. Such commodities are ARVs, ACTs (Alu) and

anti-tuberculosis medicines, Vaccines, medicines for managing OIs. This signifies that no full integration is in

effect practiced at this level. This trend should be corrected in the earliest possible time to enable the MSD

to have full control in the Supply Chain management of all medicines.

Zonal Stores determines their supply needs in the same manner as the central Store but they do not have the

procurement plan aspect as all their supplies are obtained from the Central Store on requisition. At the health

facilities however, it was found that only 25% of the health facilities surveyed conducted quantification exercise

on an annual basis of which only 22% of the facilities had procurement and supply management plans and

the rest did not have one. All facilities with the procurement plan affirmed that they have a committee for the

development of the plan. The assessment has found that staff of health facilities of Mwanza and Mtwara

regions had undergone training in Indenting but the others of Mbeya, Tabora, Dar es Salaam and Moshi

regions had not. The absence of quantification skills by most health facilities explains in part why there are

frequent stock outs at these levels. On the other hand the quantification exercise of medicines and medical

supplies in most facilities is done by a mix of professionals comprised of pharmacists and pharmaceutical

technicians, medical doctors, nursing officers, laboratory technologists, supplies officers etc. There is a need

to integrate this activity to be done by a person or group of persons who are well versed with the process in

order to improve coordination at the Health facilities, the district and regional levels.

5.6 Procurement methods

Most essential medicines and supplies stocked at MSD (80%) are procured by tender through International

Competitive Bidding. Procurement using selective and national competitive bidding is at the rate of 10%

and 5% respectively. Whereas, there are many advantages of using tenders, particularly with regard to

transparency, fairness and accountability in the use of public funds, one major drawback is long lead-time

associated to the tendering processes. Dependence on public tenders with a lead time ranging between

90 and 150 days , or more as the major means of replenishing stock, even with a good forecasting tool, will

inevitably adversely affect the availability of supplies. Results of the tender are only read out during the

opening of bids, but are not published

Procurement prices are compared with standard reference prices such as IDA and MSH price guide. The

public procurement prices were found on the average to be below those in the International market. This is

also the finding of the Survey of Medicines Prices in Tanzania.


Health facilities have a possibility of procuring medicines and supplies from other sources other than the MSD.

Of all health facilities only 33% procure products exclusively from the MSD which is the national procurement

agent. Some health facilities however, procure medicines and supplies from private pharmaceutical

wholesalers and private pharmacies. There are no official guidelines guiding HF on how and when they

are to procure from other sources besides the public entities, especially as the most used method is direct

procurement and very few use tendering system

5.7 Products storage and stock management

The assessment has found that products storage and stock management operations at the central and

regional stores are performed well. At every MSD warehouse visited stocks were securely placed, fully

protected from light, placed in properly ventilated areas, well organized and cleanly kept, functional systems

for cold storage were present and a functioning ICT system which manages stock was in place. The system

of Storage and stock management at health facilities were to the contrary of what is in the regional and

central stores. In some of the facilities visited it was found that medicines and some other medical supplies

risk loosing their efficacy due to poor storage conditions. For example only 52% of the pharmacies had cold

storage areas.

5.8 Availability of medicines and medical supplies at Health Facilities

The availability of medicines and supplies at the facility level is largely influenced by either the budget allocation

of that facility or availability of the products at the regional and central stores or the way the facility adheres to

the rational use of medicines. When the facility has run out of its allocated budget, it will inevitably register

low stock levels as it can not order replenishment supplies from the stores. On the other hand, when the

regional and central stores lack stock the situation will cascade down to all facilities that would request stock

from those stores. The assessment has found that the availability of stock at facility level at the time of survey

ranged between 96% and 52% per category of products with an overall availability of 65%. This however,

needs to be interpreted with caution as the average is not computed from similar items but rather from a

range of supplies. Of the twenty tracer items it was found that 50% were out of stock for a period ranging

from one day up to one hundred and twenty days. This implies that the stock management parameters such

as determination of Min / Max levels are not strictly followed.

The assessment has found that reasons for procuring medicines out of the EML are in the order of priority,

1) The prescribers do not agree with the STG, 2) The EML does not address local needs demands and 3)

The products on the EML are not available from the Suppliers (Central Stores and Zonal Stores). It has

further been found that 52% of facility pharmacies did not have any EML. The situation explains in part why

EML and STG are not relied upon by prescribers in making choices of medicines. Since the EML and STG

currently in use were last revised in 1997, most practitioners had lost confidence in its use. In this regard

there is a need for a regular update of the EML and STG and these documents have to be widely distributed

to all HFs. Furthermore, there is need to incorporate the EML & STG concept in all health training institutions

in the country to create awareness to students and inculcate a culture of rational use of medicines during

their practices.

