The Medical Stores Department
The Medical Stores Department, known as MSD, has a near monopoly on the national medical supply chain for Tanzania’s public facilities, which account for 60% of all health facilities nationwide. The medicines and supplies used in those public facilities are purchased with government funding that is deposited directly into MSD accounts, which then procures drugs through the Public Procurement Act of 2004. This act, though introducing an additional layer of regulation and sometimes long lead times, enables MSD to procure quality drugs at favorable prices compared to market prices.1 In addition, MSD provides supplies to private facilities and large international donor programs. There are approximately 5,000 health centers and facilities in Tanzania divided into nine MSD zones and approximately 131 districts (see map). The purchasing power and national reach of MSD make it a desired partner for non-government entities 2
Funding given to MSD for the purchase of medicines from the government and donors has increased significantly over the past ten years, both for essential medicines used in primary health care and also vertical medicines to treat specific diseases, such as HIV/AIDS. Many projects support MSD and the medical supply chain system, including a $14 million warehouse project by The Global Fund and an additional $9.5 million from USAID to increase the capacity and quality of MSD storage areas.
Unfortunately, data on the actual procurement and delivery of medicines and medical supplies down the supply chain in Tanzania are unreliable and difficult to collect. In addition, Tanzania must comply with multiple reporting requirements by donors (as shown in figure illustrating Financing and Supply Routes in Tanzania). The result has been frequent public disputes in Tanzania and among members of the international donor community about whether donated funds and medical supplies reach the intended communities. In June 2010, the Global Fund released a report saying that MSD lacked transparency and accountability. In addition, in July 2011, the MSD was publicly attacked by the local newspapers and the general assembly for corruption.
Although private facilities and vertical programs that focus on single diseases, such as TB and HIV/AIDS can often purchase supplies from other sources, shortages at MSD cause nationwide stock outs in government primary health facilities and in the public medical supply chain. The average national fill rate for orders from primary health facilities is only 60-65%, meaning that 35-40% of orders are not filled, leading to stock outs. Reasons for the stock outs are numerous and involve organizations and actors outside of MSD, including the following:
- Inadequate budget allocations to health facilities
- Delays in distribution of allocated funds
- Delay in delivery to facilities
- Inaccurate forecasting at the facility and national level
- Theft of medications at all levels
- Stock-outs at the national warehouse run by MSD
- Malfunctioning back order system for unfilled items
Twenty to thirty percent stock out rates at government facilities 3mean that patients either go without needed medical supplies, or must purchase them at a much higher cost from private pharmacies. This creates barriers to delivery of health services. For those supply chain issues within MSD's control (e.g. not problems with government budgeting or allocation of funds), lack of management capacity is repeatedly cited as a root cause. Although several changes have been made to address these problems, stock outs at health facilities and at MSD continue to pose a serious obstacle to improving health services in Tanzania.
- 1. Euro Health Group and MSH Tanzania. August 2007. Republic of Tanzania Drug Tracking Study, Final Report. http://hdptz.esealtd.com/fileadmin/documents/Key_Sector_Documents/Tanzania_Key_Health_Documents/Tanzania_Drug_tracking_study_final_report.pdf.
- 2. . Ministry of Health and Social Welfare. Mapping of partners and financial flows in the medicines supply system in Tanzania. 2008. http://apps.who.int/medicinedocs/documents/s16504e/s16504e.pdf
- 3. Center for Pharmaceutical Management. 2008. Accredited Drug Dispensing Outlets in Tanzania Strategies for Enhancing Access to Medicines Program. Prepared for the Strategies for Enhancing Access to Medicines Program. Arlington, VA: Management Sciences for Health. https://www.wbginvestmentclimate.org/toolkits/public-policy-toolkit/upload/Accredited-Drug-Dispensing-Outlets-in-Tanzania.pdf
Audit Report on Global Fund Grants to Tanzania by the Office of the Inspector General, issued June 10, 2009, documents weaknesses in Tanzania's supply chain.
View MSD's Organizational Structure and current projects.
The Medicines and Medical Supplies Availability Report by Sikika (May, 2011) describes MSD performance.
Tanzania: MSD Attacked Over Shoddy Performance by The Citizen. Published July 11, 2011. Read the article accusing MSD of poor performance.
Tanzania: Complete Overhaul Awaits MSD to Enhance Efficiency by The Citizen. Published July 13, 2011. Read the article focusing on direct delivery to improve MSD problems.