Does Accountability Matter in Supply Chain Management? - The Role of Accountability in the Performance of Jazia Prime Vendor System in Tanzania

Background: Access to safe, effective, quality, and affordable essential medicines for all is a central component of Universal Health Coverage. However, the availability of quality medicines in peripheral healthcare facilities is often limited. Several countries have developed integrated complementary pharmaceutical supply systems to address the shortage of medicines. Nevertheless, there is little evidence on how accountability contributes to the performance of such complementary pharmaceutical supply systems in low-income settings. The current study analyses how accountability mechanisms contributed to Jazia Prime Vendor System (Jazia PVS) in Tanzania.

Methodology: The study analyzed financial, performance, and procedure accountability defined in Boven's 2007 accountability framework. We conducted 30 in-depth interviews, seven group discussions, and 14 focus group discussions in 2018 in four districts that implemented Jazia PVS. We used a deductive and inductive approach to develop the themes and framework analysis to summarize the data.

Results: Several accountability mechanisms implemented in conjunction with Jazia PVS contributed to its performance. These include inventory and financial auditing conducted by district pharmacists and the internal auditors, close monitoring of standard operating procedures by the prime vendor regional coordinating office, and peer cascade coaching. Furthermore, the auditing activities allowed identifying challenges of delayed payment to the vendor and possible approaches for mitigation, while peer cascade coaching played a crucial role in enabling staff at the primary facilities to improve skills to oversee and manage the medicines supply chain.

Conclusion: Financial performance and procedure accountability measures played an essential role in the successful performance of Jazia PVS. The study highlights the need for capacity building linked to financial and supply management at lower-level health facilities, including health facility governing committees responsible for priority-setting and decision-making at the facility level. Keywords: Accountability, Prime Vendor System, Tanzania