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Drug donations in Tanzania : Stakeholders' Perception and Knowledge

Gehler Mariacher, , G. (2008) Drug donations in Tanzania : Stakeholders' Perception and Knowledge. Doctoral thesis, University of Basel.

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Abstract

Tanzania is a country with low access to essential drugs that receives substantial drug donations (DDs) as in-kind gifts. To promote good donation practice, to support the ongoing health sector reform in Tanzania and to find effective solutions for optimising DD processes, stakeholders’ and recipients’ views on the appropriateness and acceptability of DDs are of particular interest. The aims of this research project were a) to characterise DD processes in Tanzania, b) to explore the practice and perception of Tanzanian stakeholders involved in DD processes, c) to identify similarities and discrepancies between the views of Tanzanian recipients and Swiss donors and d) to develop suggestions for optimising DD processes. The project methodology employed a participatory stakeholder analysis, a triangulation of methods and qualitative research tools. The following stepwise strategy enabled an analysis of the entire DD system: a) literature review and document analysis for description of the context, b) a postal, self-administered, semi-quantitative questionnaire in Tanzania and in Switzerland for defining problems in DD processes, c) key informant interviews in which the interviewees could reflect on the results of the Tanzanian questionnaire survey within the context of public health issues and d) a workshop for elaborating practical solutions for the optimisation of DD processes in Tanzania. Data were collected from January 2000 to October 2002. Tanzania has to bridge a 30% gap in drug supply. This study found that the acceptance of DDs to fill this gap was high. Stakeholders within the country understood that donated drugs were necessary because, due to poverty, drugs were either unavailable or not affordable. The prime concern of DD recipients was the discrepancy between their needs and the donors’ supply. DDs did not cover recipients' priority needs and their quantity was insufficient for sustainable treatment of patients. DDs given from a surplus, as gifts from individuals or as single-source DDs were perceived as problematic. However, DDs provided within the framework of DD programmes with a known public health effect were welcomed. Tanzania benefits from many such programmes. Tanzania has developed the instruments for an effective regulation of DD processes: national guidelines for drug donations and a national essential drug list. The existence of these tools, however, has not guaranteed their application. The failure to implement the guidelines for DDs was perceived as being the second most important problem in the Tanzanian DD process. Knowledge of the value of DDs is prerequisite for judging the economic impact of DDs on the drug supply, but only 27% of recipients were able to estimate the value of donated drugs. Stakeholders pointed out, however, that estimating drug value is difficult when the drugs do not conform to accepted quality standards. This finding demonstrates the need for improved data registration, collection and dissemination within Tanzania. With respect to value, for these stakeholders, DD-related transaction costs must also be taken into consideration. Depending on the form of their involvement, recipients identified additional drawbacks associated with DDs, the focus being on structures and processes. The public sector requested more transparency in DD processes, the lack of transparency arising from weaknesses in public structures as well as a lack of information and accountability. Non-governmental organisations (NGOs) and religious facilities with better developed structures addressed problems such as shipment fees and insufficient infrastructure and training. These differences call for more collaboration between the private and public sectors and suggest that they could learn from each other, as recommended in the Tanzanian Health Sector Reform. Communication is crucial in the eyes of stakeholders, but was not optimal, whether between donors and recipients or among recipients themselves. An important complaint was that donors did not ask what was needed in advance and supported a supply-driven donation process. Tanzanian recipients and Swiss donors coincided in the view that the absence of sustainability and nonrelevance of donated drugs for local needs were the major problems in DD processes. Knowledge about donors’ needs was low among Swiss donor organisations. Only one-third of Swiss stakeholders knew the WHO guidelines for DDs. Both the Swiss and the Tanzanian stakeholders rated the quality of DDs as a problem of minor importance. However, donated drugs often did not comply with requested standards, even less so in Switzerland than in Tanzania. Because this study reflects the situation in 2001, directly after NGOs and PVOs stopped collecting unused drugs in Switzerland, donors in the for-profit sector did not understand that unused drugs should no longer be donated and failed to recognise that these drugs can burden a recipient. In the eyes of Tanzanian stakeholders unused DDs are obsolete. Suggestions of Tanzanian stakeholders to optimise DD processes were consistent with the core principles of the WHO guidelines for DDs: a) meeting local needs (maximum benefit for the recipients), b) participatory approach (respecting the wishes of the recipient), c) optimised DD quality (no double standard in quality) and d) effective communication between donor and recipient. The findings of this project contribute to a comprehensive understanding of DD processes in Tanzania. They show that the performance of a health system has a major impact on the quality of DD processes. Recipients in DD processes need the support that should be provided by the Tanzanian heath sector reform plans, which include continuing education of health workers and a better defined responsibility in the pharmaceutical sector to overcome problems with the structure and management of DD processes. In addition to improved implementation of DD guidelines by both donors and recipients, the main proposals arising from this project are the following: Donors should actively communicate with recipients and thereby promote a demand-driven DD process that respects Tanzanian regulations. Recipients on the other hand should a) translate the guidelines for DDs into Swahili, b) assure systematic collection of data, c) strengthen the collaboration between the public and the private sectors and d) establish an autonomous, centralised body for coordination of DDs. These findings also call for further research, which might study in more depth drug donations given within the framework of programmes, explore the means for better implementation of guidelines for DDs and investigate the mechanisms of communication between donors and recipients together with how these might be improved.

Item Type: Thesis (Doctoral)
Keywords: Drug, Health Care, Poverty, Malaria,Tuberculosis, HIV/AIDS, Tanzania
Subjects: Health Systems > Drugs, Medical Supplies & Logistics
Divisions: Other
Depositing User: Mr Joseph Madata
Date Deposited: 14 Feb 2013 07:14
Last Modified: 14 Feb 2013 07:14
URI: http://ihi.eprints.org/id/eprint/1130

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