Acceptability of a Prime Vendor System in Public Healthcare Facilities in Tanzania

Document Type : Original Article


1 Ifakara Health Institute, Dar es Salaam, Tanzania

2 Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland

3 University of Basel, Basel, Switzerland

4 School of Public Health and Social Sciences (SPHSS), The Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania

5 Health Promotion and System Strengthening (HPSS) Project, Dodoma, Tanzania


Pharmaceutical supply chain management in low- and middle-income countries has received substantial attention to address the shortage of medicines at peripheral facilities. The focus has been on health system interventions, including the establishment of public-private partnerships (PPPs). In 2014, the United Republic of Tanzania began implementing the Jazia prime vendor system (Jazia PVS) with a contracted private wholesale supplier to complement the national medicines supply chain in public facilities. Few studies have investigated the acceptability of such a prime vendor system. This study analyses factors that contributed to the acceptability of Jazia PVS introduced in Tanzania. We used qualitative analytical methods to study experiences of Jazia PVS implementers in 4 districts in mid-2018.
Data were drawn from 14 focus group discussions (FGDs), 7 group discussions (GDs) and 30 in-depth interviews (IDIs) with a range of actors involved in Jazia PVS. The study analysed 7 acceptability dimensions as defined in the acceptability framework by Sekhon et al. Framework analysis was adopted to summarise the results using a deductive and an inductive approach.
The findings show that participants’ acceptability of Jazia PVS was influenced by the increased availability of essential medicines at the facilities, higher order fulfilment rates, and timely delivery of the consignment. Furthermore, acceptability was also influenced by the good reputation of the prime vendor, close collaboration with district managers, and participants’ understanding that the prime vendor was meant to complement the existing supply chain. Intervention coherence, experienced opportunity cost and intervention burden, affective attitude and self-efficacy were also important in explaining the acceptability of the Jazia PVS.
In conclusion, the most critical factor contributing to the acceptability of the Jazia PVS was the perceived effectiveness of the system in achieving its intended purpose. Districts purchasing directly from the prime vendor have a policy based on the possibility to increase availability of essential medicines at peripheral facilities in a low income setting; however, it is crucial to select a reputable and competent vendor, as well as to abide by the contractual agreements.



