Dataset Information

Assessment of the Global Fund-supported procurement and supply chain reforms at the Ethiopian Pharmaceuticals Supply Agency: a mixed-methods study.

ABSTRACT:

Objective

The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) partnered with the Ethiopian Pharmaceutical Supply Agency (EPSA) in 2018-2019 to reform procurement and supply chain management (PSCM) procedures within the Ethiopian healthcare system. This assessment sought to determine the impact of the reforms and document the lessons learnt.

Design

Mixed-methods study incorporating qualitative and quantitative analysis. Purposive and snowballing sampling techniques were applied for the qualitative methods, and the data collected was transcribed in full and subjected to thematic content analysis. Descriptive analysis was applied to quantitative data.

Setting

The study was based in Ethiopia and focused on the EPSA operations nationally between 2017 and 2021.

Participants

Twenty-five Ethiopian healthcare decision-makers and health workers.

Intervention

Global Fund training programme for health workers and infrastructural improvements OUTCOMES: Operational and financial measures for healthcare PSCM.

Results

The availability of antiretrovirals, tuberculosis and malaria medicines, and other related commodities, remained consistently high. Line fill rate and forecast accuracy were average. Between 2018 and 2021, procurement lead times for HIV and malaria-related orders reduced by 43.0% relative to other commodities that reported an increase. Many interview respondents recognised the important role of the Global Fund support in improving the performance of EPSA and provided specific attributions to the observed successes. However, they were also clear that more needs to be done in specific critical areas such as financing, strategic reorganisation, data and information management systems.

Conclusion

The Global Fund-supported initiatives led to improvements in the EPSA performance, despite several persistent challenges. To sustain and secure the gains achieved so far through Global Fund support and make progress, it is important that various stakeholders, including the government and the donor community, work together to support EPSA in delivering on its core mandate within the Ethiopian health system.

SUBMITTER: Lesego A

PROVIDER: S-EPMC10729206 | biostudies-literature | 2023 Dec

REPOSITORIES: biostudies-literature

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Publications

Assessment of the Global Fund-supported procurement and supply chain reforms at the Ethiopian Pharmaceuticals Supply Agency: a mixed-methods study.

Lesego Abaleng A Tsegaye Tsion T Were Lawrence P O LPO Sakvarelidze George G Garg Sunil S Morrison Linden L Nigussie Solomon S Githendu Patrick P Achoki Tom T

BMJ open 20231214 12

<h4>Objective</h4>The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) partnered with the Ethiopian Pharmaceutical Supply Agency (EPSA) in 2018-2019 to reform procurement and supply chain management (PSCM) procedures within the Ethiopian healthcare system. This assessment sought to determine the impact of the reforms and document the lessons learnt.<h4>Design</h4>Mixed-methods study incorporating qualitative and quantitative analysis. Purposive and snowballing sampling technique ...[more]

PMID: 38101834

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Project description:BackgroundEffective drug procurement guarantees the sustainable supply of products for health and eliminates excessive costs. However, there is limited information on the area of pharmaceutical procurement practice in Ethiopia. Thus, this study aimed at assessing the procurement practices of program drugs and its challenges at the Ethiopian Pharmaceuticals Supply Agency.MethodsA cross-sectional study accompanied by qualitative assessment was conducted between February 21 and April 20/2020 to examine the procurement practice of the Ethiopian pharmaceutical supply agency. The quantitative data were gathered by reviewing documents and electronic records. Mean forecast error, price paid to international price reference, number of emergency orders placed, and lead time variability were the measurements used to assess the procurement practice. A statistical package for the social sciences version 23 was used to analyze the data. The results were then summarized using tables and texts. The qualitative data were collated through face-to-face in-depth interviews to explore the challenges behind the procurement practice. And the data were analyzed manually using the thematic analysis technique.ResultsThe agency had its own procurement list which defines the items to be procured. The overall mean forecast error in the 2018/19 budget year was 27.8%. Of the 70 program commodities included in the study, 52 (74.3%) items had a mean price less than the international price reference. Three of the 14 orders (21.4%) placed in the aforementioned year were emergency purchases made through direct procurement. The mean lead time for the suppliers of the agency was 137.3 days. Poor data quality from service delivery points, staff capacity constraints, communication problems, and policy issues became the major challenges to implement an effective procurement system in the agency.ConclusionThe procurement practice at the agency has strong side. However, it was not without weaknesses. Using a procurement list is a worthwhile practice. Despite this, much remains to improve lead times and forecasting accuracy.

