80 research outputs found
The private commercial sector distribution chain for antimalarial drugs in Benin - Findings from a rapid survey
In November 2008, the Global Fund to Fight HIV/AIDS, TB and Malaria announced that it would
administer the first phase of an ambitious scheme to increase the availability of effective treatment
for malaria, the Affordable Medicines Facility – malaria (AMFm). Artemisinin‐based combination
therapies (ACTs) are highly‐effective, but remain prohibitively expensive for those who are most
vulnerable to malaria infection. AMFm aims to reduce significantly the price of ACTs by offering a
co‐payment for ACTs purchased by eligible buyers at the top of the supply chain.
Recognizing that the public and private sectors are important sources of antimalarials in most
endemic countries, both public and private sector buyers will be entitled to purchase subsidized
ACTs. The involvement of the private sector is an innovative element of AMFm, as many countries
already have experience distributing ACTs in the public sector. To ensure that subsidized ACTs reach
patients at the lowest possible cost, it is necessary to gain a better understanding of the private
sector supply chains for antimalarials in each country participating in AMFm.
The objective of the rapid supply chain survey was therefore to assist Benin, which is one of the 11
countries invited to apply to the first phase of AMFm, in the development of an effective
implementation plan by providing an understanding of the current supply chain for antimalarials,
and the way in which subsidised ACTs are likely to travel through this chain to reach patients. This
report presents the findings of a series of semi‐structured interviews conducted with government
officials and private suppliers of malaria treatment operating at the various levels of the chain.
At the time of the survey, antimalarial products sold in the private commercial sector were procured
from international and domestic manufacturers by 3 active registered wholesalers and Benin’s public
sector procurement agent: the Centrale d’Achat des Médicaments Essentiels et des Consommables
médicaux (CAME). Manufacturers do not have sole distributorship agreements for registered
pharmaceuticals, or other special relationships with particular wholesalers. Consequently, each
wholesaler regularly stocks a large proportion of the antimalarials registered in Benin. CAME is
responsible for procuring the generic medicines on the National Essential Medicines List. In practice
CAME procures and supplies antimalarials not included on the National Essential Medicines List, as it
is currently out of date
The private commercial sector distribution chain for antimalarial drugs in Nigeria - Findings from a rapid survey
In November of 2008, the Global Fund to Fight HIV/AIDS, TB and Malaria announced that it would
administer the first phase of an ambitious scheme to increase the availability of effective treatment
for malaria, the Affordable Medicines Facility-malaria (AMFm). Artemisinin-based combination
therapies (ACTs) are highly effective, but remain prohibitively expensive for those who are most
vulnerable to malaria infection.1
The AMFm aims to significantly reduce the price of ACTs by offering
a co-payment for ACTs purchased by eligible buyers at the top of the supply chain.
Recognizing that the public and private sectors are important sources of antimalarials in most
endemic countries, both public and private sector buyers will be entitled to purchase subsidised
ACTs. The involvement of the private sector is an innovative element of AMFm, as many countries
already have experience distributing ACTs in the public sector. To ensure that subsidised ACTs reach
patients at the lowest possible cost, it is necessary to gain a better understanding of the private
sector supply chains for antimalarials in each country participating in the AMFm.
The objective of the rapid supply chain survey was therefore to assist Nigeria, which is one of the 11
countries invited to apply to the first phase of the AMFm, in the development of an effective
implementation plan by providing an understanding of the current supply chain for antimalarials,
and the way in which subsidised ACTs are likely to travel through this chain to reach patients. This
report presents the findings of a series of semi-structured interviews conducted with government
officials and private suppliers of malaria treatment operating at the various levels of the chain.
Supplemental sections include brief discussions on the Nigerian drug monitoring system, on the
proposed tax exemption for subsidised ACTs under the AMFm, and also on the private sector
capacity to repackage and re-label imported subsidised ACTs. In addition, data from the December
2008 report on the first round of the ACTwatch Outlet Survey in Nigeria were used to estimate key
variables, such as antimalarial market shares
ACTwatch 2009 Supply Chain Survey Results, Zambia
In Zambia, as in many low-income countries, private commercial providers play an important role in
the treatment of malaria. To design effective interventions for improved access to accurate
diagnosis and effective malaria treatment, there is a need to understand retailer behaviour and
identify the factors that influence their stocking and pricing decisions. Private commercial retailers
are the last link in a chain of manufacturers, importers and wholesalers and their supply sources are
likely to have an important influence on the price and quality of malaria treatment that consumers
can access. However, there is limited rigorous evidence on the structure and operation of the
distribution chain for antimalarial drugs that serves the retail sector.
