Dillip Angel, Kalolo Albino, Mayumana Iddy, Rutishauser Melina, Simon Vendelin T, Obrist Brigit
Apotheker Consultancy (T) Limited, Health Access Initiative, Dar es Salaam, Tanzania.
Department of Public Health, St Francis University College of Health and Allied Sciences, Ifakara, Tanzania.
J Pharm Policy Pract. 2022 Dec 29;15(1):106. doi: 10.1186/s40545-022-00507-y.
In low- and middle-income countries, too, public-private partnerships in health insurance schemes are crucial for improving access to health services. Problems in the public supply chain of medicines often lead to medicine stock-outs which then negatively influence enrolment in and satisfaction with health insurance schemes. To address this challenge, the government of Tanzania embarked on a redesign of the Community Health Fund (CHF) and established a Prime Vendor System (Jazia PVS). Informal and rural population groups, however, rely heavily on another public-private partnership, the Accredited Drug Dispensing Outlets (ADDOs). This study takes up this public demand and explores the potentials, pitfalls, and modalities for linking the improved CHF (iCHF) with ADDOs.
This was a qualitative exploratory study employing different methods of data collection: in-depth interviews, focus group discussions, and document reviews.
Study participants saw a great potential for linking ADDOs with iCHF, following continuous community complaints about medicine stock-out challenges at public health facilities, a situation that also affects the healthcare staff's working environment. The Jazia PVS was said to have improved the situation of medicine availability at public health facilities, although not fully measuring up to the challenge. Study participants thought linking ADDOs with the iCHF would not only improve access to medicine but also increase member enrolment in the scheme. The main pitfalls that may threaten this linkage include the high price of medicines at ADDOs that cannot be accommodated within the iCHF payment model and inadequate digital skills relevant for communication between iCHF and ADDOs. Participants recommended linking ADDOs with the iCHF by piloting the connection with a few ADDOs meeting the selected criteria, while applying similar modalities for linking private retail outlets with the National Health Insurance Fund (NHIF).
As the government of Tanzania is moving toward the Single National Health Insurance Fund, there is a great opportunity to link the iCHF with ADDOs, building on established connections between the NHIF and ADDOs and the lessons learnt from the Jazia PVS. This study provides insights into the relevance of expanding public-private partnership in health insurance schemes in low- and middle-income countries.
在低收入和中等收入国家，医疗保险计划中的公私伙伴关系对于改善医疗服务的可及性也至关重要。药品公共供应链中的问题常常导致药品缺货，进而对医疗保险计划的参保率和满意度产生负面影响。为应对这一挑战，坦桑尼亚政府着手重新设计社区卫生基金（CHF）并建立了主要供应商系统（Jazia PVS）。然而，非正式群体和农村人口严重依赖另一种公私伙伴关系，即经认证的药品零售点（ADDOs）。本研究顺应这一公众需求，探讨将改进后的社区卫生基金（iCHF）与经认证的药品零售点相联系的潜力、陷阱及方式。
这是一项定性探索性研究，采用了不同的数据收集方法：深入访谈、焦点小组讨论和文献回顾。
鉴于社区持续抱怨公共卫生设施存在药品缺货问题，且这种情况也影响医护人员的工作环境，研究参与者认为将经认证的药品零售点与改进后的社区卫生基金相联系具有很大潜力。据说主要供应商系统改善了公共卫生设施的药品供应情况，尽管尚未完全应对这一挑战。研究参与者认为，将经认证的药品零售点与改进后的社区卫生基金相联系不仅能改善药品可及性，还能增加该计划的参保人数。可能威胁这种联系的主要陷阱包括经认证的药品零售点的药品价格过高，改进后的社区卫生基金支付模式无法承受，以及改进后的社区卫生基金与经认证的药品零售点之间沟通所需的数字技能不足。参与者建议通过与符合选定标准的少数经认证的药品零售点试点建立联系，同时采用与将私人零售点与国家健康保险基金（NHIF）相联系类似的方式，将经认证的药品零售点与改进后的社区卫生基金相联系。
随着坦桑尼亚政府朝着单一国家健康保险基金迈进，可以利用国家健康保险基金与经认证的药品零售点之间已有的联系以及从主要供应商系统吸取的经验教训将改进后的社区卫生基金与经认证的药品零售点相联系，这是一个绝佳机会。本研究为低收入和中等收入国家扩大医疗保险计划中的公私伙伴关系的相关性提供了见解。