Project description:BackgroundThe COVID-19 pandemic has disrupted global health supply chains including manufacturing, storage, and delivery of essential medicines, testing kits, personal protective equipment, and laboratory reagents. We sought to document how pandemic impacted the procurement, prices, and supply chain of medical products in Zimbabwe.MethodsWe conducted semistructured in-depth key informant interviews with 36 health system stakeholders in Zimbabwe involved in medicine procurement. Respondents included pharmacists, regulatory officers, and procurement and supply chain management professionals from public and private sectors.ResultsBefore the COVID-19 pandemic, respondents described experiencing long-standing resource constraints, medicine shortages, foreign currency shortages, and supply chain inefficiencies. The pandemic exacerbated this situation due to supply constraints, export restrictions, medicine shortages, and movement restrictions that disrupted logistical and stock management systems. Competitive bidding and tendering processes experienced reduced participation by international suppliers. Significant price increases were initially observed among internationally shipped medicines and for personal protective equipment to cover additional freight costs. COVID-19 pandemic impacts were moderated by reduced patient demand and lower health services utilization, resulting in fewer supply shocks and less price volatility. Further, health system adaptations such as switching treatment regimens, modifying dispensing schedules based on stock availability, redistributing stock of medicines among facilities, and new service delivery models such as integrated outreach services helped ensure continued patient access to medicines.ConclusionsOur findings highlight the need for policies that ensure continuity in access to health services and medical products, even during a pandemic, by avoiding blanket restrictions on medical product exports and imports. Pooled procurement, especially at regional and global levels, with long-term service agreements may help achieve greater resiliency to supply and price shocks from supply chain disruptions. Interventions across manufacturing, trade, and regulatory policy and service delivery models are also needed for supply chain resiliency.

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Project description:BACKGROUND:Kenya has prioritized the attainment of universal health coverage (UHC) through the expansion of health insurance coverage by the National Hospital Insurance Fund (NHIF). In 2015, the NHIF introduced reforms in premium contribution rates, benefit packages, and provider payment methods. We examined the influence of these reforms on NHIF's purchasing practices and their implications for strategic purchasing and health system goals of equity, efficiency and quality. METHODS:We conducted an embedded case study with the NHIF as the case and the reforms as embedded units of analysis. We collected data at the national level and in two purposively selected counties through 41 in-depth interviews with health financing stakeholders, facility managers and frontline providers; 4 focus group discussions with 51 NHIF members; and, document reviews. We analysed the data using a Framework approach. RESULTS:The new NHIF reforms were characterized by weak purchasing actions. Firstly, the new premium contribution rates were inadequately communicated and unaffordable for certain citizen groups. Secondly, while the new benefit packages were reported to be based on service needs, preferences and values of the population, they were inadequately communicated and unequally distributed across different citizen groups. In addition, the presence of service delivery infrastructure gaps in public healthcare facilities and the pro-urban and pro-private distribution of contracted health facilities compromised delivery of, and access to, these new services. Lastly, the new provider payment methods and rates were considered inadequate, with delayed payments and weak links to financial accountability mechanisms which compromised their ability to incentivize equity, efficiency and quality of healthcare delivery. CONCLUSION:While NHIF sought to expand population and service coverage and reduce out-of-pocket payments with the new reforms, weaknesses in the reforms' design and implementation limited NHIF's purchasing actions with negative implications for the health system goals of equity, efficiency and quality. For the reforms to accelerate the country's progress towards UHC, policy makers at the NHIF and, national and county government should make deliberate efforts to align the design and implementation of such reforms with strategic purchasing actions that are aimed at improving health system goals.

Dataset Information

Assessment of the Global Fund-supported procurement and supply chain reforms at the Ethiopian Pharmaceuticals Supply Agency: a mixed-methods study.

Objective

Design

Setting

Participants

Intervention

Results

Conclusion

Publications

Assessment of the Global Fund-supported procurement and supply chain reforms at the Ethiopian Pharmaceuticals Supply Agency: a mixed-methods study.

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