The ACTwatch Supply Chain Study, one of the ACTwatch project components, aims to address this
gap by conducting quantitative and qualitative studies on distribution chains for antimalarials in the
ACTwatch countries (Cambodia, Uganda, Zambia, Nigeria, Benin, Madagascar and the Democratic
Republic of Congo). Other elements of ACTwatch include Retail Outlet and Household Surveys led by
Population Services International (PSI). This report presents the results of a cross-sectional survey of
antimalarial drug wholesalers conducted in Zambia between February and May 2009
ACTwatch 2009 Supply Chain Survey Results, Nigeria
In Nigeria, as in many low-income countries, private commercial providers play an important role in
the treatment of malaria. To design effective interventions for improved access to accurate
diagnosis and effective malaria treatment, there is a need to understand retailer behaviour and
identify the factors that influence their stocking and pricing decisions. Private commercial retailers
are the last link in a chain of manufacturers, importers and wholesalers and their supply sources are
likely to have an important influence on the price and quality of malaria treatment that consumers
can access. However, there is limited rigorous evidence on the structure and operation of the
distribution chain for antimalarial drugs that serves the retail sector.
The ACTwatch Supply Chain Study, one of the ACTwatch project components, aims to address this
gap by conducting quantitative and qualitative studies on distribution chains for antimalarials in the
ACTwatch countries (Nigeria, Cambodia, Benin, the Democratic Republic of Congo, Madagascar,
Uganda and Zambia). Other elements of ACTwatch include Retail Outlet and Household Surveys led
by Population Services International (PSI). This report presents the results of a cross-sectional
survey of antimalarial drug wholesalers conducted in Nigeria between July and September 2009
The private commercial sector distribution chain for antimalarial drugs in Madagascar: Findings from a rapid assessment
ACTwatch is a research programme funded by the Bill and Melinda Gates Foundation that aims to
provide and promote evidence and recommendations for policy makers on methods to increase
availability and decrease the consumer price of quality‐assured Artemisinin‐based Combination
Therapies (ACTs) throughout the private sector. Research has been carried out in seven countries
(Cambodia, Uganda, Zambia, Nigeria, Benin, Madagascar and D.R. Congo) and encompasses
Household Surveys, Outlet Surveys, as well as Supply Chain Surveys and Assessments.
As is the case in many developing countries, the private sector in Madagascar plays a pivotal role in
facilitating access to malaria treatment. The Household and Outlet surveys conducted in Madagascar
suggest that the general population tends to seek treatment through the private sector, and that
private sector outlets make up a substantial portion of outlets that carry antimalarials.
In order to design future interventions that will improve access to diagnostic and effective treatment
options, it is important to understand the structure of the private sector distribution chain for
antimalarials, as well as the incentives, restrictions and challenges that actors within the market
face. Despite the important role of the private sector in the supply of antimalarials, there is limited
rigorous evidence on the subject. This report contributes to addressing this gap for Madagascar
A Qualitative Assessment of the Private Sector Antimalarial Distribution Chain in Zambia, 2009
Alongside the public and non‐profit sectors, private commercial providers are also sources of malaria
treatment in Zambia. To design effective interventions for improved access to accurate diagnosis and
effective malaria treatment, there is a need to understand retailers' behaviour and identify the factors that
influence their stocking and pricing decisions. Private commercial retailers are the last link in a chain of
manufacturers, importers and wholesalers, and their supply sources are likely to have an important
influence on the price and quality of malaria treatment that consumers can access. However, there is limited
rigorous evidence on the structure and operation of the distribution chain for antimalarial drugs that serves
the retail sector.
