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dc.contributor.authorSunyoto, T
dc.contributor.authorPotet, J
dc.contributor.authorden Boer, M
dc.contributor.authorRitmeijer, K
dc.contributor.authorPostigo, JAR
dc.contributor.authorRavinetto, R
dc.contributor.authorAlves, F
dc.contributor.authorPicado, A
dc.contributor.authorBoelaert, M
dc.date.accessioned2019-06-25T14:51:39Z
dc.date.available2019-06-25T14:51:39Z
dc.date.issued2019-05-30
dc.date.submitted2019-06-11
dc.identifier.issn2044-6055
dc.identifier.pmid31152044
dc.identifier.doi10.1136/bmjopen-2019-029141
dc.identifier.urihttp://hdl.handle.net/10144/619389
dc.description.abstractOBJECTIVES: To understand stakeholders' perceptions of the access barriers to quality-assured diagnostics and medicines for leishmaniasis in the high-burden region of eastern Africa, and to identify key bottlenecks to improve the supply of commodities for neglected tropical diseases. DESIGN: Desk reviews and qualitative in-depth interview study with purposive sampling. METHODS: A landscape analysis through literature and desk review was performed. Next, 29 representatives from international organisations, non-governmental agencies, national control programmes from six countries (Ethiopia, Kenya, Somalia, South Sudan, Sudan and Uganda) and manufacturers were interviewed between May and July 2018. Participants were selected purposively and expanded through a snowballing technique.Data analysis was aided by NVivo, applying the framework method as a part of the thematic content analysis approach. RESULTS: The barriers along the visceral leishmaniasis (VL) supply chain were identified as emerging themes, grouped across supply chain activities and health systems component(s). Stakeholders expressed the perception of progress, but bottlenecks persist. VL medicines, in general, lack multisource production capacity and with small market volume, expansion of suppliers is difficult. Procurement is plagued by forecasting difficulties, complex regulatory policies and procedures, and distribution challenges. Weak communication and coordination across different levels resulted in shortages and loss of trust among different actors. Cross-cutting issues spanned from limited political and resource commitment due to low awareness and limited in-country capacity. However, study respondents were optimistic to pursue several remedies, most importantly to build bridges between supply and demand sides through continued dialogue and collaborations. Diagnostics supply has mostly been overlooked; thus, improved investment in this area is needed. CONCLUSIONS: Addressing supply barriers in eastern Africa requires consistent, specific efforts at the global and national levels, progressing from current partnerships and agreements. Priority actions include pooled procurement, improved forecast, and increased commitment and resources. Sustainability remains an elusive goal, yet to be integrated into discussions moving forward.en_US
dc.language.isoenen_US
dc.publisherBMJ Publishing Groupen_US
dc.rightsWith thanks to BMJ Publishing Groupen_US
dc.subjecthealth policy
dc.subjectleishmaniasis
dc.subjectpublic health
dc.subjectqualitative research
dc.subjectsupply chain
dc.subjecttropical medicine
dc.titleExploring global and country-level barriers to an effective supply of leishmaniasis medicines and diagnostics in eastern Africa: a qualitative study.en_US
dc.identifier.journalBMJ Openen_US
dc.source.journaltitleBMJ open
refterms.dateFOA2019-06-25T14:51:39Z


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