Understanding Private Sector Antimalarial Distribution Chains: A Cross-Sectional Mixed Methods Study in Six Malaria-Endemic Countries
Open accessAbstract
BACKGROUND: Private for-profit outlets are important treatment sources for malaria in most endemic countries. However, these outlets constitute only the last link in a chain of businesses that includes manufacturers, importers and wholesalers, all of which influence the availability, price and quality of antimalarials patients can access. We present evidence on the composition, characteristics and operation of these distribution chains and of the businesses that comprise them in six endemic countries (Benin, Cambodia, Democratic Republic of Congo, Nigeria, Uganda and Zambia). METHODS AND FINDINGS: We conducted nationally representative surveys of antimalarial wholesalers during 2009-2010 using an innovative sampling approach that captured registered and unregistered distribution channels, complemented by in-depth interviews with a range of stakeholders. Antimalarial distribution chains were pyramidal in shape, with antimalarials passing through a maximum of 4-6 steps between manufacturer and retailer; however, most likely pass through 2-3 steps. Less efficacious non-artemisinin therapies (e.g. chloroquine) dominated weekly sales volumes among African wholesalers, while volumes for more efficacious artemisinin-based combination therapies (ACTs) were many times smaller. ACT sales predominated only in Cambodia. In all countries, consumer demand was the principal consideration when selecting products to stock. Selling prices and reputation were key considerations regarding supplier choice. Business practices varied across countries, with large differences in the proportions of wholesalers offering credit and delivery services to customers, and the types of distribution models adopted by businesses. Regulatory compliance also varied across countries, particularly with respect to licensing. The proportion of wholesalers possessing any up-to-date licence from national regulators was lowest in Benin and Nigeria, where vendors in traditional markets are important antimalarial supply sources. CONCLUSIONS: The structure and characteristics of antimalarial distribution chains vary across countries; therefore, understanding the wholesalers that comprise them should inform efforts aiming to improve access to quality treatment through the private sector.
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The review identified delay, transportation, and distribution challenges in Nigeria's medicine and vaccine supply chains, including delays in importation, difficulty maintaining delivery vehicles, delays due to inventory report submission, inaccurate inventory reports, vehicle breakdowns, insecurity during vaccine transportation, logistics distance between manufacturer and Nigeria, and inabilityto
“Delays in importation and difficulty in maintaining delivery vehicles. Distribution challenge due to delay in submission of inventory reports and submission of inaccurate inventory reports, insecurity during transportation of vaccines and logistics distance between manufacturer and Nigeria. Inability to monitor and maintain optimum temperatures for vaccines during transportation”
From Medicines and vaccines supply chains challenges in Nigeria: a scoping review (2022) · cites this paper as [25]
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Cites
Djankov, S., La Porta, R., Lopez-de-Silanes, F., & Shleifer, A. (2002) · The Quarterly Journal of Economics · doi:10.1162/003355302753399436 · Cited by 3,993 · see citing works
Qualitative Research in Health Care
(2006) · Wiley eBooks · doi:10.1002/9780470750841 · Cited by 2,713 · see citing works
Pope, C. J., Ziébland, S., & Mays, N. (2006) · Wiley eBooks · doi:10.1002/9780470750841.ch7 · Cited by 431 · see citing works
Combining Qualitative and Quantitative Methods
O’Cathain, A., & Thomas, K. J. (2006) · doi:10.1002/9780470750841.ch9 · Cited by 177 · see citing works
