Cost and cost drivers associated with setting-up a prime vendor system to complement the national medicines supply chain in Tanzania

Economic analysis of supply chain management interventions to improve the availability of healthcare commodities at healthcare facilities is important in generating evidence for decision-makers. The current study assesses the cost and cost drivers for setting-up a public-private partnership programme in Tanzania in which all public healthcare facility orders for complementary medicines are pooled at the district level, and then purchased from one contracted supplier, the prime vendor (referred to as 'Jazia Prime Vendor System' (Jazia PVS)).; Financial and economic costs of Jazia PVS were collected retrospectively and using the ingredients approach. The financial costs were spread over the implementation period of January 2014-July 2019. In addition, we estimated the financial rollout costs of Jazia PVS to the other 23 regions in the country over 2 years (2018-2019). A multivariate sensitivity analysis was conducted on the estimates.; Jazia PVS start-up and recurrent financial costs amounted to US$2 170 989.74 and US$709 302.32, respectively. The main cost drivers were costs for short-term experts, training of staff and healthcare workers and the Jazia PVS technical and board management activities. The start-up financial cost per facility was US$2819.47 and cost per capita was US$0.37.; In conclusion, the study provides useful information on the cost and cost drivers for setting-up a complementary pharmaceutical supply system to complement an existing system in low-income settings. Despite the substantial costs incurred in the initial investment and operations of the Jazia PVS, the new framework is effective in achieving the desired purpose of improving availability of healthcare commodities

The effects of medicines availability and stock-outs on household's utilization of healthcare services in Dodoma region, Tanzania

Low- and middle-income countries have been undertaking health finance reforms to address shortages of medicines. However, data are lacking on how medicine availability and stock-outs influence access to health services in Tanzania. The current study assesses the effects of medicine availability and stock-outs on healthcare utilization in Dodoma region, Tanzania. We conducted a cross-sectional study that combined information from households and healthcare facility surveys. A total of 4 hospitals and 89 public primary health facilities were surveyed. The facility surveys included observation, record review over a 3-month period prior to survey date, and interviews with key staff. In addition, 1237 households within the health facility catchment areas were interviewed. Data from the facility survey were linked with data from the household survey. Descriptive analysis and multivariate logistic regressions models were used to assess the effects of medicine availability and stock-outs on utilization patterns and to identify additional household-level factors associated with health service utilization. Eighteen medicines were selected as 'tracers' to assess availability more generally, and these were continuously available in ∼70% of the time in facilities across all districts over 3 months of review. The main analysis showed that household's healthcare utilization was positively and significantly associated with continuous availability of all essential medicines for the surveyed facilities [odds ratio (OR) 3.49, 95% confidence interval (CI) 1.02-12.04; P = 0.047]. Healthcare utilization was positively associated with household membership in the community health insurance funds (OR 1.97, 95% CI 1.23-3.17; P = 0.005) and exposure to healthcare education (OR 2.75, 95% CI 1.84-4.08; P = 0.000). These results highlight the importance of medicine availability in promoting access to health services in low-income settings. Effective planning and medicine supply management from national to health facility level is an important component of quality health services

Past, Present, and Future of Japanese Encephalitis

JE is increasing in some areas (due to population growth and intensified rice irrigation) but declining in others

Impact of hand hygiene intervention: a comparative study in health care facilities in Dodoma region, Tanzania using WHO methodology

