Figure 5-1. Time taken by MSD and private wholesalers for the processes of procurement and supply of essential drugs.
SOURCE: Euro Health Group, 2007 Private tenders result in shorter delivery times, but also higher prices. The Euro Health Group study concluded that private wholesalers have an easier time maintaining relationships with suppliers and obtaining medications on short notice (Euro Health Group, 2007). Once an order is made, the challenges continue as IT systems are rarely used to monitor supplier performance. Interviews and data analysis suggest that only 50 percent of procured items arrive on time (Euro Health Group, 2007). It is unclear how many procured items reach hospitals and patients, as systems for monitoring and recording stock are weak (Mhamba & Mbirigenda, 2010). Faith-based facilities Faith-based facilities, which comprise of 42 percent of health facilities in the country, have slightly more flexibility. While they, too, have an allocated budget at MSD, they are permitted to contract with private vendors at will. Furthermore, faith-based facilities also have access to MEMS, which supplies medicines that are stocked out and not available at MSD, in addition to drugs that MSD does not carry (Jafary Liana, personal communication, 2013). Private Sector In order to import any medicine, companies must first obtain approval from TFDA. Registration of a new drug involves composition analyses, visits to the manufacturer to assess GMP compliance, quality and toxicology testing, and can take up to two years to complete. Approvals are granted for periods of five years. Renewals are granted within six months of filing an application. In addition, all companies are required to submit an invoice prior to importation to seek approval from TFDA. Once medicines reach a port of entry, samples are inspected using mini lab kits and some medicines are taken to the central laboratory for further testing. Drugs are recalled if they do not adhere to quality checks (Mary Masanja, personal communication, June 1, 2013). As a final step, TFDA also undertakes post marketing surveillance testing. Samples from pharmacies are collected and quality checks are performed. TFDA also monitors adverse drug reactions (TFDA, 2012). There are several problems with the importation of medicines and medical devices, including the submission of fake invoices, the use of unofficial ports of entry for importation, and the false declaration of goods, which prevents proper inspection. To improve this, TFDA is currently evaluating their inspection procedures (TFDA, 2012).
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