Mbwasi Final Editin2

8/4/2019 Mbwasi Final Editin2

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ABBREVIATIONS

WHO World Health Organisation

UNICEF United Nations Children’s Fund

CMS Central Medical Store

MSD Medical Store Departments

DMO District Medical Officer

MOHSW Ministry of Health and Social Welfare

RCHCO Reproductive Child Health Coordicator

PHF Primary Health Facilities

FBO Faith-Base Organization

NGO Nongovernmental Organization

TFDA Tanzania Food and Drug Authority

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1.0 INTRODUCTION.

2.0 Pharmaceutical procurement in Tanzania

1.1 Definition

Procurement is the process of obtaining/acquiring supplies and services and can

achieved through purchase (buy), manufacture in-house (from available

materials), receive donation (in kinds), agencies WHO, UNICEF or bilateral aid

program also this may occurs in cycles, as long as need persists to consume the

supplies and services

Pharmaceutical procurement is particularly prone to poor governance, as it

entails complex process, which involves several stakeholders including

government ministries, manufactures, hospitals, and other distributors. When

pharmaceutical procurement and supply chain systems work effectively they offer

high levels of quality cost effectiveness, product availability, transparency,

accountability and value for money in the use of public funds.

2.0 PHARMACEUTICAL PROCUREMENT IN TANZANIA.

Pharmaceutical procurement process in Tanzania may occur at different service

level (Central Medical Store, Health faculties, Private pharmacy, distributors etc)

so at each level may use different types of procurement depend upon on thepolicy system exist. All pharmaceutical procurement method at any lever of the

health system fall into one of the basic categories: Open tender, restricted

tender, competitive negotiation and direct procurement. How ever each of these

methods can be used with any of the standard purchasing models – annual,

scheduled, or perpetual review.

2.1 CENTRAL MEDICAL STORE

At the Central Medical Store procurement of essential medicines and all other

category of product are procured by the MSD Tender Board. The tender board

membership is comprised of people with different qualifications including,

Pharmacists, Financial expert, Material Management staff and Logisticians. So

this may result into the central buying unit manages the purchase on behalf of

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member. Most essential medicines and supplies stocked at MSD are procured by

tender through International Competitive Bidding (commonly used), National

competitive bidding, Negotiated tender, selective bidding, direct procurement and

shopping. So the Central Medical Store has the duties of to procure and

distribute to all health facilities in Tanzania.

2.2 PUBLIC HEALTH FACILITIES

Those public health facilities draw their requirements from MSD either through

their respective funds deposited at a MSD direct by MOHSW or by direct

purchase using their own funds from other sources including government basket

funds. Those who participate in procurements are Supplier officer, Pharmacist or

RCH coordinator, Clinical officer, head of facility depending on the facility in

question.

2.3 HOSPITALS:

The ordering mechanism for essential drugs is as follows:

Hospital and DMO’s procure directly from the MSD on a cash and carry basis.

This is undertaken by entering a zonal store and procuring items in stock based

on their amount on their account or cash on hand.

So kits are planned on annual basis together with MOHSW are procured anddistributed according to this plan

2.4 HEALH CENTRES AND DISPENSARY

Indent and ILS orders are in Principle the same, where Primary Health Facility fill

in an individual order (R & R) report and request which have a list of all essential

medicines according to health facilities level, (Form 2A, Form 2B and 2C) this is

for dispensary, health center and Hospital respectively and send to DMO who

channel it to MSD where it is packed individually and shipped to the DMO with

PHF name on the box. It is then transported to the PHF by the DMO. This was

done on quarterly basis

But now MSD try doing a PILOT study of direct delivery services to the Health

Facilities

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INFORMATION (ORDERS) AND SUPPLIES FLOW DIAGRAM

2.5 Vertical programme:

Procurement of vertical programme drugs is carried out partly by MSD and partly

by external procurement agents like Crown Agents and UNICEF that is are

procured only under special request by the respective programme. So the

MOHSW and programs mobilize enough funds from the government or

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via MSD

vehicle

MSD

Central and Zonal

Stores

Government

Dispensaries and

Health Centers

District

via district

vehicle

via MSD or hospital

vehicle

Dispensaries &

Health Centers:

Serve clients

Prepare orders

Collect local funds

Hospitals :

Serve clients

Prepare hospital

orders and funding

MSD Central/Zonal:

Procure

Store

Distribute

Role

MOH Programme

Managers

MOH Central:

Forecast needs

Allocate central funds

Supervise

CLIENTS

Hospitals

(Government/FBO/

NGO)

Flow of supplies

Flow of orders

NGO

Dispensaries and

Health Centers

via district or NGO

vehicle

Districts:

Review & approve

dispensary and health

center orders

Allocate local funds

Deliver to facilities

Store supplies in

transit



development partners or both and deposit the same to MSD which in turn

advertise tender,

All vertical programme under the MOHSW in Tanzania use MSD for storage and

distribution of their Items. The MSD utilizes the same storage and distribution

network for vertical programme items as is used for essential drugs that is its IT

system, personnel, warehouse, trucks, etc,

So it was the duty of programme manager or district coordinator to fill all the

order report (R&R) and submit them to MSD for processing.

2.6 Private supplier:

Private wholesalers operate under the simple mechanism of procuring items and

selling them with mark up covering the cost of the operation as well as profit. The

prices of private wholesale are not regulated by the government but the selection

of medicines is limited to drugs registered under the TFDA.

So some health facilities, procure medicines and supplies from private

pharmaceutical wholesalers and private pharmacies. This happen after the items

were being out of stock from MSD, so can be procured through quotation basis

or vendor systems depend on which system exists at that level.

