The presented work describes a situation analysis of the procedures and practices of procuring medicines and medical supplies from private suppliers in the Dar es Salaam region when those commodities are not available at the national Medical Stores Department. This assessment is the first step of the 12-step implementation sequence of the Prime Vendor System, successfully piloted and implemented in of Dodoma, Morogoro and Shinyanga regions. It provides arguments for a necessary system change in the procurement practice from private suppliers. The study results offers the rationale for regional authorities to identify one reputable private sector pharmaceutical supplier, through a transparent prequalification and procurement process, to engage as prime vendor to create a public–private partnership based on good procurement practice. Public healthcare facility orders not fulfilled by the Medical Stores Department could then be pooled at council level and purchased from the prime vendor at competitive rates. The regional prime vendors, in turn, agree to supply quality assured materials at comparable prices to the Medical Stores Department with good lead times.
The generous selection of 77 prequalified suppliers for the whole of Dar es Salaam has the potential to provide ample competition and therefore lower prices for medicines to be obtained from private suppliers. However, given the lack of transparency on the invitation to tender process, the value for money element could not be verified. Furthermore, the fact that the majority of the 17 prequalified suppliers used during the review period were small businesses, some of which not licensed to supply health commodities and 33 suppliers not even prequalified, renders the quality of the medical supplies and any medical or economic gains questionable [
15]. The budget of Dar es Salaam is approximately 1.5 billion Tanzanian shillings (~USD 700,000), for the procurement of health commodities from private suppliers from the five sample districts, when Medical Stores Department stock-outs occur. This is approximately three times the budget that the regions of Dodoma, Morogoro and Shinyanga each have for the same. Considering this significant sum, it is concerning that legislation and regulations, for this type of procurement, are not strictly adhered to and enforced. However, with a lack of guidance and SOPs, in addition to lengthy bureaucratic processes, obtaining medical necessities via speedier alternative means appears to be considered the norm; it being a more practical and attractive option to many healthcare providers, even if it is illicit. Unfortunately, healthcare regulatory systems, especially those that are weak and/or poorly enforced are attractive targets for corruption, which have the potential to cause direct and serious harm to individuals and to society [
16,
17]. In 2017, global expenditure on health reached USD 7.8 trillion and it is estimated that 10–25% of health expenditure is lost to corruption [
16,
18,
19]. Strangely, according to the World Health Organization, it is uncommon for many countries to designate more than 0.1% of their health budgets to auditing and investigating corruption despite the considerable sums that could potentially be spared if they did [
15]. Moderately high corruption levels are not unique to Tanzania; however, in 2019, Transparency International’s Corruption Perceptions Index ranked Tanzania 96th from 198 countries with a score of 37 out of 100, 0 being very corrupt and 100 being very clean [
20]. The benefits of UHC will be lost if the general perception of public healthcare is poor, the medicinal quality questionable, corruption endemic and health outcomes compromised [
21]. Poor quality of healthcare services, in particular, can discourage people to use them, even if they are financially covered, or they can lead to adverse health outcomes, both of which defy the point of UHC. High-quality health services, on the other hand, often lead to improved health outcomes, a positive user experience and more confidence in the system, therefore, positively re-enforcing a cycle of public support and sustained government financing. Furthermore, participation in community health insurance schemes, for example, is much more acceptable if the quality of services is high. This in turn helps sustain government financing and could help to lower the national incidence of catastrophic spending [
21‐
24].
The main challenges to the procurement process from private suppliers observed in Dar es Salaam, i.e., bureaucracy and a lack of transparency and standardization, was observed in all Jazia PVS pilot regions prior to the implementation of the prime vendor scheme (i.e. Dodoma, Morogoro and Shinyanga) [
10] (unpublished data). For Dodoma, at least, it has been shown that the prime vendor system has managed to simplify, shorten and standardize procurement procedures and render governance more transparent, while enhancing procurement capacity at all levels of the health system [
10].
Study limitations
This baseline study was not intended to be an in-depth investigation of health commodity suppliers. Instead, it was a situation assessment of the operational environment and conditions when purchases by public health facilities or districts from a private sector occurred. Some highly relevant qualitative documents could not be accessed and/or were not made available in some districts. Consequently, the information obtained within this assessment was mainly of descriptive and qualitative nature, based on comments, interviews, observations and perceptions. We can therefore not exclude biases and inaccuracies introduced by both public and private sector interviewees leading to difficulties in assessing lead times, for instance.