The study consisted of three parts:
• Research into the involvement in drug distribution of the different WHO/HQ programmes (see Table 1).
• Interviews with international NGOs involved in drug distribution and supply. The NGOs were selected on the basis of their degree of involvement in drug distribution and supply, and their degree of interaction with WHO.
• Country studies of three East and Central African countries. The three countries, Kenya, Malawi and Uganda, were chosen on the basis of three main criteria. Namely, they each have a high level of NGO involvement in drug distribution and supply (i.e. more than 20% of the country's drugs are distributed by NGOs); they differ in size, in terms of both population and land area; and they belong to the same region. By choosing countries from the same region, a foundation for further comparative research into the experiences of collaboration between NGOs, MoHs, and WHO in drug distribution and supply was created.
Qualitative interviews were used to obtain information from WHO/HQ, international NGOs, and stakeholders in drug distribution and supply who were contacted during the country studies (see Annexes 1, 2 and 3 for themes discussed). A snowball approach was used to identify known stakeholders and they provided information that enabled further stakeholders to be identified.
The analysis focused on collaboration between NGOs, MoHs and WHO on distribution from port to district. It might have been logical to have considered the districts, but the purpose of this analysis was more general. The district was therefore seen as a receiver, rather than as an active participant. Moreover, WHO normally orients itself towards MoHs and not NGOs. Collaboration and interaction between MoHs and NGOs at national level is thus relatively undeveloped and very little information is available on collaboration between NGOs, MoH and WHO at district level.
The study concentrated on the supply and distribution aspects of the drug management cycle. Selection, procurement and use were considered only very briefly. For a full discussion of the drug management cycle, see Managing drug supply: the selection, procurement, distribution, and use of pharmaceuticals.2