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  1. Pastakia S, Njuguna B, Tran DN. Problems and Obstacles of Poorest Countries in Having Good Governance and Quality and Effective Pharmaceutical Policy. In: Ibrahim MIM, Wertheimer AI, Babar ZU, eds. Social and Administrative Aspects of Pharmacy in Low- and Middle-Income Countries. Academic Press; 2018:387-401. doi:10.1016/B978-0-12-811228-1.00023-6
  2. Wirtz VJ, Hogerzeil HV, Gray AL, et al. Essential medicines for universal health coverage. Lancet. 2017;389(10067):403-476. doi:10.1016/s0140-6736(16)31599-9
  3. Bigdeli M, Laing R, Tomson G, Babar ZU. Medicines and universal health coverage: challenges and opportunities. J Pharm Policy Pract. 2015;8(1):8. doi:10.1186/s40545-015-0028-4
  4. Vledder M, Friedman J, Sjöblom M, Brown T, Yadav P. Improving supply chain for essential drugs in low-income countries: results from a large scale randomized experiment in Zambia. Health Syst Reform. 2019;5(2):158-177. doi:10.1080/23288604.2019.1596050
  5. El Mokrini A, Benabbou L, Berrado A. Multi-criteria distribution network redesign - case of the public sector pharmaceutical supply chain in Morocco. Supply Chain Forum: An International Journal. 2018;19(1):42-54. doi:10.1080/16258312.2018.1433436
  6. Yadav P. Health product supply chains in developing countries: diagnosis of the root causes of underperformance and an agenda for reform. Health Syst Reform. 2015;1(2):142-154. doi:10.4161/23288604.2014.968005
  7. Kumar A, Ozdamar L, Ning Zhang C. Supply chain redesign in the healthcare industry of Singapore. Supply Chain Management: An International Journal. 2008;13(2):95-103. doi:10.1108/13598540810860930
  8. Wande DP, Sangeda RZ, Tibalinda P, et al. Pharmaceuticals imports in Tanzania: overview of private sector market size, share, growth and projected trends to 2021. PLoS One. 2019;14(8):e0220701. doi:10.1371/journal.pone.0220701
  9. Bastani P, Doshmangir L, Samadbeik M, Dinarvand R. Requirements and Incentives for Implementation of Pharmaceutical Strategic Purchasing in Iranian Health System: A Qualitative Study. Glob J Health Sci. 2017;9(1):163-170. doi:10.5539/gjhs.v9n1p163
  10. Lee B, Dutta A, Lyimo H.  . Washington, DC: Palladium, Health Policy Plus; 2016.
  11. Konduri N, Rauscher M, Wang SJ, Malpica-Llanos T. Individual capacity-building approaches in a global pharmaceutical systems strengthening program: a selected review. J Pharm Policy Pract. 2017;10:16. doi:10.1186/s40545-017-0104-z
  12. Leung NH, Chen A, Yadav P, Gallien J. The impact of inventory management on stock-outs of essential drugs in Sub-Saharan Africa: secondary analysis of a field experiment in Zambia. PLoS One. 2016;11(5):e0156026. doi:10.1371/journal.pone.0156026
  13. Seidman G, Atun R. Do changes to supply chains and procurement processes yield cost savings and improve availability of pharmaceuticals, vaccines or health products? a systematic review of evidence from low-income and middle-income countries. BMJ Glob Health. 2017;2(2):e000243. doi:10.1136/bmjgh-2016-000243
  14. Kokilam MB, Joshi HG, Kamath VG. Strengthening the pharmaceutical supply chain management with information communication technology intervention: a windfall to the Indian Rural Public Healthcare System. J Health Manag. 2016;18(2):274-289. doi:10.1177/0972063416637719
  15. Shieshia M, Noel M, Andersson S, et al. Strengthening community health supply chain performance through an integrated approach: using mHealth technology and multilevel teams in Malawi. J Glob Health. 2014;4(2):020406. doi:10.7189/jogh.04.020406
  16. Fadlallah R, El-Jardali F, Annan F, Azzam H, Akl EA. Strategies and systems-level interventions to combat or prevent drug counterfeiting: a systematic review of evidence beyond effectiveness. Pharmaceut Med. 2016;30(5):263-276. doi:10.1007/s40290-016-0156-4
  17. Matowe L, Waako P, Adome RO, Kibwage I, Minzi O, Bienvenu E. A strategy to improve skills in pharmaceutical supply management in East Africa: the regional technical resource collaboration for pharmaceutical management. Hum Resour Health. 2008;6:30. doi:10.1186/1478-4491-6-30
