Table 2.
Full list of references with drug availability implications from programmes
| Author and year | Level | Country/region | Intervention | Outcome measure | Results |
|---|---|---|---|---|---|
| Comprehensive drug system policies | |||||
| Chaudhury et al (2005)15 | Subnational | India | Evaluation of a comprehensive drug policy in Delhi which included development of an Essential Drugs List, a centralised pooled procurement system and activities to promote rational drug use | Percentage availability of key drugs (eg, amoxicillin, cloxacillin) before and after implementation of centralised pooled procurement system | Key drug availability increased from 40% to 70% before implementation of system to >90% after implementation |
| Centralised procurement/tendering | |||||
| Tren et al (2009)12 | National | Kenya | Requirement by the Global Fund that Kenya purchase 75% of its annual order for first-line treatment of uncomplicated malaria (ALU) through an international open tender | Availability of ALU after tender process | Owing to tender process, which was delayed and which ended up purchasing drugs from a relatively new and unknown company, Kenya “was experiencing wide stock-outs of ALU and had to place emergency orders with the President's Malaria Initiative” |
| Supply chain management | |||||
| Alayande et al (2016)30 | Subnational | Nigeria | UNFPA-supported programme to increase distribution of contraceptives, which involved bimonthly meetings attended by reproductive health coordinators, family planning providers and representatives from the State health team to review commodity inventory and replenish stock | Annual average rate of contraceptive stock unavailability | Reduction from 30% in 2012 to 24.1% in 2013 |
| Berger et al (2007)31 | Subnational | Haiti | Evaluation of a web-based stock management system for rural clinics | Reduction in stockouts (eg, for ARVs) from initial rollout of system to end of first year | Stockouts reduced from 2.6% to 1.1% (p<0.001) in 1 year |
| Bukhari et al (2010)47 | National | Pakistan | Evaluation of 12 guidelines focused on supply and management of essential medicines during emergencies | Per cent of donated medicine wasted during a disaster | 1.3% wastage per annum in Pakistan, compared to 20–70% in other benchmark disasters |
| Daff et al (2014)32 | Subnational | Senegal | Evaluation of the IPM, which brings deliveries of drugs closer to clients in health facilities | Levels of stockouts for four types of contraceptives: IUDs, implants, injectables and pills | Stockouts for all four types of contraceptives reduced to 0% within 6 months from baseline of 14% for IUDs, 86% for implants, 57% for injectables and 57% for pills |
| Mikkelsen-Lopez et al (2014)11 | Subnational | Tanzania | Evaluation of a transition from a central ‘push’ system for drug delivery to a ‘pull’ ILS | Percentage of unaccounted antihelminthics, antimalarials and ORS before and after system implemented | Unaccounted for antimalarials decreased from 59.8% to 17.8% (p<0.05); unaccounted for antihelmintics decreased from 81.9% to 71.1% (p<0.05); unaccounted for ORS increased from 63.8% to 80.7% (p<0.05) |
| Namisango et al (2016)28 | Subnational | Uganda | mHealth application used to track supply chain and service delivery information | Reduction in emergency orders after implementing the mHealth application | Reduction from five times per quarter to two times per quarter |
| Shieshia et al (2014)29 | Subnational | Malawi | Comparison of an EPT supply chain intervention, which focused on improving product flow and data flow, with an EM intervention, which focused on product flow, data flow and improving the effectiveness of the people by promoting team performance | Mean percentage stockout rate over 18 months for six drugs (cotrimoxazole, LA 1×6, LA 2×6, ORS, paracetamol, and zinc) | EM resulted in lower stockout rates for all six drugs (p<0.001 for all six drugs) |
| Steyn et al (2009)48 | Subnational | South Africa | Comprehensive plan with ‘investments to upgrade the national drug distribution system at all levels of the healthcare system’, with particularly strict requirements to dispense ARV drugs | Availability of essential drugs and supplies for HIV care other than ARV medication (eg, antibiotics and anti-TB medications) | At baseline, 8 of 15 essential HIV care items not available at all facilities, but 2 years after intervention, only 3 of 15 items not available at all facilities |
| Tumwine et al (2010)33 | Subnational | Uganda | Implementation of a ‘pull system’ for ordering drugs at a rural hospital, in which health units had to determine the types and quantities of medicines and medical supplies needed | Median days out of stock for drugs, and average % days out-of-stock for drugs (eg, amoxicillin, diclofenac) | Median out-of-stock days reduced from 94 to 24 (p<0.001); average % out-of-stock days reduced from 15.3% to 3.5% (p<0.001) |
| Other | |||||
| Knippenberg (1997)34 | Subnational | Guinea | Evaluation of the Bamako Initiative—a RDF | Availability of vaccines | Increase from 86% in 1991 to 100% 1 year later |
| Sabot et al (2009)37 | Subnational | Tanzania | Evaluation of impact of subsidy on ex-factory price of ACTs as a pilot to test the AMFm model | Per cent of shops stocking ACTs | Increase from 0% of shops stocking ACTs before pilot to 72.2% of shops stocking ACTs 1 year later (p<0.001) |
| Tougher et al (2012)36 | International | Ghana, Kenya, Madagascar, Niger, Nigeria, Uganda, and Tanzania (and Zanzibar as a separate site) | Evaluation of AMFm pilot, which included price reductions through negotiations on QAACTs, a buyer subsidy, and interventions to support AMFm implementation | Achievement of a benchmark to show an increase of 20 percentage points from baseline to end point in the availability of QAACT among all outlets stocking antimalarial treatment | All eight sites showed an increase in availability of QAACTs, and five of eight sites showed either a statistically significant chance of achieving the benchmark or a definitive demonstration of achieving the benchmark |
| Uzochukwu et al (2002)35 | Subnational | Nigeria | Evaluation of the Bamako Initiative—a RDF | Number of essential drugs available | Average of 35.4 essential drugs available in Bamako Initiative facilities, compared with 15.3 essential drugs in other facilities (p<0.05) |
AMFm, Affordable Medicines Facility-malaria; ARV, antiretroviral treatment; EM, enhanced management; EPT, efficient product transport; ILS, Integrated Logistics System; IPM, Informed Push Distribution Model; QAACTs, quality-assured ACTs; RDF, revolving drug fund.