Public Health Department, Institute of Tropical Medicine, Antwerpen, Belgium.
Medical Department, Médecins Sans Frontières Access Campaign, Paris, France.
BMJ Open. 2019 May 30;9(5):e029141. doi: 10.1136/bmjopen-2019-029141.
To understand stakeholders' perceptions of the access barriers to quality-assured diagnostics and medicines for leishmaniasis in the high-burden region of eastern Africa, and to identify key bottlenecks to improve the supply of commodities for neglected tropical diseases.
Desk reviews and qualitative in-depth interview study with purposive sampling.
A landscape analysis through literature and desk review was performed. Next, 29 representatives from international organisations, non-governmental agencies, national control programmes from six countries (Ethiopia, Kenya, Somalia, South Sudan, Sudan and Uganda) and manufacturers were interviewed between May and July 2018. Participants were selected purposively and expanded through a snowballing technique.Data analysis was aided by NVivo, applying the framework method as a part of the thematic content analysis approach.
The barriers along the visceral leishmaniasis (VL) supply chain were identified as emerging themes, grouped across supply chain activities and health systems component(s). Stakeholders expressed the perception of progress, but bottlenecks persist. VL medicines, in general, lack multisource production capacity and with small market volume, expansion of suppliers is difficult. Procurement is plagued by forecasting difficulties, complex regulatory policies and procedures, and distribution challenges. Weak communication and coordination across different levels resulted in shortages and loss of trust among different actors. Cross-cutting issues spanned from limited political and resource commitment due to low awareness and limited in-country capacity. However, study respondents were optimistic to pursue several remedies, most importantly to build bridges between supply and demand sides through continued dialogue and collaborations. Diagnostics supply has mostly been overlooked; thus, improved investment in this area is needed.
Addressing supply barriers in eastern Africa requires consistent, specific efforts at the global and national levels, progressing from current partnerships and agreements. Priority actions include pooled procurement, improved forecast, and increased commitment and resources. Sustainability remains an elusive goal, yet to be integrated into discussions moving forward.
了解东非高负担地区利益攸关方对获得质量保证的利什曼病诊断和药品的障碍的看法，并确定改善被忽视热带病商品供应的主要瓶颈。
文献综述和定性深入访谈研究，采用目的性抽样。
通过文献和文献综述进行景观分析。接下来，于 2018 年 5 月至 7 月，对来自国际组织、非政府机构、6 个国家（埃塞俄比亚、肯尼亚、索马里、南苏丹、苏丹和乌干达）的国家控制规划以及制造商的 29 名代表进行了访谈。参与者是有目的选择的，并通过滚雪球技术进行了扩展。NVivo 辅助数据分析，采用框架方法作为主题内容分析方法的一部分。
沿着内脏利什曼病（VL）供应链确定了新兴主题，这些主题分为供应链活动和卫生系统组成部分。利益攸关方表示已经取得了进展，但瓶颈仍然存在。一般来说，VL 药品缺乏多源生产能力，且市场规模较小，供应商的扩张较为困难。采购受到预测困难、复杂的监管政策和程序以及分配挑战的困扰。不同层次之间沟通和协调不力导致不同行为者之间出现短缺和信任缺失。跨领域问题包括由于意识水平低和国内能力有限而导致的政治和资源承诺有限。然而，研究受访者对采取几种补救措施持乐观态度，最重要的是通过持续对话和合作，在供需双方之间架起桥梁。诊断用品供应大多被忽视；因此，需要在这方面增加投资。
解决东非的供应障碍需要在全球和国家层面上持续、具体地努力，从当前的伙伴关系和协议出发。优先行动包括联合采购、改善预测以及增加承诺和资源。可持续性仍然是一个难以实现的目标，尚未纳入未来的讨论。