The ACTwatch Supply Chain Study, one of the ACTwatch project components, aims to address this gap by
conducting quantitative and qualitative studies on distribution chains for antimalarials in the ACTwatch
countries (Zambia, Cambodia, Benin, the Democratic Republic of Congo (DRC), Madagascar, Nigeria and
Uganda). This report presents the results from qualitative interviews with antimalarial drug wholesalers,
retailers and other key stakeholders conducted in Zambia between February and May 2009. A summary of
the key findings is given below. To provide a complete description of the supply chain for antimalarial drugs,
this report should be read in conjunction with the report on the results of the structured supply chain survey
also conducted as part of this study, available at www.actwatch.info
A Qualitative Assessment of the Private Sector Antimalarial Distribution Chain in Nigeria, 2009
In Cambodia, as in many low‐income countries, private commercial providers play an important role in the
treatment of malaria. To design effective interventions for improved access to accurate diagnosis and
effective malaria treatment, there is a need to understand retailers' behaviour and identify the factors that
influence their stocking and pricing decisions. Private commercial retailers are the last link in a chain of
manufacturers, importers and wholesalers, and their supply sources are likely to have an important
influence on the price and quality of malaria treatment that consumers can access. However, there is
limited rigorous evidence on the structure and operation of the distribution chain for antimalarial drugs that
serves the retail sector.
The ACTwatch Supply Chain Study, one of the ACTwatch project components, aims to address this gap by
conducting quantitative and qualitative studies on distribution chains for antimalarials in the ACTwatch
countries (Cambodia, Benin, the Democratic Republic of Congo, Madagascar, Nigeria, Uganda and Zambia).
This report presents the results from qualitative interviews with antimalarial drug wholesalers, retailers and
other key stakeholders conducted in Cambodia between April and November 2009. A summary of the key
findings is given below. To provide a complete description of the supply chain for antimalarial drugs, this
report should be read in conjunction with the report on the results of the structured supply chain survey also
conducted as part of this study [1], available at www.actwatch.info.
• As the bulk of antimalarial treatment is manufactured outside of the country, pharmaceutical importers,
including PSI/Cambodia, constitute a critical component of Cambodia’s private sector distribution chain
for antimalarials by ensuring a regular national supply of antimalarials and also by facilitating their
distribution throughout the country. Non‐importing wholesalers also play a role in distributing
antimalarials, particularly to more remote areas and to retail outlet types not targeted by importers,
including more informal types such as drug shops, grocery stores, etc.
• The degree of competition varied by level in the distribution chain: at import level, competition was
restrained by sole distributor and like agreements between foreign manufacturers and domestic
importers, and also by a number of barriers to entry, including the costs of importing, the limited size of
the overall market and lack of access to capital. Competition was less restrained at lower levels of the
chain where the key barrier in theory to market entry was the difficulty of securing a license to operate,
though many believed it was a barrier easily circumvented.
• Commodities for malaria treatment, including ACTs and RDTs, were perceived to be generally available
in the private sector distribution chain; however, availability of ACTs and RDTs at lower levels of the
chain was poorer. At both wholesale and retail levels, stocking decisions were driven by perceived drug
quality, which was in turn affected by factors such as media promotion and social marketing targeting
wholesalers, retailers and consumers, as in the case of Malarine (the ACT brand socially marketed by
PSI/Cambodia). However, supplier stock outs of Malarine combined with its perceived side effects led
some providers to continue stocking alternatives treatments, including artemisinin monotherapies, even
though they were aware that sales of such products were prohibited.
• Most wholesalers and retailers purchased new stock from either one or two suppliers. When choosing a
supplier, factors considered were supplier selling prices, availability of delivery services, and perceived
knowledge/expertise of the supplier in the treatment of malaria. Offering credit facilities was also cited
as a strategy to attract custom, but access to supplier credit was perceived to be restricted to customers
known to suppliers.
2
• Retailers and wholesalers had similar price setting behaviours. Providers reported setting their price on
the basis of antimalarial purchase price and their price mark‐ups on the basis of transport costs. At the
top of the chain, importers considered a broader range of costs when setting prices, including overhead
and promotion costs among others. In addition, most providers admitted seeking profits, although many
argued that their pricing decision was constrained by the price set by other shops. Second and third‐
degree price discrimination strategies were commonly reported by both retailers and wholesalers who
varied prices on the basis of volume purchased and customer characteristics.