Most facilities visited do not have transport facilities and some that are in place are old. The assessment

has established that total lack of transport, high cost of it and poor conditions of vehicles are major setbacks

at facility levels, when it comes to collecting medicines and medical supplies from stores. In addressing

this challenge alternative means such as entering into contract with private transporting agents can be

explored.


The assessment has also found that factors such as error in forecasting non adherence to FEFO lead to

both un-availability of medicines at facility level and expiry of the same. These along other factors such as

receiving supplies excess of order, or with short expiry dates or supplies not based on what was demanded

can be eliminated or greatly reduced if training workshops are conducted involving both health facility and

MSD staff.

5.9 Quality Assurance system

During a survey conducted by TFDA in some of the HFs under this assessment, inadequacies in the batch

tracking system of pharmaceutical products was noted. The weakness needs to be addressed at the

earliest possible date and must be initiated from the Central Store management. Its importance cannot be

overemphasized as it is a central issue in ensuring that medicines distributed and dispensed to patients are

effectively monitored. The presence of a working batch tracking system offers assurance that a product can

be recalled for evaluation or from use at any stage in the supply chain process.

Inspection is not conducted regularly at HFs and this situation leads to compromising of standards. Frequent

supervision of HFs is essential in ensuring that management of facilities and services to patients are kept at

the highest standards possible. As part of ensuring that standards are maintained all HFs pharmacies need

to have SOP’s documents in place. The on-going MSD Customer visits should be improved to accommodate

elements of improvement of standards the facilities visited.

5.10 The impact of Vertical Programs

The size of the Vertical Programs budget relative to the core drug budget, , is an issue which merits

discussion to make sure that access to essential medicines particularly to diseases which affect the majority

of the population is given precedence. One reason for the concern with the relative size of VP-spending

on pharmaceutical is that these VPs distort relative priorities, as the large size of the VPs appears to be

driven by the availability of donor resources for a specific vertical program rather than by the health sector’s

priorities. This means that non-donor funded core drug spending is ‘crowded out’, as it receives proportionately

inadequate attention and funding.

Furthermore, setting up parallel mechanisms causes duplication and inefficiencies in the provision of

pharmaceuticals, as identified in the previous chapters. It also places a greater administrative burden on

DMOs and facility Pharmacists and Pharmacy Technicians to manage the parallel funding flows.


6.0 CONCLUSION The condition of most of the lower health facilities (Health Centers and Dispensaries) visited requires a face

uplift and improvement in terms of working tools. Most facilities do not have conducive and adequate storage

space. Medicines are stored in areas that may lead to fast deterioration.

There are notable shortages of qualified Human resource and almost all that are in place are civil servants

who have been at their stations for a considerable period of time without continuous training courses and are

not well versed with the current dynamism of improvement of quality of health care.

Stock management knowledge has been found to be quite a challenge in most facilities studied. The

assessment noted that the FIFO principle is the most widely used parameter during dispensing. This may

lead to letting other medicines expire on the shelves. This is further compounded by a fact that some

medicines are received from the zonal stores with a short remaining shelf-life.

The assessment has found that medicines in the Zonal and Central store are stored according to good

storage practice whereby stocks are under secure systems, fully protected from sunlight, properly ventilated,

well organized and clean. There is a functioning system for cold storage, Information and Telecommunication

system is in place which manages the stocks for both MSD and vertical programs across the country.

It has been established that there are challenges with the quantification process and staffs interviewed do not

have a unified system of determining what to order from the Central Store. This has been noted as one of the

reasons why there are frequent stock outs that cascades down to the facility levels. The forecasting ability

is still low, and this assessment has found that (78%) of the respondents affirm that very minimal initiatives

are in place to provide continuous training to Health facility staff. This calls for a need to institute a program

of continuous training through the zonal training institutions for all health facilities especially in forecasting

and quantification, Stock Management system and Stores Record keeping. While both the public health

facilities and medical stores are public entities within the MOHSW structure and especially when it is comes

to handling and use of medicines and medical supplies, there is room for improving the shortfalls noted at

facility levels by using MSD sites as training centers for HF staff. This is one area that has opportunity for

continuous training to be offered to HF staff at minimum cost and PSU of the MOHSW is best placed to

coordinate this activity.

