Discussing the problems in carrying out multi-country studies, and the solutions.
This article produced from comprehensive information about operations of a company and how their services are perceived. The results confirmed that are generally performing well, largely due to their transparent procurement procedures, competitive prices and highly motivated staff. They have won the trust of their customers, appreciation from ministries of health and good relationships with their founding church bodies. Among the major findings was that the proportion of the population served by 15 faith based in 10 countries ranged from 25‐60%, with an average of 43%. This figure indicates that public medicines supply systems do not cover the entire population and that faith‐based supply organizations are a necessary complement to public systems. (One was excluded from this calculation as it only supplied customers in other countries). Another key finding was that behave like small business entities, with either elected or nominated boards or committees to oversee their work. The majority of functions and the services offered were based on a mix of options, which was appreciated by customers and which allowed to be more flexible in their own operations. For example, choices were offered in procurement practices, supply and funding sources, methods of inventory control and quality control testing, delivery systems and methods of customer payments. The study highlighted areas of weakness in some ʹ systems. These included quality assurance, computerized drug management information and rational use of medicines policies. In a number of , lack of adherence to good storage, distribution and drug donation practices created inefficiencies that affected the ʹ sustainability and increased their operating costs. Some were hampered by having no business plan. During the feedback meeting, quality assurance was identified as the highest priority area in the action plan participants developed to improve performance. Only half the undertook regular quality control testing of the batches they procured and few retained batch samples for an agreed period of time. All reported that they were unable to carry out full GMP site inspections of their suppliers. Half the received drug donations for distribution to their customers free of charge, and the study revealed that these donations could create problems rather than responding to real needs. When communication and coordination between and donors were inadequate, inappropriate donations adversely affected supply management, storage and distribution. ʹ financial systems had to cope with unforeseen costs and the reduced revenues generated for their revolving drug funds. Overall customer feedback about services was positive, with all expressing their appreciation of the quality and price of products and the good personal relationships established. However, many customers indicated that only 0‐50% of the number of items and between 50‐100% of the quantities of items ordered were met by . The study showed that customers had multiple sources of supply besides supply services and that they supplemented their stocks with government supplies or buying from private wholesalers. To improve performance, all customers interviewed indicated that they needed to be offered a wider range of medicines and quantities. They wanted more information‐sharing on current prices and quantities of products in stock, and improved delivery services. All the customers indicated the need for technical assistance and supervisory visits to improve their management of medicines at health care facility level. Also requested were in service training courses on prescribing, dispensing and rational use of medicines, especially ARVs, and on drug supply management, quality issues, stock control and estimating drug needs. Government representatives greatly appreciated faith‐based ʹ contribution to supply systems. However, they indicated room for improvement in formal reporting and collaboration between and their respective ministries of health, and for better drug donation policies. Licensing of by national drug regulatory authorities was identified as one major step towards official recognition and increased collaboration with governments.