Understanding Practice and Associated Factors of Implementers on Fidelity Implementation of Prime Vendor System: A Case Study of Tanzania Mainland

Abstract

The practice of Supply Chain Management is an application of the process view, focusing on delivering health commodities to clients and transitioning from functions to processes. The Prime Vendor system has been implemented through the existing institutional structures at various levels of government and funded exclusively by complementary funds. The availability of quality medicines in low-income and middle-income countries is often limited, especially in peripheral health facilities. This study provides a comprehensive understanding of the actual practice and associated factors of implementers on fidelity implementation of the prime vendor system.

Materials and Methods: Data was collected from June to September 2023 using the ODK application from 356 respondents in the Dodoma, Morogoro, Mtwara, and Mwanza regions in Tanzania. They were analysed using SAS version 9.4. Statistical significance was determined at a 95% confidence level."5% confidence level.

Results: In the study, 98.60% of health facility respondents reported procuring health commodities from prime vendors only when they received out-of-stock notifications from the Medical Stores Department. However, 85.67% disagreed with the practice of quarterly procurement. Additionally, 50.56% of respondents agreed they incurred costs upon consignment receipt, and 58.15% disagreed with health facility overseers being responsible for prime vendor preparation. The study revealed that 90.45% of respondents acknowledged the Health Facility Governing Committee/Medicine and Therapeutic Committee's role in approving orders and funds for health commodities procurement through the prime vendor system. Regarding payment timelines, 65.17% of respondents were uncertain about settling invoices within seven days. Most respondents (86.80%) disagreed with using online payment platforms when traditional banking services were unavailable. Furthermore, 88.76% relied on supplementary funds for procurement, while 73.60% disagreed with using in-kind receipts as a source of funds in implementing the prime vendor system. Regarding order submission and delivery, 73.60% did not support health facilities directly submitting their orders to prime vendors, and 56.18% were unaware of the delivery timelines used by the prime vendor to supply various destinations.

Conclusion: The study elucidates the issues surrounding the procurement practices and procedures of health commodities through the prime vendor system, revealing significant variations in implementation fidelity among respondents. Factors influencing implementers' practices underscore the complex interplay between individual characteristics and systemic factors. Addressing these challenges requires targeted interventions, which are essential in enhancing smooth and consistent fidelity in the implementation of the prime vendor system, which will ensure equitable access to health commodities across healthcare facilities.