Though there are elements of performance monitoring at both the facility and at the Regional Stores levels,

the performance indicators are yet to be used routinely to improve the levels of service delivery. There is a

need for the MOHSW to take up the issue and design a mechanism of conducting close follow-ups at both

the health facilities and regional stores. The monitoring component should provide feedback to ensure that

all the players of service delivery are made aware of the outcomes.

The phasing-out of the kit system and shift to the indent/ILS system may partially explain the increasing

emergence of Vertical Programs in recent years. Perhaps more importantly is the availability of external

funds for specific, targeted health sector objectives, within the areas of HIV/AIDS, malaria, STI, maternal

and child health, and other health issues. However, negative effects of the emergence of VPs has been (i)

the creation of duplicative resource channels for drug resources, (ii) the ‘crowding-out’ of resources for the

essential drug budget, and (iii) distributing drugs (or VP-defined kits) through vertical programs preempts the

prioritization of drug resources in favor of priorities felt at the local level. It is thus desirable to integrate drug

resources for Vertical Programs into essential drug budget whenever possible


As regards stocks situation at all levels, innovative way in improving stock availability at the MSD stores and

at health facility levels throughout the year need to be explored. Dependence on public tenders with long

lead time as the only major means of replenishing stock is not ideal. The possibility of introducing framework

contracts especially with manufacturers of essential medicines and supplies on one hand and frequent use of

direct procurement method and or placement of repeated orders for items recently procured through tender

on the other can improve the stock availability at both the stores and at health facilities.

Similarly Hospital facilities need to be given more flexibility in accessing medicines from other suppliers in the

country. The idea of availing a certain percentage of the hospitals’ medicines budget (30%) to be managed

by the Hospital administration for procurements outside MSD’s arrangement needs to be experimented.

This assessment has brought to the fore much useful information on the performance of major elements of

the medicines and medical supplies management system in the public sector of Tanzania mainland. The

information thus obtained can be used to improve the operating mechanisms of the supply chain and at the

same time be used as a guide in conducting future assessments of the same facilities studied with a view to

assessing the extent of their improvement in providing services of medicines and medical supplies.


7.0 RECOMMENDATIONS

There is a need for equity in access to medicines by Zone, Region and District.1)

More facilities needs to be upgraded to qualify for keeping stocks of HIV medicines for both adults 2)

and children, reagents for blood safety including HIV test kits, anti-Tuberculosis medicines as well as

other essential medicines.

The MoHSW and the PMORALG must ensure that Hospitals and Health facilities have adequate cold 3)

storage facilities for medicines to minimize the risk medicines losing their efficacy due to poor storage

conditions.

EML and STG documents need to be regularly updated, printed and widely distributed to all HFs. 4)

Health Training Institutions should incorporate the EML & STG concept their training curricula to 5)

create awareness to students and inculcate a culture of rational use during their practices.

Forecasting and quantification of medicines need should be integrated and be done by a person or 6)

group of persons who are well versed with the process.

PSU and MSD to ensure that Batch tracking system of pharmaceuticals and medical supplies is 7)

operational. Staff training on its usefulness has to be emphasized.

PSU of the MOHSW should institute frequent supervision of HFs to ensure that management of 8)

facilities and services to patients are provided at the highest standards possible.

PSU to develop a quality management system which will include guidelines and SOP’s for HF 9)

pharmacies as well as the regional and district supervisors and they should be distributed and used.

Integrate all supply management activities of selection, procurement and distribution of VP products 10)

into MSD to avoid duplication of efforts.

MSD should continue the use of framework contracts especially with manufacturers of essential 11)

medicines and supplies, and also frequent use of direct procurement method and or placement of

repeated orders for items recently procured through tender to improve the stock availability at both

the stores and at health facilities.

PSU/ MOHSW to avail a certain percentage of the hospitals’ medicines budget (20%-30%) to be 12)

managed by the Hospital administration for procurement of medicines from either MSD or other

sources.

IN-DEPTH ASSESSMENT OF THE MEDICINES SUPPLY SYSTEM IN TANZANIA44Ta

ble

33:

Are

as n

eed

ing

imp

rove

men

t id

enti

fied

du

rin

g a

wo

rksh

op

to

dis

sem

inat

e re

sult

s o

f th

e as

sess

men

tTo

pic

Issu

e to

be

add

ress

edR

eco

mm

end

ed A

ctio

ns

Act

ivit

ies

to b

e C

om

ple

ted

Wh

o is

res

po

nsi

ble

or

invo

lved

?

