Understanding Private Sector Antimalarial Distribution Chains: A Cross-Sectional Mixed Methods Study in Six Malaria-Endemic Countries

被引：27

作者：

Palafox, Benjamin ^{[1
]}

Patouillard, Edith ^{[1
]}

Tougher, Sarah ^{[1
]}

Goodman, Catherine ^{[1
]}

Hanson, Kara ^{[1
]}

Kleinschmidt, Immo ^{[1
]}

Rueda, Sergio Torres ^{[1
]}

Kiefer, Sabine ^{[2
]}

O'Connell, Kathryn A. ^{[3
]}

Zinsou, Cyprien ^{[4
]}

Phok, Sochea ^{[5
]}

Akulayi, Louis ^{[6
]}

Arogundade, Ekundayo ^{[7
]}

Buyungo, Peter ^{[8
]}

Mpasela, Felton ^{[9
]}

Chavasse, Desmond ^{[3
]}

机构：

[1] London Sch Hyg & Trop Med, London WC1, England

[2] Swiss Trop & Publ Hlth Inst, Basel, Switzerland

[3] Populat Serv Int, Malaria & Child Survival Dept, Nairobi, Kenya

[4] Populat Serv Int, Assoc Beninoise Mkt Social, Cotonou, Benin

[5] Populat Serv Int Cambodia, Phnom Penh, Cambodia

[6] Assoc Sante Familiale, Kinshasa, DEM REP CONGO

[7] Soc Family Hlth, Abuja, Nigeria

[8] Programme Accessible Hlth Commun & Educ, Kampala, Uganda

[9] Soc Family Hlth, Lusaka, Zambia

来源：

PLOS ONE | 2014年 / 9卷 / 04期

关键词：

COMBINATION THERAPIES; FEBRILE ILLNESS; CASE-MANAGEMENT; ANTI-MALARIALS; RETAIL SECTOR; MARKET SHARE; DRUG SHOPS; HEALTH; PROVIDERS; AVAILABILITY;

D O I：

10.1371/journal.pone.0093763

中图分类号：

O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];

学科分类号：

07 ; 0710 ; 09 ;

摘要：

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.

引用

页数：13

共 37 条

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