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. 2014 May 11:13:181.
doi: 10.1186/1475-2875-13-181.

The challenge to avoid anti-malarial medicine stock-outs in an era of funding partners: the case of Tanzania

Inez Mikkelsen-Lopez  1 , Winna Shango, Jim Barrington, Rene Ziegler, Tom Smith, Don deSavigny
Affiliations

The challenge to avoid anti-malarial medicine stock-outs in an era of funding partners: the case of Tanzania

Inez Mikkelsen-Lopez et al. Malar J. .

Abstract

Background: Between 2007 and 2013, the Tanzanian public sector received 93.1 million doses of first-line anti-malarial artemisinin-based combination therapy (ACT) in the form of artemether-lumefantrine entirely supplied by funding partners. The introduction of a health facility ACT stock monitoring system using SMS technology by the National Malaria Control Programme in mid 2011 revealed a high frequency of stock-outs of ACT in primary care public health facilities. The objective of this study was to determine the pattern of availability of ACT and possible causes of observed stock-outs across public health facilities in Tanzania since mid-2011.

Methods: Data were collected weekly by the mobile phone reporting tool SMS for Life on ACT availability from over 5,000 public health facilities in Tanzania starting from September 2011 to December 2012. Stock data for all four age-dose levels of ACT across health facilities were summarized and supply of ACT at the national level was also documented.

Results: Over the period of 15 months, on average 29% of health facilities in Tanzania were completely stocked out of all four-age dose levels of the first-line anti-malarial with a median duration of total stock-out of six weeks. Patterns of total stock-out by region ranged from a low of 9% to a high of 52%. The ACT stock-outs were most likely caused by: a) insufficient ACT supplies entering Tanzania (e.g. in 2012 Tanzania received 10.9 million ACT doses compared with a forecast demand of 14.4 million doses); and b) irregular pattern of ACT supply (several months with no ACT stock).

Conclusion: The reduced ACT availability and irregular pattern of supply were due to cumbersome bureaucratic processes and delays both within the country and from the main donor, the Global Fund to Fight AIDS, Tuberculosis and Malaria. Tanzania should invest in strengthening both the supply system and the health information system using mHealth solutions such as SMS for Life. This will continue to assist in tracking ACT availability across the country where all partners work towards more streamlined, demand driven and accountable procurement and supply chain systems.

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Figures

Figure 1
Figure 1
Percentage of health facilities reporting total artemisinin combination therapy stock-out, by health facility type (Public and Voluntary), Tanzania, October 2011 to December 2012.
Figure 2
Figure 2
Percentage of health facilities with total artemisinin combination therapy stock-out, Tanzania, October 2011 to December 2012. Bars show ACT dose shipments (millions) from the supplier to the public sector (either from PMI or AMFm or both in June 2012).
Figure 3
Figure 3
Malaria prevalence (top panel) and average annual total stock-out rate of artemisinin combination therapy in health facilities (bottom panel) by region in 2011–2012 in mainland Tanzania.
Figure 4
Figure 4
Chronology of important procurement and supply events for artemisinin combination therapy, Tanzania mainland, 2004 to 2012.
See this image and copyright information in PMC

References

    1. National Bureau of Statistics (NBS), Office of the Chief Government Statistician (OCGS), CF International. Tanzania HIV/AIDS and Malaria Indicator Survey 2011–2012. Dar es Salaam, Tanzania: TACAIDS, ZAC, NBS, OCGS, ICF International; 2013.
    1. National Bureau of Statistics (NBS), Chief Government Statistician (OCGS), Macro International Inc. Tanzania HIV/AIDS and Malaria Indicator Survey 2007–2008. Dar es Salaam, Tanzania: TACAIDS, ZAC, NBS, OCGS, and Macro International Inc; 2009.
    1. Ministry of Health and Social Welfare Tanzania. Tanzania Mainland National Health Accounts 2009/10. Dar es Salaam, Tanzania: Ministry of Health and Social Welfare Tanzania; 2010.
    1. The Global Fund to Fight AIDS Tuberculosis and Malaria. Proposal Form - Round 9 Tanzania. Geneva: GFATM; 2009. - PubMed
    1. Ministry of Health and Social Welfare Tanzania. Health sector performance profile report, Mainland Tanzania July 2006 - June 2007. Dar es Salaam, Tanzania: Ministry of Health and Social Welfare Tanzania; 2008.

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