Wh

en d

oes

this

nee

d t

o b

e

com

ple

ted

by?

Str

uct

ure

Inad

equa

te d

ecen

tral

ized

func

tions

to th

e zo

nal o

ffice

s.

Dec

entr

aliz

atio

n of

key

func

tions

to

the

zone

to in

crea

se e

ffici

ency

To d

ecen

tral

ize

key

func

tions

to z

one

offic

e fo

cusi

ng o

n th

e st

akeh

olde

r’s

need

s to

incr

ease

cus

tom

ers’

satis

fact

ion.

CM

SJu

ne 2

009

Lack

of h

arm

oniz

atio

n an

d

coor

dina

tion

of p

rogr

ams

carr

ying

out

var

ious

func

tions

rela

ted

to s

uppl

y of

med

icin

es

sim

ilar

to M

SD

.

Har

mon

izat

ion

and

coor

dina

tion

of th

e

prog

ram

s

To d

evel

op p

olic

y st

atem

ent,

regu

latio

ns a

nd g

uide

lines

on

prop

er m

anag

emen

t of p

rogr

ams

rela

ted

to s

uppl

y of

med

icin

es

to th

e G

over

nmen

t, F

aith

bas

ed

orga

niza

tion

etc.

Est

ablis

h a

unit

unde

r th

e P

SU

for

coor

dina

tion

of a

ll pr

ogra

ms

rela

ted

to s

uppl

y of

med

icin

es

MO

HS

W (

PS

U)

Dec

embe

r 20

09

Mon

opol

y of

MS

D in

the

supp

ly

syst

em

Intr

oduc

e co

mpe

titiv

e su

pplie

rs

Con

duct

sta

keho

lder

s m

eetin

g a

nd

intr

oduc

e th

e id

ea, d

raw

out

str

ateg

ies

intr

oduc

ing

com

petit

ive

supp

liers

of

med

icin

es a

nd im

plem

ent t

hem

MO

HS

WJu

ne 2

009

Lack

of p

rogr

am s

uppo

rt fo

r

war

ehou

sing

and

sto

rage

Dev

elop

a p

rogr

am s

uppo

rt fo

r

phar

mac

eutic

al w

areh

ousi

ng a

nd

good

sto

rage

pra

ctic

e.

Con

trac

t out

a c

onsu

ltant

to

perf

orm

ass

essm

ent o

f the

exi

stin

g

phar

mac

eutic

al w

areh

ouse

s an

d

stor

age

faci

lity

in p

ublic

hos

pita

ls.

Con

stru

ct o

r re

nova

te

phar

mac

eutic

al w

areh

ouse

s an

d

inst

all p

rope

r st

orag

e fa

cilit

ies

Dev

elop

gui

delin

es fo

r go

od s

tora

ge

cond

ition

s, d

istr

ibut

e to

all

hosp

itals

and

trai

n th

e ph

arm

acy

pers

onne

l.

MO

SH

W &

Prim

e

Min

iste

r’s

offic

e, R

egio

nal

Adm

inis

trat

ion

and

loca

l

Gov

ernm

ent

(PM

OR

ALG

)

June

201

0

EM

L no

t bei

ng u

sed

cons

iste

ntly

at m

ost h

ealth

faci

lity

leve

l

Ens

ure

use

of E

ML

for

sele

ctio

n of

med

icin

es a

t all

leve

ls is

per

form

ed

cons

iste

ntly

as

per

the

heal

th fa

cilit

y

need

s

To p

repa

re a

nd d

istr

ibut

e E

ML

book

lets

spec

ific

for

each

cat

egor

y of

hea

lth

faci

lity.

PS

U a

nd M

SD

June

200

9

Sel

ecti

on

The

ST

G &

EM

L no

t rev

iew

ed

regu

larly

The

ST

G &

EM

L to

be

rev

iew

ed

bian

nual

ly

To c

ondu

ct a

sta

keho

lder

s m

eetin

g

bian

nual

ly fo

r re

view

of t

he S

TG

and

EM

L

MO

HS

WJu

ne 2

010

8.0

R

EC

OM

ME

ND

AT

ION

S O

F T

HE

STA

KE

HO

LD

ER

S W

OR

KS

HO

P


Top

icIs

sue

to b

e ad

dre

ssed

Rec

om

men

ded

Act

ion

sA

ctiv

itie

s to

be

Co

mp

lete

dW

ho

is r

esp

on

sib

le o

r

invo

lved

?

