Accessibility of malaria commodities in Geita District Council, mainland Tanzania: the experiences from healthcare providers and clients

ABSTRACT

Background:

Access to essential malaria commodities is a cornerstone in malaria control. However optimal availability and access to essential malaria commodities remain a challenge in Tanzania. Therefore, this study aimed to explore the factors affecting the accessibility of malaria commodities in Tanzania.

Methods:

This was a mixed-method cross-sectional study using both quantitative and qualitative approaches. Data were collected between February and March 2023 from health facilities, health facility staff, and patients.

Results:

Availability of malaria commodities in government health facilities was 100% for all items while in the private and faith-based facilities, this ranged from 10% to 80%. The reasons for stockouts in Government facilities were related to delayed and inadequate quantity delivery while in private facilities the main reason was the lack of cash for procurement. Both private facilities’ clients and healthcare providers concurred that most people do not access complete treatment due to the high costs of prescribed medicines and poor stocking levels.

Conclusion:

The availability, hence the accessibility, of malaria commodities in private and faith-based health facilities is still sub-optimal. Logistic management needs to be improved to eliminate stockouts and malaria commodities high costs need a permanent solution.

KEYWORDS:

• Accessibility
• factors
• malaria commodities
• Tanzania

Acknowledgements

The authors of this paper gratefully acknowledge the funding of the Masters of Health Supply Chain Management by the German Federal Ministry for Economic Cooperation and Development (BMZ) through KfW Development Bank and the East African Community Regional Center of Excellence for Vaccines, Immunisation, and Health Supply Chain Management. In addition, this research would not have been possible without the assistance of the College of Medicine and Health Sciences, University of Rwanda. The authors also acknowledge healthcare workers for their contribution in facilitating data collection in their Health Facilities. AD designed the study, collected data and drafted the manuscript. OS and JDA participated in the design and implementation of the study. SB, DA, FC, and FM participated in data analysis, drafting the manuscripts, and critically reviewed and revised the manuscript. All authors read and approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Datasets used during the study are available from the corresponding author on reasonable request.

Ethics approval and consent to participate

Ethical approval/clearance to conducting this research was obtained from National Institute for Medical Research- National Health Research Ethics Review Committee. A letter of authorisation to conduct data collection of this research in Geita District Council were obtained from the President's Office for Local Government and Regional Administration (PO-LARG). Before data collection all participants were requested to consent voluntarily and assured that their participation in the study was voluntary and they were free to withdraw without any negative impact.

Additional information

Funding

This research did not receive funding either for data collection or manuscript publication. However, it is prepared from a master’s dissertation that was conducted to fulfil the requirement of a master’s degree in Health Supply Chain Management, in EAC RCE – VIHSCM. This master’s degree was funded by German Federal Ministry for Economic Cooperation and Development (BMZ) through KfW Development Bank.

Notes on contributors

Anna David

Ms Anna David is a pharmacist with a remarkable focus on supply chain expertise. Holding an MSc in Health Supply Chain Management from the EAC Regional Centre of Excellence for Vaccine, Immunization, and Health Supply Chain Management at the University of Rwanda, Kigali, she further fortified her knowledge with an MSc in Public Health from Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania. Anna’s commitment to addressing health challenges extends beyond borders, as she passionately endeavors to contribute to the betterment of healthcare in Tanzania, Africa, and globally. Currently, she lends her expertise to the National Malaria Control Program at the Ministry of Health in Tanzania, where she has amassed a decade of invaluable experience. As the head of the Commodity and Logistic Management unit at Malaria control Program, Anna spearheads the coordination of Malaria commodities supply chain activities at the national level. Her responsibilities span from meticulous planning to seamless implementation, overseeing logistics activities that significantly enhance the availability of Malaria commodities across all levels of the supply chain. Through her unwavering dedication, Anna David continues to play a pivotal role in advancing healthcare delivery and combatting health challenges on a grand scale.

Omary Swalehe

Dr. Omary Swalehe holds first, second and third degrees in marketing management from three continents. He has more than 17 years of teaching in higher education in both Africa and Asia. He has conducted a number of studies and consultancies both within and outside Tanzania. He is an alumnus of Bradford University, Durham University, Bangalore University and Mzumbe University where he graduated and teaches various programmes. His research interest lies in the area of Marketing, Economics and strategies for competitive advantage for Small Business Enterprises and Supply chain management in Health and allied studies.

Jean D’ Amour Habagusenga

Mr. Jean D’ Amour Habagusenga is a highly motivated public health specialist with experience and education in health project management, health supply chain management and human resource management for health. He is proactive, adaptive, and creative with excellent proven problem-solving skills; he works well in teams and self-directed basis with ability to work in challenging physical and cross-cultural environments acquired through a wide range of projects from academia as well as professional world. He shows interest in issues related to health training programs design, management and implementation. In the past, Jean d’Amour served as a research assistant, fieldwork coordinator, project manager of a great lakes region project under Swedish cooperation with former National University of Rwanda. From January 2017 up to February 2019, he has been the Director of the EAC Regional Centre of Excellence for Vaccines, Immunization and Health Supply Chain Management. From March 2019, he was appointed as Operations Coordinator of the same Centre of Excellence until now. As training background, he has got a BSc in Pyschopedagogy from the University of Rwanda and an MPH with a focus on Health Workforce Development from University of the Western Cape SA, in addition to a good number of professional trainings including Strategic Change Management obtained from International Centre for Parliamentary Studies in the United Kingdom.