Tougher, S., Ye, Y., Amuasi, J. H., Kourgueni, I. A., Thomson, R., Goodman, C., Mann, A. G., Ren, R., Willey, B. A., Adegoke, C. A., et al. (2012) · The Lancet · doi:10.1016/s0140-6736(12)61732-2 · Cited by 173 · see citing works
Self-citationO’Connell, K. A., Gatakaa, H. W., Poyer, S., Njogu, J. N., Evance, I., Munroe, E., Solomon, T., Goodman, C. A., Hanson, K., ZINSOU, C., et al. (2011) · Malaria Journal · doi:10.1186/1475-2875-10-326 · Cited by 159 · see citing works
Self-citationHanson, K. (1998) · Health Policy and Planning · doi:10.1093/heapol/13.3.195 · Cited by 157 · see citing works
Self-citationLittrell, M., Gatakaa, H., Evance, I., et al. (2011) · Malaria Journal · doi:10.1186/1475-2875-10-327 · Cited by 140 · see citing works
Rutebemberwa, E., Pariyo, G. W., Peterson, S. S., Tomson, G. B., & Källander, K. (2009) · Malaria Journal · doi:10.1186/1475-2875-8-45 · Cited by 138 · see citing works
Sabot, O. J., Mwita, A., Cohen, J. M., Ipuge, Y., Gordon, M., Bishop, D., Odhiambo, M., Ward, L., & Goodman, C. (2009) · PLoS ONE · doi:10.1371/journal.pone.0006857 · Cited by 105 · see citing works
Self-citationChaturvedi, H. K., Mahanta, J., & Pandey, A. (2009) · Malaria Journal · doi:10.1186/1475-2875-8-301 · Cited by 89 · see citing works
Berman, P., & ROSE, L. (1996) · Health Policy and Planning · doi:10.1093/heapol/11.2.142 · Cited by 85 · see citing works
Awor, P., Wamani, H., Bwire, G., et al. (2012) · American Journal of Tropical Medicine and Hygiene · doi:10.4269/ajtmh.2012.11-0791 · Cited by 84 · see citing works
Okeke, T. A., & Okeibunor, J. (2009) · Health Policy · doi:10.1016/j.healthpol.2009.11.005 · Cited by 83 · see citing works
Kangwana, B. P., Kedenge, S. V., Noor, A. M., Alegana, V. A., Nyandigisi, A. J., Pandit, J. M., Fegan, G., Todd, J., BROOKER, S. J., Snow, R. W., et al. (2011) · PLoS Medicine · doi:10.1371/journal.pmed.1000437 · Cited by 82 · see citing works
Self-citationYeung, S., Patouillard, E., Allen, H., & Socheat, D. (2011) · Malaria Journal · doi:10.1186/1475-2875-10-243 · Cited by 74 · see citing works
Self-citationAlba, S., Dillip, A., Hetzel, M. W., et al. (2010) · Malaria Journal · doi:10.1186/1475-2875-9-163 · Cited by 69 · see citing works
Nabyonga‐Orem, J., Mugisha, F., Okui, A. P., et al. (2013) · Malaria Journal · doi:10.1186/1475-2875-12-175 · Cited by 69 · see citing works
Optimizing Investments in Malaria Treatment and Diagnosis
Cohen, J. M., Woolsey, A. M., Sabot, O. J., Gething, P. W., Tatem, A. J., & Moonen, B. (2012) · Science · doi:10.1126/science.1229045 · Cited by 67 · see citing works
Rutta, E., Senauer, K., Johnson, K. W., Adeya, G., Mbwasi, R., Liana, J., Kimatta, S. S., Ndomondo-Sigonda, M., & Alphonce, E. (2009) · Progress in community health partnerships · doi:10.1353/cpr.0.0063 · Cited by 55 · see citing works
The ACTwatch project: methods to describe anti-malarial markets in seven countries
Shewchuk, T., O’Connell, K. A., Goodman, C. A., Hanson, K., Chapman, S., & Chavasse, D. (2011) · Malaria Journal · doi:10.1186/1475-2875-10-325 · Cited by 52 · see citing works
Self-citationPatouillard, E., Hanson, K. G., & Goodman, C. A. (2010) · Malaria Journal · doi:10.1186/1475-2875-9-50 · Cited by 47 · see citing works
Self-citationKaplan, W., & Laing, R. (2005) · World Bank, Washington, DC eBooks · doi:10.1596/13723 · Cited by 43 · see citing works
Littrell, M., Gatakaa, H., Phok, S., et al. (2011) · Malaria Journal · doi:10.1186/1475-2875-10-328 · Cited by 41 · see citing works
Self-citationSmith, N., Obala, A. A., Simiyu, C. J., Menya, D., Khwa-Otsyula, B. O., & O’Meara, W. P. (2011) · Malaria Journal · doi:10.1186/1475-2875-10-316 · Cited by 34 · see citing works
Kahabuka, C., Kvåle, G., & Hinderaker, S. G. (2013) · PLoS ONE · doi:10.1371/journal.pone.0058789 · Cited by 33 · see citing works
Onwujekwe, O. E., Hanson, K., Uzochukwu, B. S. C., et al. (2009) · Health Policy · doi:10.1016/j.healthpol.2009.09.010 · Cited by 30 · see citing works
Self-citationTalisuna, A. O., Daumerie, P. G., Balyeku, A., Egan, T. J., Piot, B., Coghlan, R., Lugand, M. M., Bwire, G., Rwakimari, J. B., Ndyomugyenyi, R., et al. (2012) · Malaria Journal · doi:10.1186/1475-2875-11-356 · Cited by 28 · see citing works