  18. Wiedenmayer K, Mbwasi R, Mfuko W, et al. Jazia prime vendor system- a public-private partnership to improve medicine availability in Tanzania: from pilot to scale. J Pharm Policy Pract. 2019;12:4. doi:10.1186/s40545-019-0163-4
  19. Manji I, Manyara SM, Jakait B, et al. The revolving fund pharmacy model: backing up the Ministry of Health supply chain in western Kenya. Int J Pharm Pract. 2016;24(5):358-366. doi:10.1111/ijpp.12254
  20. Arney L, Yadav P, Miller R, Wilkerson T. Strategic contracting practices to improve procurement of health commodities. Glob Health Sci Pract. 2014;2(3):295-306. doi:10.9745/ghsp-d-14-00068
  21. Patterson AA, Pierce RA, 2nd, Powell AP. Prime vendor purchasing of pharmaceuticals in the Veterans Affairs health care system. Am J Health Syst Pharm. 1995;52(17):1886-1889. doi:10.1093/ajhp/52.17.1886
  22. Sekhon M, Cartwright M, Francis JJ. Acceptability of health care interventions: a theoretical framework and proposed research agenda. Br J Health Psychol. 2018;23(3):519-531. doi:10.1111/bjhp.12295
  23. Sekhon M, Cartwright M, Francis JJ. Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework. BMC Health Serv Res. 2017;17(1):88. doi:10.1186/s12913-017-2031-8
  24. Diepeveen S, Ling T, Suhrcke M, Roland M, Marteau TM. Public acceptability of government intervention to change health-related behaviours: a systematic review and narrative synthesis. BMC Public Health. 2013;13:756. doi:10.1186/1471-2458-13-756
  25. Bos C, Van der Lans IA, Van Rijnsoever FJ, Van Trijp HC. Understanding consumer acceptance of intervention strategies for healthy food choices: a qualitative study. BMC Public Health. 2013;13:1073. doi:10.1186/1471-2458-13-1073
  26. Borrelli B, Sepinwall D, Ernst D, et al. A new tool to assess treatment fidelity and evaluation of treatment fidelity across 10 years of health behavior research. J Consult Clin Psychol. 2005;73(5):852-860. doi:10.1037/0022-006x.73.5.852
  27. Bigdeli M, Jacobs B, Tomson G, et al. Access to medicines from a health system perspective. Health Policy Plan. 2013;28(7):692-704. doi:10.1093/heapol/czs108
  28. Guillermet E, Dicko HM, Mai le TP, et al. Acceptability and feasibility of delivering pentavalent vaccines in a compact, prefilled, autodisable device in Vietnam and Senegal. PLoS One. 2015;10(7):e0132292. doi:10.1371/journal.pone.0132292
  29. Glenton C, Khanna R, Morgan C, Nilsen ES. The effects, safety and acceptability of compact, pre-filled, autodisable injection devices when delivered by lay health workers. Trop Med Int Health. 2013;18(8):1002-1016. doi:10.1111/tmi.12126
  30. 30.   Yale. The Medical Stores Department: An Innovative Public-Private Partnership: Medical Supply Solutions in Tanzania. Accessed June 2020.
  31. HPSS. Complementing the medicines supply gap with a regional Prime Vendor system in Dodoma Region. HPSS; 2014.
  32. HPSS. News and Announcements: launch of a new regional prime vendor system for supplementary medicines and supplies in Dodoma region. Accessed November 30, 2016.
  33. Kuwawenaruwa A, Tediosi F, Obrist B, et al. The role of accountability in the performance of Jazia prime vendor system in Tanzania. J Pharm Policy Pract. 2020;13:25. doi:10.1186/s40545-020-00220-8
  34. Penchansky R, Thomas JW. The concept of access: definition and relationship to consumer satisfaction. Med Care. 1981;19(2):127-140. doi:10.1097/00005650-198102000-00001
  35. Bowen DJ, Kreuter M, Spring B, et al. How we design feasibility studies. Am J Prev Med. 2009;36(5):452-457. doi:10.1016/j.amepre.2009.02.002
  36. Abun D, Magallanes T, Incarnacion M. College students’ cognitive and affective attitude toward higher education and their academic engagement. International Journal of English Literature and Social Sciences. 2019;4(5):1494-1507. doi:10.22161/ijels.45.38
  37. Bandura A. Self-Efficacy: The Exercise of Control. New York, NY: W H Freeman; 1997.
  38. van der Meer HG, Wouters H, Teichert M, et al. Feasibility, acceptability and potential effectiveness of an information technology-based, pharmacist-led intervention to prevent an increase in anticholinergic and sedative load among older community-dwelling individuals. Ther Adv Drug Saf. 2019;10:2042098618805881. doi:10.1177/2042098618805881
