The purpose of this study was to assess the performance of Jazia PVS in complementing MSD to deliver health commodities so as to improve their availability in Singida Region, Tanzania. This was achieved by comparing the performance indicators before the adoption of Jazia PVS in 2017 and after in 2019.

Availability of health commodities before PVS (2017) and after PVS (2019)

The results show that after introducing Jazia PVS, availability of health commodities increased by 4.78% from 54.39% in 2017 to 59.17% in 2019. These results are inconsistent with the study done in Dodoma Region in 2018 by Wiedenmayer et al. [4], which showed that the availability of health commodities in health facilities in the Region increased from 69 to 94% after the introduction of Jazia PVS. The observed difference might be attributed a number possible reasons. First, the Dodoma Region study [4] was conducted after a number of years of piloting Jazia PVS in the area, which might have given the health facility staff and the contracted Jazia PVS considerable experience, and hence better performance compared to the team in Singida Region study [15, 18]. Secondly, it is likely that acceptability of a private vendor (Jazia PVS) was still low, which might have resulted in delays of making orders and payments, hence, low performance of Jazia PVS [19]. The level of health commodity availability in our study was still lower than 80% recommended by WHO [10]. This can be attributed to the fact that the increase in availability of health commodities appears to be incremental, improving gradually with training and experience of the actors [15]. Furthermore, increase in availability of health commodities demands adequacy of budget, high level of transparency, accountability, good governance and management, committed and adequate staff and supervision, as well as reputation of Jazia PVS, which may not be homogeneous across the Regions [13, 16, 20].

Jazia PVS order fill rate

The results from the study show that Jazia PVS did not satisfy the requests of the health facilities as only 109 (25.9%) of the total orders were fulfilled while 312 (74.1%) orders were not honoured. The order fill rate by Jazia PVS observed in this study is far below the 99% reported in the study conducted in Dodoma Region, Tanzania in 2018 [15]. The discrepancy in these findings might be attributed to Jazia PVS having limited capacity to stock sufficient number of items, to restock the delivered items; financial difficulties due to delayed payments [13, 16]; and by both Jazia PVS and health facilities not to make the right forecasting [21]. Unfulfilled orders could lead to stock-outs at health facilities thereby eroding away the trust of the people, who then resort to out-of-pocket purchase of medicines and other health commodities [22]. To attain universal health coverage, it is essential that out-of-pocket payments by patients for medicines and other health commodities be reduced substantially, by markedly improving order fulfilments [23].

Order lead time for delivery of health commodities by Jazia PVS

The results of this study have shown that Jazia PVS met the less than 14 days contractual order lead time for delivery of health commodities to health facilities by 73.7% (320), while 26.3% (114) delayed. This is consistent with the results of the studies conducted in Dodoma Region and Dar-es-Salaam in which the lead times conformed to the target of less than 14 days [12, 15]. The performance of the supplier to deliver the consignment on time is influenced by several factors such as distance from the source to the user, reliable transport system from the supplier as well as timely payment by the user to enhance the financial capacity of the supplier to restock the commodities [16]. Shortening lead time for delivery of health commodities reduces stock-outs, the need for overstocking and attendant high holding cost, and expirations; and eventually there is cost saving [24]. Furthermore, short lead time ensures supply chain agility, by being able to manage unpredictable exigencies without causing a shortage. It is therefore essential that short lead times should be taken into account in the selection of suppliers [24].

Timely payment of Jazia PVS by health facilities

The results have shown that most (217, 57%) health facilities did not pay Jazia PVS on time. This is in accord with earlier study conducted in Dodoma Region to assess the performance of the pilot programme of Jazia PVS which revealed that there was a delay in payment of the supplier by most public health facilities [15]. This is not surprising because delayed payment to suppliers is a universal phenomenon; and it constitutes one of the major challenges in supply chain management across different socio-economic sectors [25, 26]. In health supply chain, delayed payment is mainly attributed to financial constraints and inefficient payment systems on the part of the health facility; and improperly prepared claims by the supplier [14, 27]. Delayed payments can reduce the financial capacity and performance of the supplier thereby increasing the cost, resulting in disruptions down the supply chain and stock-outs [14, 28]. Furthermore, health providers become demoralized that they cannot provide desired service due to stock-out; or ask for informal fee for the few health commodities available [29]. With increased demand for high level of efficiency to ensure availability of heath commodities, there is need for health facilities to enhance the financial position of Jazia PVS by prompt payments after delivery of orders [8]. In addition, both the supplier and the health facilities should strive to utilize finance technology in processing payments for increased efficiency [28].

Level of satisfaction of pharmacists incharge with performance of Jazia Prime Vendor System

Overall, the satisfaction level of the pharmacists incharge with Jazia PVS based on their responses of “Yes” or “No”, was 11.8%. This finding is in contrast with that of a study conducted in the USA which reported that there was increased satisfaction of vendor system users [30]. There are two likely causes of the differences between the two studies. First, in the USA study there were more than one prime vendor, which could have generated a competitive spirit. Secondly, the USA setting in which the study was conducted might have been more financially and logistically capable than the Singida Region study area. The low level of satisfaction in this study could be attributed to the low availability (54.39%), and low order fill rate (25.9%), which most likely adversely affected the performance of the pharmacists incharge considerably, and hence only 7.2% recommended Jazia PVS in complementing the Medical Stores Department in supply of health commodities [19]. In addition, stock-outs have a tendency to lower the morale of the health care providers and creating among them a negative attitude towards the suppliers.

Limitations

This study has some imitations that need to be taken into consideration. First, the study used data of one year (i.e. 2019) after the introduction of Jazia PVS due to the effect of COVID-19 on research activities. Therefore, further research is needed to cover a longer period of operation of Jazia PVS. Secondly, some data were missing in the archives, which calls for improvements to be made in record keeping. Thirdly, this study was done in only one Region, and therefore it should be interpreted with caution due to limited generalizability. There is a likelihood of the positive influence of other initiatives in the Region that might have contributed to the results but were not controlled for in the analysis. However, the results from this study can be used to design ways for improvement of Jazia PVS operations, and conducting further studies covering a wider range of Regions, indicators and respondents.