# The effects of Jazia prime vendor system in complementing the existing pharmaceutical supply chain across public healthcare facilities in Tanzania

Shayo, August Joachim Kuwawenaruwa. The effects of Jazia prime vendor system in complementing the existing pharmaceutical supply chain across public healthcare facilities in Tanzania. 2021, Doctoral Thesis, University of Basel, Faculty of Medicine.

Official URL: https://edoc.unibas.ch/85035/

Results: The results showed that household’s healthcare utilization was positively and significantly associated with continuous availability of essential medicines (odds ratio (OR): 3.49; 95% 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 health promotion (OR: 2.75; 95% CI: 1.84-4.08; p~0.000). Qualitative findings revealed that some 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. Besides, 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. The most critical factor contributing to the acceptability of the Jazia PVS was the perceived effectiveness of the system in achieving its intended purpose. Participants’ acceptability of Jazia PVS was influenced by the increased availability of essential medicines at the facilities, higher-order fulfilment rates, and timely delivery of the consignment. Furthermore, acceptability was also influenced by the good reputation of the prime vendor, close collaborations with district managers and participants’ understanding that prime vendor was meant to complement the existing supply chain. The estimated Jazia PVS start-up financial costs amounted to US$2,170,989.74. Training of the staff and healthcare workers accounted for 27.9% (US$ 605,060.13) while the health facility baseline assessment and the official launch of the Jazia PVS amounted to 5.4% (US$117,406.86) and 3.7% (US$ 79,951.42) respectively. The economic start-up costs accounted for about 52.2% (US$1,209,573.47) of the total economic costs and the largest share 32.0% (US$ 741,836.55) was for staff and healthcare workers training. The Jazia PVS national roll-out costs amount to US$8,031,335.3 with the largest share going to the training of the staff and healthcare workers 45.8% (US$ 3,618,682.96). The current study provides evidence on the potentiality of the Jazia PVS in complementing existing pharmaceutical supply chain, indicating that such a model can be used to increase efficiency in the provision of services. LMICs interested in establishing PPP within the intension of improving healthcare delivery may adopt good lessons from the Jazia PVS in Tanzania. Nonetheless, strong capacity of various bodies to exercise oversight and sanctions in the implementation of the PPP is important in ensuring accountability linkages for the public and private entities.