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Assessment of the Prices and Availability of Medicines for Children in Tanzania

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Assessment of the Prices and Availability of Medicines for Children in Tanzania THE UNITED REPUBLIC OF TANZANIA MINISTRY OF HEALTH AND SOCIAL WELFARE Assessment of the prices and availability of medicines for children in Tanzania NOVEMBER 2010 Published by the Ministry of Health and Social Welfare, Dar es Salaam, The United Republic of Tanzania. © 2011 Ministry of Health and Social Welfare, The United Republic of Tanzania Any part of this document may be reproduced in any form without the prior permission of the publisher provided that this is not for profit and that due acknowledgement is given. Any reproduction for profit must be made with the prior permission of the publisher. Copies of this report may be obtained from: The Permanent Secretary Ministry of Health and Social Welfare P.O. Box 9083 Dar es Salaam Tel: 255 22 2120261 Fax: 255 22 2139951 TABLE OF CONTENTS ACKNOWLEDGMENTS...................................................................................................................................... I EXECUTIVE SUMMARY ....................................................................................................................................II 1. INTRODUCTION ...................................................................................................................................1 1.1 Background....................................................................................................................................................... 1 1.2 Country background ....................................................................................................................................... 2 1.3 The rational use of paediatric medicines ...................................................................................................... 3 1.4 Cost sharing in Tanzania ................................................................................................................................ 4 1.5 Medicine procurement .................................................................................................................................... 4 1.6 Medicine prices ................................................................................................................................................ 5 2. OBJECTIVES ............................................................................................................................................6 2.1 Broad objective ................................................................................................................................................. 6 2.2 Specific objectives ............................................................................................................................................ 6 3. METHODOLOGY ...................................................................................................................................7 3.1 Description of the study areas........................................................................................................................ 7 3.2 Study population and sampling .................................................................................................................... 8 3.2.1 National level................................................................................................................................... 8 3.2.2 Selection of health facilities............................................................................................................ 8 3.3 Survey medicines ............................................................................................................................................. 8 3.4 Selection and training of survey personnel.................................................................................................. 9 3.5 Methods of data collection.............................................................................................................................. 9 3.5.1 Data collection at the national level...................................................................................................... 9 3.5.2 Data collection at health facilities ......................................................................................................... 9 3.6 Data entry and analysis................................................................................................................................. 10 3.7 Ethical considerations.................................................................................................................................... 10 3.8 Expected results ............................................................................................................................................. 10 4. RESULTS.................................................................................................................................................11 4.1 Availability of medicines in the public, private and nongovernmental organization sectors ............ 12 4.2 Cross‐sector comparison of medicine availability..................................................................................... 14 4.2 Facility prices in the public, private and nongovernmental organization sectors................................ 16 4.5 Cross‐sector comparison of patient prices.................................................................................................. 19 4.6 Affordability ................................................................................................................................................... 22 5. DISCUSSION.........................................................................................................................................23 5.1 Public sector availability ............................................................................................................................... 23 5.2 Public sector prices ........................................................................................................................................ 25 5.3 Private sector availability and patient prices ............................................................................................. 26 5.4 Nongovernmental Organization sector patient prices and availability ................................................. 26 5.5 Intersectoral comparison of patient prices ................................................................................................. 27 5.6 Affordability to patients................................................................................................................................ 27 6. CONCLUSIONS ....................................................................................................................................28 7. RECOMMENDATIONS ......................................................................................................................30 REFERENCES .......................................................................................................................................................31 BIBILIOGRAPHY ................................................................................................................................................32 ANNEXES..............................................................................................................................................................33 Annex 1: Timetable of survey.............................................................................................................................. 33 Annex 2: Medicines data collection form used for survey .............................................................................. 34 INSTRUCTIONS .................................................................................................................................................35 Annex 3: List of facilities and outlets sampled.................................................................................................. 42 Annex 4: List of the paediatric medicines surveyed......................................................................................... 44 Annex 5: Analysis summary sheets.................................................................................................................... 45 List of figures Figure 1 A map of Tanzania showing the six regions surveyed in the study: A‐Dar es Salaam, B‐ Mtwara, C‐Mbeya, D‐ Manyara, E‐Shinyanga and F‐Tabora ...................................................... 7 Figure 2: Percentage availability of 50 target medicines in the three sectors ........................................... 14 Figure 3 Median price ratios of lowest price generic medicines in the private sector ........................... 17 Figure 4: Comparison of median price ratios between public procurement prices and public sector facility (patient) prices ..................................................................................................................... 20 List of tables Table 1: Trends in early childhood mortality rates............................................................................... 1 Table 2: Geographical distribution of the surveyed health facilities (n = 143)...................................... 8 Table 3: Analysis of medicine availability (%) by therapeutic class ................................................... 15 Table 4: Number of times more expensive, highest priced vs. lowest priced generics ...................... 18 Table 5: Price variation across nongovernmental organization medicine outlets
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