The impact of an integrated electronic immunization registry and logistics management information system (EIR-eLMIS) on vaccine availability in three regions in Tanzania: A pre-post and time-series analysis.

BACKGROUND: Since 2016, the Government of Tanzania has been implementing TImR, an integrated Electronic Immunization registry-logistics management information system (EIR-LMIS) that includes stock notifications. The objective of this study is to estimate the impact of this intervention on vaccine availability. METHODS: Monthly stock-out data were collected from paper registers at facilities, an Excel-based system at districts, and the new system (TImR) across all 924 health facilities in Arusha, Tanga and Kilimanjaro Regions. Six months of stockout rates pre- and post-introduction, by antigen, were compared via a two-way analysis of variance (ANOVA). A mixed-effects logistic regression model with the TImR data identified predictors of vaccine availability across antigens. FINDINGS: Post-introduction, ANOVA models estimated that overall stock-out rates declined from a monthly average of 7.1% to 2.1% (p < 0.01). Three specific vaccines had fewer stock-outs; OPV's monthly average dropped from 12.5% to 2.1% (p < 0.01), MR from 9.4% to 1.0% (p < 0.01) and DTP-HepB-HiB from 8.1% to 1.7% (p < 0.01). In the mixed-effects logistic regression model, controlling for antigen, odds of stock-out were 4.1% (95% CI: 3.3 - 4.9) lower for each week of tenure. Compared to DTP-HepB-HiB vaccine, odds of BCG vaccine being stocked out were 4.31 as high (95% CI: 3.1 - 5.0). The odds of being stocked-out were 29.7% lower for PCV (95% CI: 8.8 - 45.8) and 26.6% (95% CI: 3.4 - 44.1) lower for rotavirus vaccines compared to DTP-HepB-HiB. The odds of stock out were 37.7% lower for MR vaccine than DTP-HepB-HiB (95% CI: 18.1 - 52.6). CONCLUSIONS: Tanzania's integrated EIR-eLMIS may increase vaccine availability compared to its paper and Excel based system. Post-introduction of an eLMIS, the odds of a vaccine stock-out reduced over time. Further research could determine the impact of this intervention on vaccine wastage and replenishment response times.

Improving the efficiency and standards of a National Immunization Program Review: lessons learnt from United Republic of Tanzania.

A National Immunization Program Review (NIP Review) is a comprehensive external assessment of the performance of a country's immunization programme. The number of recommended special-topic NIP assessments, such as those for vaccine introduction or vaccine management, has increased. These assessments often have substantial overlap with NIP reviews, raising concern about duplication. Innovative technical and management approaches, including integrating several assessments into one, were applied in the United Republic of Tanzania's 2015 NIP Review. These approaches and processes were documented and a post-Review survey and group discussion. The Tanzania Review found that integrating assessments so they can be conducted at one time was feasible and efficient. There are concrete approaches for successfully managing a Review that can be shared and practiced including having a well-planned desk review and nominating topic-leads. The use of tablets for data entry has the potential to improve Review data quality and timely analysis; however, careful team training is needed. A key area to improve was to better coordinate and link findings from the national-level and field teams.

Availability and affordability of anticancer medicines at the Ocean Road Cancer Institute in Dar es Salaam, Tanzania.

BACKGROUND: To ensure effective control of cancer, patients undergoing chemotherapy should get continuous supply of anticancer medicines. In Tanzania and other East African countries little is documented regarding the availability and affordability of anticancer medicines at the patient level. The number of anticancer medicines prescribed to the cancer patients and its cost implication is also not known. OBJECTIVE: To determine the availability of anticancer medicines to patients attending chemotherapy clinic at Ocean Road Cancer Institute (ORCI) in Dar es salaam, Tanzania. Also to find out the prices of anticancer medicines in private pharmacies and affordability by cancer patients treated at ORCI. METHODOLOGY: A cross-sectional study was carried out between February and May 2010 in patients receiving cancer chemotherapy at ORCI. A total of 384 adult cancer patients registered for chemotherapy were included in the study. Patients, health care providers at the chemotherapy department and dispensing personnel in the private pharmacies were interviewed regarding availability, accessibility and affordability of anticancer medicines. RESULTS: The mean anticancer medicines prescribed per patient was 2.01, with the mean cost for anticancer drugs reported by patients to be 106,300 shillings. The availability of medicines at the ORCI for the management of cancer patients was about 50% of all surveyed medicines. As a result more than 70% of patients did not get the prescribed anticancer medicines at the hospital. In the private pharmacies, the unit cost for anticancer medicines was very high, ranging from 2,500 to 744,000 shillings, which is equivalent to 1-7 months income of the patient. CONCLUSION: Availability of anticancer medicines at ORCI in Dar es Salaam is not adequate. As a result, some patients are required to buy anticancer medicines from private pharmacies. In these private pharmacies anticancer medicines are too costly and most patients are not covered by health insurance to purchase their medicines. Efforts should be made to increase budgetary allocation to ensure adequate and uninterrupted supply of anticancer medicines to cancer patients at ORCI.