London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.
Malar J. 2010 Feb 11;9:50. doi: 10.1186/1475-2875-9-50.
In many low-income countries, the retail sector plays an important role in the treatment of malaria and is increasingly being considered as a channel for improving medicine availability. Retailers are the last link in a distribution chain and their supply sources are likely to have an important influence on the availability, quality and price of malaria treatment. This article presents the findings of a systematic literature review on the retail sector distribution chain for malaria treatment in low and middle-income countries.
Publication databases were searched using key terms relevant to the distribution chain serving all types of anti-malarial retailers. Organizations involved in malaria treatment and distribution chain related activities were contacted to identify unpublished studies.
A total of 32 references distributed across 12 developing countries were identified. The distribution chain had a pyramid shape with numerous suppliers at the bottom and fewer at the top. The chain supplying rural and less-formal outlets was made of more levels than that serving urban and more formal outlets. Wholesale markets tended to be relatively concentrated, especially at the top of the chain where few importers accounted for most of the anti-malarial volumes sold. Wholesale price mark-ups varied across chain levels, ranging from 27% to 99% at the top of the chain, 8% at intermediate level (one study only) and 2% to 67% at the level supplying retailers directly. Retail mark-ups tended to be higher, and varied across outlet types, ranging from 3% to 566% in pharmacies, 29% to 669% in drug shops and 100% to 233% in general shops. Information on pricing determinants was very limited.
Evidence on the distribution chain for retail sector malaria treatment was mainly descriptive and lacked representative data on a national scale. These are important limitations in the advent of the Affordable Medicine Facility for Malaria, which aims to increase consumer access to artemisinin-based combination therapy (ACT), through a subsidy introduced at the top of the distribution chain. This review calls for rigorous distribution chain analysis, notably on the factors that influence ACT availability and prices in order to contribute to efforts towards improved access to effective malaria treatment.
在许多低收入国家，零售部门在疟疾治疗中发挥着重要作用，并且越来越被视为改善药品供应的渠道。零售商是分销链中的最后一环，其供应来源可能对疟疾治疗的供应、质量和价格产生重要影响。本文介绍了针对中低收入国家疟疾治疗零售部门分销链的系统文献综述结果。
使用与服务所有类型抗疟零售商的分销链相关的关键词，在出版物数据库中进行检索。与参与疟疾治疗和分销链相关活动的组织联系，以确定未发表的研究。
共确定了 32 篇参考资料，分布在 12 个发展中国家。分销链呈金字塔形，底层供应商众多，顶层供应商较少。为农村和较不正规的销售点服务的供应链比为城市和更正规的销售点服务的供应链具有更多的层次。批发市场往往相对集中，尤其是在供应链的顶层，少数进口商占销售的大部分抗疟药物量。批发价格加价在各供应链层级有所不同，从供应链顶层的 27%到 99%不等，中间层级（仅有一项研究）为 8%，直接向零售商供货的层级为 2%到 67%。零售加价往往更高，且因销售点类型而异，从药店的 3%到 566%，从药店的 29%到 669%，到杂货店的 100%到 233%不等。关于定价决定因素的信息非常有限。
关于零售部门疟疾治疗分销链的证据主要是描述性的，并且缺乏全国范围内的代表性数据。在平价药品机制推出之际，这些都是重要的局限性，平价药品机制旨在通过在分销链顶层引入补贴，增加消费者获得青蒿素为基础的联合疗法（ACT）的机会。本综述呼吁对分销链进行严格的分析，特别是对影响 ACT 供应和价格的因素进行分析，以促进努力改善获得有效疟疾治疗的机会。
