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(2010; 25 pages)
This paper outlines the flows of private capital that lie behind the growth of the for-profit pharmaceutical sector in Tanzania, and analyzes the policy, access and equity challenges posed by the shift to increasing private sector participation in medicine provision. The study was implemented within the Regional Network for Equity in Health in East and Southern Africa (EQUINET) by the Institute of Development Studies, University of Dar es Salaam, in a regional programme co-ordinated by the Institute for Social and Economic Research, South Africa. The Tanzanian drug policy specifically highlights the government’s intention to ensure that quality, effective essential medicines reach all Tanzanians at an affordable price. Using case study examples, this study explored the concept of access to essential medicines in four dimensions: physical availability, affordability, geographic accessibility, and acceptability (or satisfaction) defined as the fit between users’ and providers’ attitudes and expectations about products and services and the actual characteristics of these products and services (MSH, 2001). Three pharmaceutical companies involved in Public-Private Partnerships (PPPs) were studied — two in Dar es Salaam city (Shelys and Keko) and one in Arusha town (Tanzanian Pharmaceutical Industry (TPI)). Data was also collected from the relevant government ministries, departments, and agencies; and development partners. The study found that the quality of medicines manufactured in Tanzania was often inadequate, with Tanzania’s general manufacturing practices (GMP) being lower than international standards, and with government failing to adequately monitor even those standards. Only two of the eight pharmaceutical manufacturers are meeting the standards — in the case of TPI this is thanks to funding from development partners and in the case of Shelys, it is thanks to foreign direct investment from Aspen Holdings.
While TPI can be considered to be improving access to medicine at an affordable price in Tanzania, a substantial portion of Shelys’ production (41%) is not for local consumption and is exported to other countries. Shelys is also not concerned with producing medicine at affordable prices for Tanzanians, but more interested in profit generation. TPI’s production — focused on antiretroviral, anti-malarials and anti-tuberculosis drug production — is insufficient to ensure an adequate supply and access to all essential medicines for all Tanzanians. Drug stock-outs are common in Tanzanian health facilities, distribution is inadequately monitored, and it is quite possible that medicines intended for free distribution in the public sector are leaking onto the black market. As a result of drug stock-outs at public facilities, many Tanzanians pay out-of pocket to retail pharmacists in order to access medicines, frequently impoverishing themselves further in the process...