Compliance with guidelines on hand hygiene (HH) is pivotal to prevent and control health-care associated infections and contributes to mitigating antimicrobial resistance. A baseline assessment in Dodoma region, Tanzania in March 2018 showed inadequate HH levels across health care facilities. We evaluated the impact of training in HH as part of a water, sanitation and hygiene (WASH) interventions of "Maji kwa Afya ya Jamii" (MKAJI) project.; A comparative HH assessment was conducted in June 2019 involving health care facilities under MKAJI project (n = 87 from which 98 units were assessed) vs non-MKAJI facilities (n = 85 from which 99 units were assessed). Irrespective of MKAJI interventional status, baseline assessment in March 2018 were compared to re-assessment in June 2019 in all health care facility units (unpaired comparison: 261 vs 236 units, respectively), and in facilities assessed in both surveys (paired comparison: 191 versus 191 units, respectively). The 'WHO HH Self-Assessment Framework Tool, 2010' with five indicators each counting 100 points was used. The cumulative scores stratified each health facility's unit into inadequate (0-125), basic (126-250), intermediate (251-375) or advanced (376-500) HH level (score). The HH compliance rates were also assessed and compared.; The overall post-intervention median HH score [interquartile range (IQR)] was 187.5 (112.5-260). MKAJI health facilities had significantly higher median HH scores (IQR) [190 (120-262.5)] compared with non-MKAJI facilities [165 (95-230); p = 0.038]. Similarly, the HH compliance rate of ≥51% was significantly higher in MKAJI than non-MKAJI facilities [56.1% versus 30.3%; chi2 = 13.39, p < 0.001]. However, the recommended WHO compliance rate of ≥81% was only reached by 6.1 and 3.0% units of MKAJI and non-MKAJI facilities, respectively. Both paired and unpaired comparisons during baseline and re-assessment surveys showed increase in HH level from inadequate to basic level.; The overall HH level after the combined WASH and training intervention was at basic level. Higher median HH scores (IQR) and HH compliance rates were evident in health facilities of the MKAJI project, underscoring the impact of the intervention and the potential value of a national roll-out

The role of accountability in the performance of Jazia prime vendor system in Tanzania

Access to safe, effective, quality and affordable essential medicines for all is a central component of Universal Health Coverage (UHC). However, the availability of quality medicines in peripheral healthcare facilities is often limited. Several countries have developed integrated complementary pharmaceutical supply systems to address the shortage of medicines. Nevertheless, there is little evidence on how accountability contributes to the performance of such complementary pharmaceutical supply systems in low-income settings. The current study analyses how accountability mechanisms contributed to the performance of Jazia Prime Vendor System (Jazia PVS) in Tanzania.; The study analysed financial, performance and procedure accountability as defined in Boven's accountability framework. We conducted 30 in-depth interviews (IDIs), seven group discussions (GD) and 14 focus group discussions (FGDs) in 2018 in four districts that implemented Jazia PVS. We used a deductive and inductive approach to develop the themes and framework analysis to summarize the data.; The study findings revealed that a number of accountability mechanisms implemented in conjunction with Jazia PVS contributed to the performance of Jazia PVS. These include inventory and financial auditing conducted by district pharmacists and the internal auditors, close monitoring of standard operating procedures by the prime vendor regional coordinating office and peer cascade coaching. Furthermore, the auditing activities allowed identifying challenges of delayed payment to the vendor and possible approaches for mitigation while peer cascade coaching played a crucial role in enabling staff at the primary facilities to improve skills to oversee and manage the medicines supply chain.; Financial, performance and procedure accountability measures played an important role for the successful performance of Jazia PVS in Tanzania. The study highlights the need for capacity building linked to financial and supply management at lower level health facilities, including health facility governing committees, which are responsible for priority-setting and decision-making at facility level

Housing infrastructure: contemporary issues in timber adoption

Scotland currently has 76·7% of all implemented timber-framed buildings in the UK housing market. England’s figure is 16%. The English contribution is considered relatively low given its demand for more sustainable, low-cost social housing. The aim of this study is to investigate potential contemporary barriers to the adoption of timber as a primary structural material in residential housing developments in England. The research methodology is quantitative and findings revealed that a combination of economic, cultural and psychological issues rather than technical and durability performance are responsible. These are fundamentally due to lack of education regarding the use of timber, erroneously perceived increased maintenance costs of timber housing, developers’ influence and monopoly over timber technology, uncertainty in property resale value and the recent overall lack of confidence in timber technology. It is recommended that improved training comprising compulsory basic timber technology and sustainable construction is adopted as a formal prerequisite for the attainment of relevant qualifications within the built environment, civil engineering and architecture. To this end, the benefits of sustainable construction, specifically, timber, in housing should be introduced even at the pre-university level, within schools and colleges. Also recommended are public awareness campaigns through relevant institutions, in the public and private sectors and among construction professionals, of the merits and misconceptions surrounding timber technology.N/