Wh

en d

oes

this

nee

d t

o b

e

com

ple

ted

by?

Hu

man

Res

ou

rce

Inad

equa

te n

umbe

r of

phar

mac

y pr

ofes

sion

s in

the

field

To in

crea

se o

utpu

t of p

harm

acy

prof

essi

ons

To c

ondu

ct s

take

hold

ers

mee

ting

to d

evel

op s

trat

egie

s fo

r pr

omot

ing

publ

ic a

nd p

rivat

e se

ctor

to in

vest

in

phar

mac

y sc

hool

s

To in

crea

se n

umbe

r of

stu

dent

inta

ke to

the

exis

ting

phar

mac

y

scho

ols.

To r

eins

tate

sch

ool o

f

phar

mac

eutic

al a

ssis

tant

s

MO

HS

WJu

ne 2

010

Qu

anti

fica

tio

nIn

adeq

uate

ski

lls o

n fo

reca

stin

g

and

quan

tific

atio

n

Impa

ct k

now

ledg

e an

d

skill

s on

fore

cast

ing

quan

tific

atio

n.

Dev

elop

trai

ning

mat

eria

ls fo

r

fore

cast

ing

and

quan

tific

atio

n

WH

O, P

MO

RA

LG a

nd

MO

HS

W.

July

200

9

Con

duct

Zon

al tr

aini

ng

wor

ksho

ps o

n qu

antif

icat

ion

to h

ealth

per

sonn

el

invo

lved

in p

harm

aceu

tical

man

agem

ent.

WH

O, P

MO

RA

LG a

nd

MO

HS

W.

Dec

embe

r 2

009

Inad

equa

te to

ols

for

fore

cast

ing

and

quan

tific

atio

n

Pro

visi

on t

ools

for

fore

cast

ing

and

quan

tific

atio

n

Pur

chas

e co

mpu

ter

and

softw

are

for

drug

man

agem

ent s

yste

m.

Con

duct

trai

ning

on

com

pute

r

prog

ram

.

WH

O, P

MO

RA

LG a

nd

MO

HS

W.

Dec

embe

r 20

10

Str

engt

hen

the

role

of

ther

apeu

tic

Com

mitt

ee (

TC

)

Re

orie

nt T

C o

n th

eir

role

s

and

resp

onsi

bilit

y

Con

duct

orie

ntat

ion

sess

ion

and

prov

ide

rele

vant

guid

elin

es

MO

HS

W a

nd P

MO

RA

LGJu

ly 2

009

Pro

cure

men

t A

dher

ence

to P

ublic

Pro

cure

men

t Act

and

its

regu

latio

n.

Adv

ocac

y o

n P

ublic

Pro

cure

men

t A

ct a

nd it

s

regu

latio

n

Con

duct

trai

ning

on

Pub

lic

Pro

cure

men

t A

ct a

nd it

s

regu

latio

n

MO

HS

W ,

PP

RA

and

PM

OR

ALG

July

200

9

Par

tner

s ha

ve d

iffer

ent

proc

urem

ent p

olic

ies

Har

mon

izin

g pa

rtne

rs to

proc

ure

unde

r go

vern

men

t

polic

y

Con

duct

orie

ntat

ion

sess

ion

and

prov

ide

rele

vant

guid

elin

es to

par

tner

s

MO

HS

W ,

PP

RA

and

PM

OR

ALG

July

2009

IN-DEPTH ASSESSMENT OF THE MEDICINES SUPPLY SYSTEM IN TANZANIA46To

pic

Issu

e to

be

add

ress

edR

eco

mm

end

ed A

ctio

ns

Act

ivit

ies

to b

e C

om

ple

ted

Wh

o is

res

po

nsi

ble

or

invo

lved

?

Wh

en d

oes

this

nee

d t

o b

e

com

ple

ted

by?

Ord

erin

gIr

ratio

nal o

rder

ing

of

phar

mac

eutic

al s

uppl

ies

due

to in

adeq

uate

pro

cure

men

t

plan

ning

Pre

para

tion

of p

rocu

rem

ent

plan

invo

lvin

g al

l key

stak

ehol

ders

Est

ablis

h pr

ocur

emen

t nee

ds

to a

lign

with

app

rove

d bu

dget

(MT

EF

)

