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Transformation of the Tanzania Medical Store Department through Global Fund support: lessons learned from the field

By Patrick Githendu, Linden Morrison, Sai Pothapregada, Rafiu Idris, Sarah Asiimwe, Tatjana Peterson, Abaleng Lesego, Neema Mwale, Rosemary Silaa, Emma Davidson, Sako Mwakalobo, Laurean Bwanakunu, Tom Achoki

Posted 17 Apr 2020
medRxiv DOI: 10.1101/2020.04.14.20065813

Background: The Tanzania government sought support from The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) to reform its Medical Stores Department (MSD), with the aim of improving performance. Our study aimed to assess the impact of the reforms and document the lessons learned. Methods: We applied quantitative and qualitative research methods to assess the impact of the reforms. The quantitative part entailed a review of operational and financial data covering the period before and after the implementation of the reforms. We applied interrupted time series analysis to determine the change in average availability of essential health commodities at health zones. Qualitative data was collected through 41 key informant interviews. Participants were identified through stakeholder mapping, purposive and snowballing sampling techniques, and responses were analyzed through thematic content analysis. Results: Availability of essential health commodities increased significantly by 12.6% (95%CI, 9.6-15.6), after the reforms and continued to increase on a monthly basis by 0.2% (95%CI, 0.0-0.3) relative to the preintervention trend. Sales increased by 56.6% while the cost of goods sold increased by 88.6% between 2014/15 and 2017/18. Surplus income increased by 56.4% between 2014/15 and 2017/18, with reductions in rent and fuel expenditure. There was consensus among participants that the reforms, were instrumental in improving performance of MSD. Conclusion: Many positive results were realized through the reforms at MSD. However, despite the progress, there were risks such as the increasing government receivable that could jeopardize the gains. Multi-stakeholder efforts are necessary, to sustain the progress and expand public health.

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