• Retailers employed a wide range of tactics to gain competitive advantage over other businesses, attract
consumers and generate demand. A retailer’s reputation for delivering high quality treatment, reflected
in their length of operation in a market, positive consumer experiences, and through the provision of
‘cocktail’ therapies, was viewed as crucial to achieving this; however, providing added value services,
such as of blood diagnostic testing, was not. Nevertheless, RDTs were available from many outlets and
were perceived to be easy to use, although less precise than microscopy for confirming malaria
infection
A Qualitative Assessment of the Private Sector Antimalarial Distribution Chain in Benin, 2009
In Benin, as in many low‐income countries, private commercial providers play an important role in the
treatment of malaria. To design effective interventions for improved access to accurate diagnosis and
effective malaria treatment, there is a need to understand retailers' behaviour and identify the factors that
influence their stocking and pricing decisions. Private commercial retailers are the last link in a chain of
manufacturers, importers and wholesalers, and their supply sources are likely to have an important
influence on the price and quality of malaria treatment that consumers can access. However, there is
limited rigorous evidence on the structure and operation of the distribution chain for antimalarial drugs that
serves the retail sector.
The ACTwatch Supply Chain Study, one of the ACTwatch project components, aims to address this gap by
conducting quantitative and qualitative studies on distribution chains for antimalarials in the ACTwatch
countries (Benin, Cambodia, the Democratic Republic of Congo (DRC), Madagascar, Nigeria, Uganda and
Zambia). This report presents the results from qualitative interviews with antimalarial drug wholesalers,
retailers and other key stakeholders conducted in Benin in June 2009. To provide a complete description of
the supply chain for antimalarial drugs, this report should be read in conjunction with the report on the
results of the structured supply chain survey also conducted as part of this study, available at
www.actwatch.info
A Qualitative Assessment of the Private Sector Antimalarial Distribution Chain in Benin, 2009
In Benin, as in many low‐income countries, private commercial providers play an important role in the
treatment of malaria. To design effective interventions for improved access to accurate diagnosis and
effective malaria treatment, there is a need to understand retailers' behaviour and identify the factors that
influence their stocking and pricing decisions. Private commercial retailers are the last link in a chain of
manufacturers, importers and wholesalers, and their supply sources are likely to have an important
influence on the price and quality of malaria treatment that consumers can access. However, there is
limited rigorous evidence on the structure and operation of the distribution chain for antimalarial drugs that
serves the retail sector.
The ACTwatch Supply Chain Study, one of the ACTwatch project components, aims to address this gap by
conducting quantitative and qualitative studies on distribution chains for antimalarials in the ACTwatch
countries (Benin, Cambodia, the Democratic Republic of Congo (DRC), Madagascar, Nigeria, Uganda and
Zambia). This report presents the results from qualitative interviews with antimalarial drug wholesalers,
retailers and other key stakeholders conducted in Benin in June 2009. To provide a complete description of
the supply chain for antimalarial drugs, this report should be read in conjunction with the report on the
results of the structured supply chain survey also conducted as part of this study, available at
www.actwatch.info
ACTwatch 2009 Supply Chain Survey Results, Benin
In Benin, as in many low‐income countries, private commercial providers play an important role in
the treatment of malaria. To design effective interventions for improved access to accurate
diagnosis and effective malaria treatment, there is a need to understand retailer behaviour and
identify the factors that influence their stocking and pricing decisions. Private commercial retailers
are the last link in a chain of manufacturers, importers and wholesalers and their supply sources are
likely to have an important influence on the price and quality of malaria treatment that consumers
can access. However, there is limited rigorous evidence on the structure and operation of the
distribution chain for antimalarial drugs that serves the retail sector.
The ACTwatch Supply Chain Study, one of the ACTwatch project components, aims to address this
gap by conducting quantitative and qualitative studies on distribution chains for antimalarials in the
ACTwatch countries (Benin, Cambodia, the Democratic Republic of Congo (DRC), Madagascar,
Nigeria, Uganda and Zambia). Other elements of ACTwatch include Retail Outlet and Household
Surveys led by Population Services International (PSI). This report presents the results of a cross‐
sectional survey of antimalarial drug wholesalers conducted in Benin in June 2009
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