MO

HS

W a

nd P

MO

RA

LGJu

ly 2

009

Sto

rag

e1-

Lack

and

non

-res

pect

of

SO

Ps

SO

P s

houl

d be

dev

elop

ed a

t all

leve

ls a

nd b

e re

spec

ted

Dev

elop

and

dis

trib

ute

SO

Ps

Tra

in o

n us

e of

SO

Ps

Mon

itor

and

eval

uate

the

use

of S

OP

s

PS

U

PS

U/R

HM

T/D

HM

T

Fac

ility

man

agem

ent t

eam

2008

/200

9

2-In

adeq

uate

sto

rage

faci

litie

s

for

med

icin

es a

nd m

edic

al

supp

lies

Pro

visi

on o

f ade

quat

e st

orag

e

faci

litie

s an

d eq

uipm

ent

Ren

ovat

ion

and

cons

truc

tion

of

med

icin

es s

tore

s

Pro

cure

men

t of c

old

chai

n eq

uipm

ent

Inst

alla

tion

of a

ir co

nditi

oner

s

Inst

all s

helv

es, p

alle

ts

Inst

all f

ire e

xtin

guis

hers

.

Fac

ility

Man

agem

ent T

eam

(RA

S/D

MO

/DE

D)

2008

/200

9

2009

/201

0

3-La

ck o

f sta

ndar

ds s

truc

ture

for

med

icin

es s

tore

s

Est

ablis

h a

desi

gned

sta

ndar

d

stru

ctur

e fo

r m

edic

ines

sto

res

Des

ign

a st

anda

rd s

truc

ture

for

med

icin

es s

tore

s

Dis

sem

inat

e th

e st

anda

rd d

esig

n

Pro

vide

fina

ncin

g fo

r co

nstr

uctio

n/

reno

vatio

n

PS

U/M

OH

SW

PS

U/M

OH

SW

Fac

ility

Man

agem

ent T

eam

(RA

S/D

MO

/DE

D)

Aug

200

9

2009

/201

0


Top

icIs

sue

to b

e ad

dre

ssed

Rec

om

men

ded

Act

ion

sA

ctiv

itie

s to

be

Co

mp

lete

dW

ho

is r

esp

on

sib

le o

r

invo

lved

?

Wh

en d

oes

this

nee

d t

o b

e

com

ple

ted

by?

Qu

alit

y

Ass

ura

nce

Inad

equa

te p

ost m

arke

ting

surv

eilla

nce

and

qual

ity

assu

ranc

e.

To in

trod

uce

SO

Ps

in s

urve

illan

ce

and

qual

ity a

ssur

ance

at a

ll le

vels

Dev

elop

SO

Ps

for

surv

eilla

nce

and

qual

ity a

ssur

ance

.

Dis

sem

inat

e S

OP

s to

sta

keho

lder

s

Tra

in S

taff

on u

se o

f SO

Ps

TF

DA

and

PS

UJu

ne _

Oct

ober

,

2008

.

Nov

embe

r,200

8

June

, 200

9

Is q

ualit

y as

sura

nce

bein

g

carr

ied

out a

t all

leve

ls?

To e

nsur

e po

st m

arke

ting

surv

eilla

nce

and

qual

ity a

ssur

ance

is

carr

ied

out a

t all

leve

ls

To e

nsur

e av

aila

bilit

y of

equ

ipm

ent

for

carr

ying

out

pos

t mar

ketin

g

surv

eilla

nce

and

qual

ity a

ssur

ance

at o

ut a

t all

leve

ls

Car

ry o

ut m

edic

ines

and

med

ical

supp

lies

insp

ectio

n at

ent

ry

poin

ts, w

areh

ouse

s an

d ou

tlets

.

Pre

pare

and

sub

mit

repo

rt q

uart

erly

To in

trod

uce

min

ilabs

at r

egio

nal a

nd

Dis

tric

t lev

els

PS

U

TF

DA

RH

MTs

CH

MTs

Rou

tine

as r

equi

red

Qua

rter

ly

Sub

stan

dard

or

coun

terf

eit

supp

lies.

