Dar es Salaam. Each time a patient is told that medicines are out of stock at a public health facility, the same questions arise: who is responsible and why does the problem persist despite increased government spending on healthcare?
This concern continues to trouble many citizens, particularly at a time when the government has pledged to improve access to medicines nationwide.
In a recent interview in Dodoma, Chief Government Pharmacist Daudi Msasi offered a detailed explanation of how the health commodities supply chain operates, from dispensary level to the national stage, and where breakdowns can occur.
Supply chain begins at facility level
According to Mr Msasi, the availability of medicines does not start at the Ministry of Health or the Medical Stores Department (MSD), but at individual health facilities.
Each year, more than 8,000 health facilities across the country prepare medicine forecasts between August 1 and December 31. During this four-month period, health workers collect data on patient numbers, disease trends and medicine usage to estimate demand for the following year.
“This system uses modern technology known as the Electronic Logistics Management Information System (eLMIS), through which all facilities submit their requirements digitally,” he explained.
No facility is allowed to submit requests outside the system, a measure aimed at enhancing transparency and accountability.
However, this raises a key question: do frontline health workers have the capacity to make accurate forecasts?
Multi-level review process
Mr Msasi said once facilities submit their forecasts, the data undergoes several stages of review—at council, regional and ultimately national level through the President’s Office–Regional Administration and Local Government (Tamisemi).
At each stage, the projections are scrutinised, adjusted and aligned with available funding. They are then submitted to the National Medicines Forecasting Committee, chaired by the Chief Government Pharmacist.
“We receive national demand estimates, analyse them and ensure they reflect reality before forwarding them to MSD for implementation,” he said.
Yet, the multiple layers of review raise further concerns about whether actual needs may be altered or diluted along the way, ultimately affecting medicine availability.
Funding gaps drive shortages
After approval, the next step involves planning for procurement and distribution, undertaken jointly by the Ministry of Health, Tamisemi and MSD.
This stage assesses existing stock levels against projected needs for the year. However, a major challenge arises when available funds fall short of actual requirements.
“When there is a mismatch between funding and real demand, that is where another source of shortages begins,” Mr Msasi noted.
Roles of MSD and health facilities
Once funds are secured and medicines procured, MSD is responsible for distributing them to health facilities based on orders placed every two months.
Health facilities, in turn, must submit timely and accurate orders based on their needs.
If MSD fails to deliver, it bears responsibility. However, if facilities make errors in forecasting or fail to order correctly, accountability shifts to facility staff and local government authorities.
“This is a chain involving many actors, each with their own responsibility,” Mr Msasi emphasised. Still, for the ordinary citizen, such explanations may offer little comfort when medicines are unavailable.
A pharmacist dispenses medicines at a public health facility. Every year, more than 8,000 health facilities across the country prepare medicine forecasts between August 1 and December 31. PHOTO | FILE
The government has invested in digital systems to improve medicine tracking. In addition to eLMIS, health facilities use electronic medical records systems.
The goal is to integrate these platforms to provide real-time data—from when medicines enter the system to when they are dispensed to patients.
“We aim to reach a point where, within minutes, we can identify which facility has shortages and take immediate action,” he said.
Artificial intelligence is also being introduced to enhance forecasting accuracy.
However, questions remain as to whether technology alone can address deeper structural challenges such as shortages of skilled personnel and limited financial resources.
Shortage of professionals
A significant challenge facing the health sector is the shortage of qualified personnel, particularly pharmacists.
As a result, medicine management is often handled by nurses or laboratory technicians, which can affect the quality of decision-making.
Mr Msasi said the government has begun addressing this gap, including the recruitment of 12,000 health workers in the current financial year.
“We are also providing extensive training. Our teams are in the field supporting staff—often you find a nurse or lab technician stepping in to help with forecasting and stock verification,” he said.
“We believe that having the right professionals in place, as the government continues to address this, will be a key solution in reducing this challenge.”
Expiry losses unavoidable
Despite improvements, the expiry of medicines remains an unavoidable challenge, particularly in countries that rely on imports.
“You have to prepare for diseases even if they may not occur. If they do not occur, medicines remain unused and expire,” Mr Msasi explained.
He stressed, however, that performance is measured by the rate of expired medicines. Tanzania’s rate is currently below two percent, compared to the global benchmark of five percent.
“In the 2024/2025 financial year, expired medicines accounted for about 0.9 percent—far below previous levels,” he said.
Nonetheless, for citizens facing shortages, even such figures may appear significant.
“Medicine expiry at facilities or MSD warehouses is unavoidable because we procure in anticipation of diseases. If outbreaks such as cholera do not occur, some medicines will expire,” he added.
Diversion and accountability
Mr Msasi also acknowledged the problem of medicine diversion, with reports indicating cases of theft and misuse involving some health workers.
He said robust monitoring systems are in place, including internal and external audits and collaboration with institutions such as the Prevention and Combating of Corruption Bureau (PCCB).
“When medicines do not reach patients, investigations are triggered through audit units and oversight bodies such as the Controller and Auditor General (CAG),” he said.
“There are ongoing court cases involving staff accused of diverting medicines or medical supplies. Some have been convicted, while others are facing legal action. PCCB continues to play a key role in ensuring accountability.”
In situations where medicines are unavailable in public facilities, patients are often forced to purchase them from private outlets at their own cost.
This increases the financial burden, particularly for low-income households.
The government hopes that the implementation of universal health insurance will help ease this pressure by ensuring access to services without out-of-pocket payments.
A closer look shows there is no single cause of drug shortages. The issue spans a complex chain involving health workers, local authorities, regional administrations, ministries, MSD and even the Ministry of Finance.
Mr Msasi said when any link in this chain fails, the impact is ultimately felt by the patient in need.
Perhaps the more important question, he suggested, is not who to blame, but how the system can be strengthened to ensure consistent availability of medicines.
Because, in the end, the health of citizens cannot wait for administrative solutions.
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