2.7 Agencies / Donation:

Also sometime hospitals, health centers and dispensary may get assistance of

pharmaceutical products from the donors or Agencies such as WHO and

UNICEF. But this assistance of pharmaceutical products should comply with the

list of National Essential Drugs according to the level of services and Standard

Treatment Guideline.

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3.0 OBJECTIVES OF GOOD PROCUREMENT PRACTICE

The following are main objectives in a good procurement practice system:

To procure the right drugs in the right quantities at the lowest possible

total cost. This may help to reduce the occurrence of drug resistance and

the over stock of the products

In a decision making process it is required to select reliable suppliers of

quality products. Supplier should be flexible and able to provide service

and satisfy the need of the customer.

Also to ensure timely delivery and notification. Supplier should be able to

delivery the service on time and according to the planned schedule and

contract made. This may increase the sustainability of pharmaceutical

product

3.1 PHARMACEUTICAL PROCUREMENT PRACTICE

The following are examples of process should be involved in good procurement

practice:

Generic name:

Always we use generic names (International Non-Proprietary name, INN) for

fair competition. So we need to specify Quality Standards, not specific

brands, for drugs with bioavailability problems. Since this emphasize the

NEED to reduce cost via generic purchase. Examples of generic names: use

metronidazole instead of Flagyl, etc.

Limited to essential medicines list or formulary list:

This can be done by Select Safe, Effective, Cost-effective drugs. Since we

can’t buy everything in a real situation. Also when required, we should use

formal approval procedures for procurement of non-listed medicines. This list

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can prepare at International, National, Hospital level depending on the needs,

want and demand at that level.

Bulk purchases:

Concentrate purchases on limited List of items to increase quantities and

hence reduce price. In addition the commitment to award a single contract for

the entire volume of each item raises the supplier’s interest in bidding and

provides an incentive for them to offer competitive prices.

Formal supplier qualification and monitoring.

Use formal supplier qualification based on medicine quality, service reliability,

and financial viability. This may help to the service to be standard and

smooth oriented with minimal resistance Approve suppliers before tendering

(Prequalification) or after (Post qualification) this may be done by using a

formal Monitoring System to Ensure continued supplier qualification.

Competitive bidding process.

Also there is need to use Competitive bidding on all but very small or

Emergency purchases to obtain the best prices. In Restrictive tender, only

prequalified suppliers should be allowed to compete. In Open tenders,

suppliers must be evaluated after submission of bids.

Commitment to a sole source:

To procure all contracted medicines only from winning suppliers. We are not

required to enter into any separate deals with non-contracted suppliers. If you

do so it may reach a point they will sell to us at high price or susceptible to

influence by special interest.

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4.0 EFFICIENT AND TRANSPARENCY PHARMACEUTICAL PROCUREMENT.

4.1 Separation of key function:

It may happen in our system whereby all duties of procurement of

pharmaceutical material were done by one person or one office. These duties

such as product selection, forecasting, product specification, pre-selection of

suppliers and adjudication of tenders etc all these were done by one individual

person or office.

In most of public sector context the reality is that all function of the drug

procurement process are entirely in the hand of one office or official. So without

appropriate separation of function and authority the procurement process is

much more susceptible to influence by special interest. This may result into

procurement personnel may be able to bias drug selection, manipulate orders to

increase the quantities, prejudice supplier qualification decisions, manipulate the

final award tender and slant product specification to limit competition.

Separations of key functions contribute to professionalism accountability and

efficient procurement system.

4.2 Following written procedures and should be well plan and monitor.

Most of our health facilities in public or private sectors their systems at work

place not well computerize or organized. This result into a system being not able

to retrieve all data at a right time and if we got them will be not completed and not

well organized during planning process. So it was advisable to have a

procurement and supply management activities that are well planned and

performance to be monitored regularly.

4.3 Regular reporting on procurement performance.

Health facilities now days they don’t have good and sufficient reporting system.

Most of the activities done through the basket fund or their own source of fund

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not well reported at a right time or not reported completely. The procurement

office should be required to report regularly on key procurement performance

indicators. The organization should make sure that efficient and reliable

information management system should be in place this may help to track the

flow of product in the system.

4.4 Annual audit with published results

.Finally it is required even once a year the procurement department be audited

by internal or external auditor and audit report issued. The aim of auditing was to

see if all necessary process/steps were followed and documented accordingly.

The auditors were required to issue a detailed Letter of Comment to the

management of the organization and to the appropriate public supervisory body.

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5.0 Conclusion and recommendation

Effective procurement is collaborative process between the procurement office,

with requirements for trained staff and appropriate management systems, and

technical and policy committees, which make final decisions as to which drugs to

buy, in what quantities, and from which suppliers.

Also the moves towards reducing donor on direct funding to budget support to

the government need to be addressed. Training of in forecasting and

quantification for essential drugs, HIV/AIDS related commodities is a priority

together with proper inventory management leading to availability and accuracy

of raw data.

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6.0 Reference:

1. Class review notes/handouts

2. http://www.who.int/medicines/areas/coordination/tanzania_mapping_suppl

y.pdf

3. http://hdptz.esealtd.com/fileadmin/documents/Key_Sector_Documents/Ta

nzania_Key_Health_Documents/Tanzania_Drug_tracking_study_final_rep

ort.pdf

4. Management Science for health. Managing drug supply; the selection,

procurement, distribution and use of Pharmaceuticals. Kumarian Press,

199, Second edition, revised and expanded.

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http://www.who.int/medicines/areas/coordination/tanzania_mapping_supply.pdf



http://hdptz.esealtd.com/fileadmin/documents/Key_Sector_Documents/Tanzania_Key_Health_Documents/Tanzania_Drug_tracking_study_final_report.pdf








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