Stany Banzimana

Mr. Stany Banzimana, holds a MSc in Public Procurement Management for Sustainable Development and currently doing research on Vaccine Supply Chain Management System Design for Rwanda and Kenya as part of his PhD trajectory. He is a permanent lecturer at the University of Rwanda (UR), College of Business and Economics (CBE) since 2013. From 2014 to date, he works with the East Africa Community Regional Centre of Excellence for Vaccines, Immunization and Health Supply Chain Management (EAC RCE-VIHSCM) hosted by the UR on behalf of the EAC Partner States. At the RCE-VIHSCM, he has served in different positions and is currently responsible for designing and delivering professional courses for health supply chain workforce development in the EAC Region and around 2,000 health professionals across the EAC region have been trained on various topics related to supply chain management and access to medicines. From 2020 to date, he is supporting the National Immunization Programme (EPI) of the Rwanda Biomedical Center as a member of the National Immunization Logistics Working Group (NILWG) and his support focuses on new and routine vaccine introduction, storage, distribution, cold-chain management, vaccination coverage and system re-design to improve the uptake. Mr. Stany is currently involved in research, training and teaching Procurement, Logistics and Supply Chain related topics at both College of Business and Economics (UR-CBE) and the Centre of Excellence for Vaccines, Immunization and Health Supply Chain Management (EAC RCE-VIHSCM) and is a co-author of six papers on access to medicines and supply chain management.

Domina Asingizwe

Dr. Domina Asingizwe is a Research, Innovation, and Technical Assistance Coordinator in the EAC RCE-VIHSCM since 2020. In her current position, she coordinates the selection and implementation of the RCE research grants, coordinate and lead the grants applications in the areas of VIHSCM, support the center’s staff and students to write manuscripts for publication in peer reviewed journals, and represent the centre at research forums at national, regional and international levels, among other activities. She is also a Senior Lecturer in the College of Medicine and Health Sciences (CMHS), University of Rwanda. She has a PhD in Public Health with interest in malaria prevention. She has over ten years of experience in Research. She is currently part of the Research team supporting the Directorate of Research and Innovation in CMHS. Since 2011, She has been participating in pre-award, award, and post wards grant management. Besides, she has also been consistently involved in organizing and coordinating research trainings to support the University of Rwanda staff and Partner Institutions to improve their research administration, grant management, and manuscript writing skills. She has published in multiple venues, and she has been involved in implementation research that feeds into evidence-based health care policy and practice as foundational to cost-effective targeted interventions for optimal population health outcomes.

Frank Chacky

Frank Chacky is a Programme Officer at the Tanzania National Malaria Control Programme (NMCP) with over 15 years of work experience in malaria epidemiology, and Monitoring and Evaluation. Frank Chacky is a focal point for Operational Research at NMCP and PI of the ongoing biennial study since 2015 titled “School Malaria Parasitological Survey among children in Public Primary Schools in mainland Tanzania”. After completion of a Masters of Health Monitoring and Evaluation in 2012 from Jimma University, Ethiopia; his expertise has been built on the evaluation of malaria control interventions, development of Guidelines, Strategic Plans, Study Protocols, Project Planning, Data Management and establishment of stratification of the malaria according to endemicity risk to guide allocation of interventions. Additionally, Frank Chacky has expertise to conduct routine data quality checks and a pioneer of the Tanzania Malaria Service and Data Improvement (MSDQI) package; modules dedicated to monitor performance of malaria indicators in the health facilities. Currently he is undertaking doctoral training in Medical Sciences on a project titled “Malaria transmission, burden and control measures in school-aged children and adolescents: An experience of school-based surveillance in mainland Tanzania” from the Global Health Institute, University of Antwerp in Belgium.

Fabrizio Molteni

Fabrizio Molteni is a Medical Doctor with a MMed in Tropical and Subtropical Medicine. He graduated and specialized at the Universita’ degli Studi, Milan, Italy. He has been working for more than 20 years in the field of malaria control. The main interests are on planning and implementing initiatives on malaria case management, prevention, epidemiology and surveillance in Tanzania Mainland and Zanzibar. After working with the Italian State Agency for Cooperation and Development, he spent a few years in malaria vector control activities within the US President Malaria Initiative project. For the last 10 years he has been engaged with the Swiss Tropical and Public Health Institute as a senior technical advisor for the National Malaria Control Programme in Tanzania and Zanzibar Malaria Elimination Programme. Over the two decades working in the malaria field he has been instrumental in developing large programmatic and operational schemes for resource mobilization through international institutions. He is currently living and working in Zanzibar.