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Understanding Private Sector Antimalarial Distribution Chains: A Cross-Sectional Mixed Methods Study in Six Malaria-Endemic Countries
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 quali...
Autores principales: | , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3974780/ https://www.ncbi.nlm.nih.gov/pubmed/24699934 http://dx.doi.org/10.1371/journal.pone.0093763 |
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author | Palafox, Benjamin Patouillard, Edith Tougher, Sarah Goodman, Catherine Hanson, Kara Kleinschmidt, Immo Rueda, Sergio Torres Kiefer, Sabine O’Connell, Kathryn A. Zinsou, Cyprien Phok, Sochea Akulayi, Louis Arogundade, Ekundayo Buyungo, Peter Mpasela, Felton Chavasse, Desmond |
author_facet | Palafox, Benjamin Patouillard, Edith Tougher, Sarah Goodman, Catherine Hanson, Kara Kleinschmidt, Immo Rueda, Sergio Torres Kiefer, Sabine O’Connell, Kathryn A. Zinsou, Cyprien Phok, Sochea Akulayi, Louis Arogundade, Ekundayo Buyungo, Peter Mpasela, Felton Chavasse, Desmond |
author_sort | Palafox, Benjamin |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-3974780 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-39747802014-04-08 Understanding Private Sector Antimalarial Distribution Chains: A Cross-Sectional Mixed Methods Study in Six Malaria-Endemic Countries Palafox, Benjamin Patouillard, Edith Tougher, Sarah Goodman, Catherine Hanson, Kara Kleinschmidt, Immo Rueda, Sergio Torres Kiefer, Sabine O’Connell, Kathryn A. Zinsou, Cyprien Phok, Sochea Akulayi, Louis Arogundade, Ekundayo Buyungo, Peter Mpasela, Felton Chavasse, Desmond PLoS One Research Article 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. Public Library of Science 2014-04-03 /pmc/articles/PMC3974780/ /pubmed/24699934 http://dx.doi.org/10.1371/journal.pone.0093763 Text en © 2014 Palafox et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited. |
spellingShingle | Research Article Palafox, Benjamin Patouillard, Edith Tougher, Sarah Goodman, Catherine Hanson, Kara Kleinschmidt, Immo Rueda, Sergio Torres Kiefer, Sabine O’Connell, Kathryn A. Zinsou, Cyprien Phok, Sochea Akulayi, Louis Arogundade, Ekundayo Buyungo, Peter Mpasela, Felton Chavasse, Desmond Understanding Private Sector Antimalarial Distribution Chains: A Cross-Sectional Mixed Methods Study in Six Malaria-Endemic Countries |
title | Understanding Private Sector Antimalarial Distribution Chains: A Cross-Sectional Mixed Methods Study in Six Malaria-Endemic Countries |
title_full | Understanding Private Sector Antimalarial Distribution Chains: A Cross-Sectional Mixed Methods Study in Six Malaria-Endemic Countries |
title_fullStr | Understanding Private Sector Antimalarial Distribution Chains: A Cross-Sectional Mixed Methods Study in Six Malaria-Endemic Countries |
title_full_unstemmed | Understanding Private Sector Antimalarial Distribution Chains: A Cross-Sectional Mixed Methods Study in Six Malaria-Endemic Countries |
title_short | Understanding Private Sector Antimalarial Distribution Chains: A Cross-Sectional Mixed Methods Study in Six Malaria-Endemic Countries |
title_sort | understanding private sector antimalarial distribution chains: a cross-sectional mixed methods study in six malaria-endemic countries |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3974780/ https://www.ncbi.nlm.nih.gov/pubmed/24699934 http://dx.doi.org/10.1371/journal.pone.0093763 |
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