Self-citationHealth service providers in Somalia: their readiness to provide malaria case-management
Noor, A. M., Rage, I. A., Moonen, B., et al. (2009) · Malaria Journal · doi:10.1186/1475-2875-8-100 · Cited by 27 · see citing works
Public and private sector treatment of malaria in Lao PDR
Nonaka, D., Vongseththa, K., Kobayashi, J., et al. (2009) · Acta Tropica · doi:10.1016/j.actatropica.2009.08.013 · Cited by 25 · see citing works
Health-seeking behaviour for febrile illness in malaria-endemic Kolasib district, Mizoram, India
Lalchhuanawma, R., & Murhekar, M. V. (2012) · International Health · doi:10.1016/j.inhe.2012.06.003 · Cited by 17 · see citing works
An economic analysis of the market for malaria treatment in Cambodia
Patouillard, E. (2012) · LSHTM Research Online (London School of Hygiene and Tropical Medicine) · doi:10.17037/pubs.04646548 · Cited by 5 · see citing works
Self-citationThe Push for Local Production, Costs and Benefits – A Case Study of Uganda's Quality ChemicalsPreprint
James, T., Bate, R., Putze, E., et al. (2013) · SSRN Electronic Journal · doi:10.2139/ssrn.2342846 · Cited by 4 · see citing works
CHAPTER 7 - Analysing qualitative data
Skovdal, M., & Cornish, F. (2015) · doi:10.3362/9781780448534.007 · Cited by 4 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- [29]Hanson K, Palafox B, Anderson S, Guzman J, Moran M, et al.. (2011) Chapter 14 Pharmaceuticals. In: Merson MH, Black RE, Mills AJ, editors. Global Health: Diseases, Programs, Systems, and Policies, 3rd edition. Burlington, MA: Jones & Bartlett Learning.
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Medicines and vaccines supply chains challenges in Nigeria: a scoping review
Olutuase, V. O., Iwu-Jaja, C. J., Akuoko, C. P., Adewuyi, E. O., & Khanal, V. (2022) · BMC Public Health · doi:10.1186/s12889-021-12361-9 · Cited by 99 · see citing works
Chukwu, O. A., Chukwu, U., & Lemoha, C. (2018) · Journal of Pharmaceutical Health Services Research · doi:10.1111/jphs.12274 · Cited by 31 · see citing works
- Authors
- Palafox, B., Patouillard, E., Tougher, S., Goodman, C., Hanson, K., Kleinschmidt, I., Rueda, S. T., Kiefer, S., O’Connell, K. A., Zinsou, C., Phok, S., Akulayi, L., Arogundade, E., Buyungo, P., Mpasela, F., & Chavasse, D.
- Affiliations
- London School of Hygiene & Tropical Medicine (GB)
- Swiss Tropical and Public Health Institute (CH)
- Population Services International (US)
- Population Services International (ZM)
- Society for Family Health Nigeria (NG)
- Programme for Accessible Health Communication and Education (UG)
- Corresponding author
- Palafox, Benjamin
- ORCID
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2014-04-03
- Volume
- 9
- Issue
- 4
- Pages
- e93763
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC3974780
- OpenAlex
- W2053306219
- Cited by
- 46
- References
- 34
- Citations by year
- 2025: 4 · 2024: 2 · 2023: 3 · 2022: 2 · 2021: 6 · 2020: 3 · 2019: 14 · 2018: 2 · 2017: 4 · 2016: 1 · 2015: 3 · 2014: 2
- FWCI
- 8.29
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- edoc (University of Basel) (acceptedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- edoc (University of Basel)
- Funders
- Bill and Melinda Gates Foundation (058992)
- London School of Hygiene and Tropical Medicine
- Medical Research Council (MR/K012126/1)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Pharmaceutical Economics and Policy
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pharmaceutical Quality and Counterfeiting
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Malaria Research and Control
- Keywords
- private sector, artemisinin-based combination therapy, chloroquine, pharmaceutical supply chain, drug pricing, drug quality, regulatory compliance, drug approval, consumer demand, traditional markets, malaria-endemic countries
- MeSH terms
- Africa, Antimalarials, Commerce, Cross-Sectional Studies, Health Services Accessibility, Humans, Malaria, Medication Systems, Private Sector
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