  39. Al-Taee MA, Kapoor R, Garrett C, Choudhary P. Acceptability of robot assistant in management of type 1 diabetes in children. Diabetes Technol Ther. 2016;18(9):551-554. doi:10.1089/dia.2015.0428
  40. Murphy AL, Gardner DM. Pharmacists' acceptability of a men's mental health promotion program using the Theoretical Framework of Acceptability. AIMS Public Health. 2019;6(2):195-208. doi:10.3934/publichealth.2019.2.195
  41. Mukunya D, Haaland MES, Tumwine JK, et al. "We shall count it as a part of kyogero": acceptability and considerations for scale up of single dose chlorhexidine for umbilical cord care in Central Uganda. BMC Pregnancy Childbirth. 2018;18(1):476. doi:10.1186/s12884-018-2116-3
  42. Strait A, Velasquez A, Handley MA, et al. Acceptability of a multilevel intervention to improve blood pressure control among patients with chronic kidney disease in a public health care delivery system. Clin Kidney J. 2018;11(4):540-548. doi:10.1093/ckj/sfx141
  43. Sekhon M, Cartwright M, Francis J. Application of a theoretical framework to assess intervention acceptability: a semi –structured interview study. Presented at: EHPS/DHP; 2016; Aberdeen. doi:10.13140/RG.2.2.13207.98727
  44. Strauss A, Corbin J. Open coding. In: Strauss A, Corbin J, eds.Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. 2nd ed. Thousand Oaks CA: Sage Sage; 1990:101–121.
  45. Gale NK, Heath G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol. 2013;13:117. doi:10.1186/1471-2288-13-117
  46. Bradley EH, Curry LA, Devers KJ. Qualitative data analysis for health services research: developing taxonomy, themes, and theory. Health Serv Res. 2007;42(4):1758-1772. doi:10.1111/j.1475-6773.2006.00684.x
  47. Carter N, Bryant-Lukosius D, DiCenso A, Blythe J, Neville AJ. The use of triangulation in qualitative research. Oncol Nurs Forum. 2014;41(5):545-547. doi:10.1188/14.onf.545-547
  48. Salkind NJ. Encyclopedia of Research Design. Los Angeles: SAGE/Reference; 2010.
  49. Heath L. Triangulation: Methodology. In: Smelser NJ, Baltes PB, eds. International Encyclopedia of the Social & Behavioral Sciences. Oxford: Pergamon; 2001:15901-15906.
  50. Velásquez G, Madrid Y, Quick J. Health Reform and Drug Financing. Selected Topics - Health Economics and Drugs Series, No. 006.  Accessed March 5, 2020. Published 1998.
  51. Management Sciences for Health (MSH). MDS-3: Managing Access to Medicines and Health Technologies. Arlington, VA: MSH; 2012.
  52. Waning B, Kaplan W, King AC, Lawrence DA, Leufkens HG, Fox MP. Global strategies to reduce the price of antiretroviral medicines: evidence from transactional databases. Bull World Health Organ. 2009;87(7):520-528. doi:10.2471/blt.08.058925
  53. Banda M, Ombaka E, Logez S, Everard M. Multi-Country Study of Medicine Supply and Distribution Activities of Faith-Based Organizations in Sub-Saharan African Countries. Geneva, Switzerland; Nairobi, Kenya.  Department of Medicines Policy and Standards World Health Organization, Ecumenical Pharmaceutical Network; 2006.
  54. WHO. Essential Drugs Monitor: Good Drugs at Low Cost: Thailand’s Provincial Collective Bargaining System for Drug Procurement. Geneva: WHO; 1998.
  55. Kim SW, Skordis-Worrall J. Can voluntary pooled procurement reduce the price of antiretroviral drugs? a case study of Efavirenz. Health Policy Plan. 2017;32(4):516-526. doi:10.1093/heapol/czw165
  56. World Health Organization, PATH. Optimize: Senegal Report. Seattle: PATH; 2013.
  57. Goodman C, Kachur SP, Abdulla S, Bloland P, Mills A. Drug shop regulation and malaria treatment in Tanzania--why do shops break the rules, and does it matter? Health Policy Plan. 2007;22(6):393-403. doi:10.1093/heapol/czm033
  58. Steene-Johannessen J, Anderssen SA, van der Ploeg HP, et al. Are self-report measures able to define individuals as physically active or inactive? Med Sci Sports Exerc. 2016;48(2):235-244. doi:10.1249/mss.0000000000000760
Volume 10, Issue 10
October 2021
Pages 625-637
  • Receive Date: 27 November 2019
  • Revise Date: 01 June 2020
  • Accept Date: 01 June 2020
  • First Publish Date: 01 October 2021