5 research outputs found
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Upgrading under globalization in health-related industries in Tanzania: the case for dynamic industrial deepening
Globalization of markets and production networks has made it progressively harder for low income countries to industrialize. This article addresses a conundrum facing industrial firms and industrial policy in a low-income African country: how to achieve upgrading necessary for sustained competitiveness. Using data from a study of manufacturers of health products in Tanzania, we document the double âsqueezeâ on firmsâ profits exerted by sharp price competition alongside competitive pressure for rising product quality within globalized markets. Drawing on Suttonâs model of competing on capabilities, and
the sectoral systems of innovation and production framework, we argue that âdynamic industrial deepeningâ, strengthening domestic inter-firm linkages, is a key requirement for sustainable development of these health industries. We present evidence that sectoral industrial support for the health industries can promote sustainable technological upgrading, and reflect on the challenge of building developmental linkages where external investment to support upgrading is transforming existing business structures
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Cancer patientsâ pathways: evidence and implications for policy
This Discussion Paper presents findings from a patients' pathways survey conducted in 2019 with 62 Tanzanian participants suffering from cancer or survivors of cancer. The paper looks at facilitators and barriers to accessing cancer care in Tanzania. A number of identified challenges that hinder patients from accessing care in a timely manner relate to costs, diagnosis and referrals. The paper highlights the social and economic burden faced by patients on the path to treatment. The research forms part of a larger collaborative project, Innovation for Cancer Care in Africa (ICCA).
The survey included an innovative methodology, tracing in detail patientsâ pathways through their experience of cancer from first symptoms to diagnosis to treatment and after. Key findings in this paper include the following.
* Late-stage presentation of cancer is acknowledged to be a serious impediment to effective treatment in Tanzania. The average delay for these patients between first going to a health facility with symptoms that were those of cancer, to diagnosis, was 2.13years. This delay is a central cause of late stage presentation for treatment.
* In their search for a diagnosis, many patients have moved repeatedly between formal facilities as their (often severe) symptoms worsened. While most public sector patients had to move âupâ the system, from district to zonal or national level hospitals to obtain a diagnosis, only 15% of all these movements between facilities were the result of a referral. Most were patientsâ (and their familiesâ) search for diagnosis.
* Regional hospitals, to which many patients moved from district level, did not do well in terms of diagnosis; only 8 people were eventually diagnosed at regional level including none who began their pathways at that level.
* Several patients had been well served by dispensaries and district hospitals: two directly diagnosed there, and several moving directly to the facility where diagnosed: there is thus some good practice at district level to be shared.
* Two patients were diagnosed through screening, both after several moves between formal health facilities, evidencing both the importance of screening and the lack of effective investigation of symptoms within the system.
* Out-of-pocket costs were high for patients in the period when they were seeking treatment, an average of over TZS 400,000. For those on lower household incomes in particular, this had imposed a major burden and source of impoverishment. This effect was worsened by the addition of transport costs of moving between facilities.
* Patients starting in the private sector, generally with NHIF or private insurance, experienced shorter and more direct trajectories to diagnosis. Insurance was only partially financially protective before diagnosis, reducing on average but not eliminating out of pocket (OOP) spending.
* Delays between diagnosis and treatment were much shorter: average 16 weeks to start of treatment. A cancer diagnosis triggered, on average, burdensome continuing costs: while half of respondents made no OOP payments after diagnosis, the average payments for all respondents were over TZS 1.6 million. Of those who made these payments, 80% had no insurance.
* Over half of respondents said they had used a complementary or alternative form of care. For many this was prayer and faith healing, sometime associated with other forms of mosque or church support. Those who went to alternative healers and gave cost details had spent an average of nearly TZS half a million.
* Free treatment at Ocean Road Cancer Institute (ORCI) is effective in protecting many lower income patients, who made up the majority of respondents interviewed at ORCI, from prohibitive costs of treatment, and is hugely appreciated by patients
Rethinking health sector procurement as developmental linkages in East Africa
Health care forms a large economic sector in all countries, and procurement of medicines and other essential commodities necessarily creates economic linkages between a country's health sector and local and international industrial development. These procurement processes may be positive or negative in their effects on populations' access to appropriate treatment and on local industrial development, yet procurement in low and middle income countries (LMICs) remains under-studied: generally analysed, when addressed at all, as a public sector technical and organisational challenge rather than a social and economic element of health system governance shaping its links to the wider economy. This article uses fieldwork in Tanzania and Kenya in 2012â15 to analyse procurement of essential medicines and supplies as a governance process for the health system and its industrial links, drawing on aspects of global value chain theory. We describe procurement work processes as experienced by front line staff in public, faith-based and private sectors, linking these experiences to wholesale funding sources and purchasing practices, and examining their implications for medicines access and for local industrial development within these East African countries. We show that in a context of poor access to reliable medicines,
extensive reliance on private medicines purchase, and increasing globalisation of procurement systems, domestic linkages between health and industrial sectors have been weakened, especially in Tanzania. We argue in consequence for a more developmental perspective on health sector procurement design, including closer policy attention to strengthening vertical and horizontal relational working within local health-industry value chains, in the interests of both wider access to treatment and improved industrial development in Africa
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Markets and Policy Challenges in Access to Essential Medicines for Endemic Disease
Access to essential medicines is a core element of the effective health systems that are required to deal with endemic disease. Cost-effective access relies in turn on efficient market functioning and on appropriate polices towards the role of markets at national and international levels. This article argues that current international policy frameworks for promoting access to essential medicines lack coherence and display weak empirical foundations for proposed market interventions. A study of medicines markets in Tanzania questions some assumptions about market functioning underlying international policy, and shows how exploratory field studies can reduce the knowledge gap. Medicines policy should aim for rational use of essential medicines and for universal access free at the point of use to medicines essential to treat endemic diseases and other major causes of death. Unregulated retail market competition in essential medicines should be progressively constrained by government and NGO action. Wholesale market competition, in contrast, should be promoted, while the rebuilding of African pharmaceutical manufacturing is important for promoting and sustaining access. At each market level, public and non-governmental non-profit traders and providers can play a regulatory role alongside greater citizen information and civic activism. Copyright 2010 The author 2010. Published by Oxford University Press on behalf of the Centre for the Study of African Economies. All rights reserved. For permissions, please email: [email protected], Oxford University Press.
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NGOs, consumer rights and access to essential medicines: non-governmental public action in a low-income market context
If medicines are obtained by a low income population largely through market exchange, then consumer rights become a key aspect of the right to health, and hence a key aspect of tackling severe injustice and inequality. In Tanzania and India, where market-based access to medicines is dominant, regulation of retail sales is also weak and impoverished consumers lack necessary information about the medicines they are buying. As a result they face, unprotected, dangers of the medicine markets that may include substandard medicines, incomplete treatment, inappropriate and even dangerous treatments, over-priced medicines, worsening impoverishment and/or exclusion for inability to pay, and rising anti-microbial resistance.
We document just how vulnerable medicines consumers are in these circumstance, and the lack of effective consumer protection. We argue that consumers cannot place their trust in the market transaction alone to gain access to rational treatment with essential medicines. In these circumstances, non-governmental public action has an important role to play. We conclude that local and international non-governmental public action can do much more to promote consumer rights as one key route to the promotion of the right to health of impoverished populations