The reality of task shifting in medicines management - a case study from Tanzania

Tanzania suffers a severe shortage of pharmaceutical staff. This negatively affects the provision of pharmaceutical services and access to medicines, particularly in rural areas. Task shifting has been proposed as a way to mitigate the impact of health worker shortfalls.The aim of this study was to understand the context and extent of task shifting in pharmaceutical management in Dodoma Region, Tanzania. We explored 1) the number of trained pharmaceutical staff as compared to clinical cadres managing medicines, 2) the national establishment for staffing levels, 3) job descriptions, 4) supply management training conducted and 5) availability of medicines and adherence to Good Storage Practice.; A cross-sectional study was conducted in 270 public health facilities in 2011. A pre-tested questionnaire was administered to the person in charge of the facility to collect data on staff employed and their respective pharmaceutical tasks. Availability of 26 tracer medicines and adherence to Good Storage Practice guidelines was surveyed by direct observation. The national establishments for pharmaceutical staffing levels and job descriptions of facility cadres were analysed.; While required staffing levels in 1999 were 50, the region employed a total of only 14 pharmaceutical staff in 2011. Job descriptions revealed that, next to pharmaceutical staff, only nurses were required to provide dispensing services and adherence counselling. In 95.5% of studied health facilities medicines management was done by non-pharmaceutically trained cadres, predominantly medical attendants. The first training on supply management was provided in 2005 with no refresher training thereafter. Mean availability of tracer medicines was 53%, while 56% of health facilities fully met criteria of Good Storage Practice. Task shifting is a reality in the pharmaceutical sector in Tanzania and it occurs mainly as a coping mechanism rather than a formal response to the workforce crisis. In Dodoma Region, pharmacy-related tasks and supply management have informally been shifted to clinical staff without policy guidance, explicit job descriptions, and without the necessary support through training. Implicit task shifting should be recognized and formalized. Job orientation, training and operational procedures may be useful to support non-pharmaceutical health workers to effectively manage medicine supply

Adherence to standard treatment guidelines among prescribers in primary healthcare facilities in the Dodoma region of Tanzania

Background Tanzania's primary healthcare system suffers from a scarcity of financial and human resources that impedes its effectiveness to deliver dependable and uniform quality healthcare. Adherence to standard treatment guidelines (STG) can help provide more consistent and correct diagnoses and treatments and limit the irrational use of medicines and the negative health consequences that can occur as a result. The purpose of this study was to investigate prescribers' adherence of their diagnoses and respective treatments to national STG and to identify potential areas for planning interventions. Methods A cross-sectional study on prescribers' adherence to diagnosis and treatment, according to national STG, was conducted in 2012 in public primary healthcare facilities (HCF) in the Dodoma region of Tanzania. Information on 2886 patients was collected, prospectively and retrospectively, from 120 HCF across the Dodoma region using a structured questionnaire. Twenty-five broadly defined main illness groups were recorded and the nine most prevalent and relevant conditions were statistically analysed in detail. Results Diagnoses and related treatments were recorded and analysed in 2872 cases. The nine most prevalent conditions were upper respiratory tract infections (25%), malaria (18%), diarrhoea (9.9%), pneumonia (6.1%), skin problems (5.8%), gastrointestinal diagnoses (5%), urinary tract infections (4%), worm infestations (3.6%) and eye problems (2.1%). Only 1.8% of all diagnoses were non-communicable diseases. The proportion of prescribers' primary diagnoses that completely adhered to national STG was 599 (29.9%), those that partially adhered totalled 775 (38.7%), wrong medication was given in 621 cases (30.9%) and no diagnosis or medication was given in nine cases (0.5%). Sixty-one percent of all patients received an antibiotic regardless of the diagnoses. Complete adherence was highest when worms were diagnosed and lowest for diarrhoea. The proportion of cases that did not adhere to STG was highest with patients with skin problems and lowest for malaria. Conclusion Prescribers' general adherence to national STG in primary HCF in the public sector in Dodoma region is sub-optimal. The reasons are multifaceted and focused attention, directed at improving prescribing and pharmacotherapy, is required with a view of improving patient care and health outcomes