Table 4. Summary of literature on presumed benefits of local production of medical products.

Potential Benefit of LP	Country	Analytical Method	Conclusion(s)	Reference
Reliable supply	Tanzania	Survey	In Tanzania, there are several competing supply chains: 1. Delivery chain of mostly ARV and Tuberculosis (TB) medicines from only international firms to facilities treating free at point of use. 2. Supply chain from local firms and Indian importers to public/NGO facilities for out-ofpocket payment. 3. Private market without a controlled supply chain, selling both subsidized imports and local and imported commercial supplies. The ARV/TB supply chain excludes local suppliers. The supply chain for public/NGO facilities tends to encourage local suppliers, and could lead to "...upgrading of local industrial capabilities and employment", although the validity of this assertion was not analyzed.	[40]
Improved quality standards	Seven African countries	Survey/chemical analyses of a pilot study to assess the quality of chloroquine syrup (CQS) or tablets (CQT)	There were quality failures of 56% (27/48) among locally made products, compared to 47.2% (17/36) for foreign products for CQT active ingredient content, and 28% (7/25) versus 13% (3/23) for CQS active ingredient content.	[41]
	Kenya	Cross-sectional laboratory analysis and survey of pharmaceutical companies in Nairobi	Private pharmacies stocked few of the locally manufactured products due to "low doctor and/or patient acceptance." Varying factors contributed to poor availability and acceptability of some locally manufactured products in Kenya.	[42]
Developing innovation capacity	Uganda	Survey; case studies	Ugandan pharmaceutical companies upgraded their technology by a combination of upstream vertical linkages to suppliers, their existing linkages downstream in the chain as importers and retailers of pharmaceuticals for the domestic market, and by the government policies. The Ugandan companies have upgraded by importing finished technologies and knowledge, not by learning production methods. Production is at a low level technologically and has not increased the companies' technological capabilities.	[43]
Developing human capital	Tanzania	Survey of a single company whose staff comprised mainly of Indian and British expatriates	Tanzanian staff was in the minority and that this was "... a major problem." The company would prefer to employ Tanzanian staff, but the competency needed for pharmaceutical production is simply not available in the country. In total the company employs 800 people in Tanzania. The Tanzanian employees are unskilled and work in the packaging area, whereas the Indian and British staff is skilled.	[12]