Drug donations in Tanzania : stakeholders' perception and knowledge

Tanzania is a country with low access to essential drugs that receives substantial drug donations (DDs) as
in-kind gifts. To promote good donation practice, to support the ongoing health sector reform in Tanzania
and to find effective solutions for optimising DD processes, stakeholders’ and recipients’ views on the
appropriateness and acceptability of DDs are of particular interest.
The aims of this research project were a) to characterise DD processes in Tanzania, b) to explore the
practice and perception of Tanzanian stakeholders involved in DD processes, c) to identify similarities
and discrepancies between the views of Tanzanian recipients and Swiss donors and d) to develop
suggestions for optimising DD processes.
The project methodology employed a participatory stakeholder analysis, a triangulation of methods and
qualitative research tools. The following stepwise strategy enabled an analysis of the entire DD system: a)
literature review and document analysis for description of the context, b) a postal, self-administered,
semi-quantitative questionnaire in Tanzania and in Switzerland for defining problems in DD processes, c)
key informant interviews in which the interviewees could reflect on the results of the Tanzanian
questionnaire survey within the context of public health issues and d) a workshop for elaborating practical
solutions for the optimisation of DD processes in Tanzania. Data were collected from January 2000 to
October 2002.
Tanzania has to bridge a 30% gap in drug supply. This study found that the acceptance of DDs to fill this
gap was high. Stakeholders within the country understood that donated drugs were necessary because,
due to poverty, drugs were either unavailable or not affordable. The prime concern of DD recipients was
the discrepancy between their needs and the donors’ supply. DDs did not cover recipients' priority needs
and their quantity was insufficient for sustainable treatment of patients. DDs given from a surplus, as gifts
from individuals or as single-source DDs were perceived as problematic. However, DDs provided within
the framework of DD programmes with a known public health effect were welcomed. Tanzania benefits
from many such programmes.
Tanzania has developed the instruments for an effective regulation of DD processes: national guidelines
for drug donations and a national essential drug list. The existence of these tools, however, has not
guaranteed their application. The failure to implement the guidelines for DDs was perceived as being the
second most important problem in the Tanzanian DD process.
Knowledge of the value of DDs is prerequisite for judging the economic impact of DDs on the drug
supply, but only 27% of recipients were able to estimate the value of donated drugs. Stakeholders pointed
out, however, that estimating drug value is difficult when the drugs do not conform to accepted quality
standards. This finding demonstrates the need for improved data registration, collection and dissemination
within Tanzania. With respect to value, for these stakeholders, DD-related transaction costs must also be
taken into consideration.
Depending on the form of their involvement, recipients identified additional drawbacks associated with
DDs, the focus being on structures and processes. The public sector requested more transparency in DD
processes, the lack of transparency arising from weaknesses in public structures as well as a lack of
information and accountability. Non-governmental organisations (NGOs) and religious facilities with
better developed structures addressed problems such as shipment fees and insufficient infrastructure and
training. These differences call for more collaboration between the private and public sectors and suggest
that they could learn from each other, as recommended in the Tanzanian Health Sector Reform.
Communication is crucial in the eyes of stakeholders, but was not optimal, whether between donors and
recipients or among recipients themselves. An important complaint was that donors did not ask what was
needed in advance and supported a supply-driven donation process.
Tanzanian recipients and Swiss donors coincided in the view that the absence of sustainability and nonrelevance
of donated drugs for local needs were the major problems in DD processes. Knowledge about
donors’ needs was low among Swiss donor organisations. Only one-third of Swiss stakeholders knew the
WHO guidelines for DDs. Both the Swiss and the Tanzanian stakeholders rated the quality of DDs as a
problem of minor importance. However, donated drugs often did not comply with requested standards,
even less so in Switzerland than in Tanzania.
Because this study reflects the situation in 2001, directly after NGOs and PVOs stopped collecting unused
drugs in Switzerland, donors in the for-profit sector did not understand that unused drugs should no
longer be donated and failed to recognise that these drugs can burden a recipient. In the eyes of Tanzanian
stakeholders unused DDs are obsolete.
Suggestions of Tanzanian stakeholders to optimise DD processes were consistent with the core principles
of the WHO guidelines for DDs: a) meeting local needs (maximum benefit for the recipients), b)
participatory approach (respecting the wishes of the recipient), c) optimised DD quality (no double
standard in quality) and d) effective communication between donor and recipient.
The findings of this project contribute to a comprehensive understanding of DD processes in Tanzania.
They show that the performance of a health system has a major impact on the quality of DD processes.
Recipients in DD processes need the support that should be provided by the Tanzanian heath sector
reform plans, which include continuing education of health workers and a better defined responsibility in
the pharmaceutical sector to overcome problems with the structure and management of DD processes. In
addition to improved implementation of DD guidelines by both donors and recipients, the main proposals
arising from this project are the following: Donors should actively communicate with recipients and
thereby promote a demand-driven DD process that respects Tanzanian regulations. Recipients on the
other hand should a) translate the guidelines for DDs into Swahili, b) assure systematic collection of data,
c) strengthen the collaboration between the public and the private sectors and d) establish an autonomous,
centralised body for coordination of DDs.
These findings also call for further research, which might study in more depth drug donations given
within the framework of programmes, explore the means for better implementation of guidelines for DDs
and investigate the mechanisms of communication between donors and recipients together with how these
might be improved.