Str

engt

hen

and

supp

ort m

edic

ine

insp

ectio

n at

all

leve

l

Iden

tify

pros

pect

ive

insp

ecto

rs

Bud

get f

or tr

aini

ng c

ondu

ctin

g

insp

ectio

n

Con

duct

trai

ning

to in

spec

tors

Car

ry o

ut s

urve

illan

ce

PS

U

TF

DA

RH

MTs

CH

MTs

July

, 200

9


FIN

AN

CIN

GH

arm

oniz

atio

n of

don

or

and

Gov

ernm

ent f

unds

Hea

lth B

aske

t Fun

d fo

r al

l ver

tical

pro

gram

sE

stab

lish

a st

eerin

g co

mm

ittee

Iden

tify

all d

onor

s an

d pa

rtne

rs

Con

duct

sta

keho

lder

s m

eetin

g

(Don

ors

and

Gov

t) fo

r

sens

itiza

tion

and

advo

cacy

Est

ablis

h th

e ba

sket

fund

The

GoT

thro

ugh

the

MO

HS

W

Sep

tem

ber

2008

Har

mon

izin

g re

port

ing

syst

em

Est

ablis

h a

repo

rtin

g to

ol to

ser

ve fo

r al

l

vert

ical

pro

gram

s

Pre

para

tion

of th

e to

ol

Pre

test

the

tool

Con

duct

trai

ning

The

GoT

thro

ugh

the

MO

HS

W

Dec

embe

r 20

08

Har

mon

izin

g D

onor

finan

cing

pol

icy

Est

ablis

h a

unifi

ed fi

nanc

ing

polic

y C

ondu

ct s

take

hold

ers

mee

ting

The

GoT

thro

ugh

the

MO

HS

W

Mar

ch 2

009

Fun

ds r

emitt

ance

Est

ablis

h a

disb

urse

men

t pla

nId

entif

y fa

ctor

s as

soci

ated

with

fund

s de

lays

Pre

pare

a d

isbu

rsem

ent p

lan

by c

onsi

derin

g fa

ctor

s id

entif

ied

abov

e

The

GoT

thro

ugh

the

MO

HS

W

Dec

embe

r 20

08

Info

rmat

ion

man

agem

ent

Util

izat

ion

of r

epor

tsS

tren

gthe

ning

rep

ortin

g sy

stem

Mer

ging

of t

he e

xist

ing

repo

rtin

g

tool

s to

hav

e co

mpr

ehen

sive

and

sim

plifi

ed fo

rm

Dis

trib

ute

man

agem

ent t

ools

to

HF

s

Tra

in h

ealth

wor

kers

on

how

to

repo

rt

Put

in p

lace

a fe

edba

ck

mec

hani

sm

PS

U, R

HM

T, C

HM

TO

ctob

er 2

008

Doc

umen

tatio

n sy

stem

Str

engt

hen

the

docu

men

tatio

n sy

stem

Dis

sem

inat

e do

cum

enta

tion

tool

s

to a

ll H

Fs

Con

duct

a r

efre

sher

trai

ning

on

inve

ntor

y m

anag

emen

t

Con

duct

follo

w u

p vi

sits

to H

Fs

Intr

oduc

e so

ftwar

e fo

r

phar

mac

eutic

al m

anag

emen

t

Con

duct

trai

ning

on

the

use

of

softw

are

PS

U, R

HM

T, C

HM

TO

ctob

er 2

008

June

200

9

Top

icIs

sue

to b

e ad

dre

ssed

Rec

om

men

ded

Act

ion

sA

ctiv

itie

s to

be

Co

mp

lete

dW

ho

is r

esp

on

sib

le o

r

invo

lved

?

Wh

en d

oes

th

is n

eed

to b

e co

mp

lete

d b

y?


Co

ord

inat

ion

and

pla

nn

ing

Med

icin

es s

uppl

y sy

stem

stru

ctur

e is

not

wel

l coo

rdin

ated

(fu

nd

ing

, sel

ecti

on

,

qu

anti

fica

tio

n, p

rocu

rem

ent,

sto

rag

e an

d d

istr

ibu

tio

n)

Nee

d of

cen

tral

coo

rdin

atin

g

body

Str

engt

hen

Cen

tral

cap

acity

on

coor

dina

ting

of s

uppl

y sy

stem

MoH

SW

– P

SU

With

in 6

mon

ths

MS

D s

houl

d be

use

d as

a

cent

ral w

areh

ouse

for

all

prog

ram

s, d

onor

s an

d pa

rtne

rs.

Str

engt

hen

capa

city

to q

uant

ify,

proc

ure

and

man

age

stoc

ks

PS

U/M

SD

/Par

tner

s/

Pro

gram

s

With

in 3

6 m

onth

s

Enc

oura

ge m

ore

dono

rs a

nd

part

ners

to s

uppo

rt g

over

nmen

t

budg

et

Adv

ocac

y fo

rum

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9.0 REFERENCESMOHSW/ EHG/MSH ;Tanzania Drug Tracking Study, 2007 1.

MSD price catalogue of essential medicines and hospital supplies, 2006-072.

MOHSW/WHO/EC; Survey of the medicine Prices in Tanzania, 20043.

MSD /WHO/ PHASUMA; Improving Stock Control and Forecasting, , October 20064.

Preparation of MSD Medium Term Strategic Plan, Assessment Report, Sep 20065.

Rational Pharmaceutical Management – An Indicator Approach (MSH/RPM 1995/97)6.

Resources Allocation Formula for Health Block Grant and Basket Funds7.

Review of the Accredited Drug Dispensing Outlets (ADDO), Roll out Program inTanzania, HERA, 16 8.

March 2006

MOH; The Tanzania National Drug Policy, 19909.

Master Plan for the Pharmaceutical Sector 1992-2000, 10.

Hospital Therapeutic Committees, Feb 199311.

The United Republic of Tanzania 2003: The Tanzania Food, Drugs and Cosmetics Act 2003; 12.

Government Printer, Dar es Salaam, 2003

Monica Fletcher; Continuing education for health professionals - time to prove its worth. Primary 13.

healthcare Journal (2007) 16(3) 188-190


10.0 ANNEXES

Annex 1: Data Collection Points

DAR MWANZA TABORA MTWARA MOSHI MBEYA

MSD -DAR MSD-MWANZA MSD-TABORA MSD-MTWARA MSD-

MOSHI

MSD-MBEYA

Muhimbili

National Hospital

BMC Kitete Ligula KCMC Rufaa-Mbeya

Mwananyamala Sekou Toure Sikonge Hosp Tandahimba Mawenzi Rmo-Mbeya

Magomeni Dmo Magu Puge Hc Nanguruwe Hc Majengo Hc Rungwe

Sinza Makongoro Clinic

Hc

Anglican Disp Ziwani Disp Mbalizi- Hc

Sangabuye Disp Iziwa Dsp

Annex 2: List of names of Data Collectors for the Assessment

S/N Name Place of Work Place of

Assignment

Phone number

1 Dr. Mary Jande Depart. of Pharmacology, School of

Medicine, MUCHS

MZA 0754 298978

2 Dr. Gerald Rimoy Depart. Pharmacology, School of

Medicine, MUCHS

Moshi 0713 223 433

3 Mr. Fredric

Nicolaus

Depart. Of Quality Control, MSD- Mtwara 0713 454 445

4 Dr. Veronica

Mugoyela

Depart. of Medicinal Chemistry, School of

Pharmacy MUCHS

MZA 0754 2610532

5 Mr. Elford Ngaimisi Depart. Pharmaceutics, School of

Pharmacy MUCHS

Mbeya 0713 256 396

6 Ms Consolata

Muzaga

MSH Mbeya 0754 677 976

7 Winna Shango MOH & SW Tabora 0754 303 733

8 Ms. Magege Private Pharmacist DSM Tabora 0754 618 245

9 Prof. Dr. Mary

Justin-Temu

Depart. Pharmaceutics, School of

Pharmacy, MUCHS

Moshi 0784 320 558

10 Mr. A. Malisa Hospital Pharmacist –Morogoro Regional

Hospital

Dar 0754 820 378

11 Ms Rose Tumbo Muhimbili National Hospital Dar 0784 357 141

12 Noel Mhadu PO –SH Office Mtwara 0713 569 509


Annex 3: List of Tracer Medicines

No Tracer Products

1 Alu (Artemisinin + Lumefantrine) in four different pack

sizes

30 x 6's

30 x 12's

30 x 18's

30 x 24's

2 QUININE pack of 1000 tabs

3 SP pack of 1000

4 ERYTHROMYCIN TABS pack of 1000

5 AMOXYCILLIN CAPS pack of 1000

6 AMOXYCILLIN SYRUP pack of 100 ml

7 COTRIMOXAZOLE TABS pack of 1000

8 COTRIMOXAZOLE SUSPENSION pack of 100ml

9 BENZYL PENICILLIN 5 MU pack of 1 vial

10 ORS –sachet

11 METRONIDAZOLE SUSP

12 DOXYCYCLINE TABS pack of 1000

13 CIPROFLOXACIN TABS pack of 100

14 PARACETAMOL TABS pack of 1000

15 NITROFURANTOIN TABS pack of 1000

16 GRISEOFULVIN TABS pack of 1000

17 CLOTRIMAZOLE CREAM pack of 10 ml

18 METRONIDAZOLE TABS pack of 1000

19 CEFTRIAXONE INJ 250 mg pack of 1 vial

20 MEBENDAZOLE TABS pack of 1000

in-depth assessment of the medicines supply...

Documents