| dc.description.abstract |
Health care forms a large economic sector in all countries, and procurement of medicines
and other essential commodities necessarily creates economic linkages between a
country's health sector and local and international industrial development. These
procurement processes may be positive or negative in their effects on populations' access
to appropriate treatment and on local industrial development, yet procurement in low and
middle income countries (LMICs) remains under-studied: generally analysed, when
addressed at all, as a public sector technical and organisational challenge rather than a
social and economic element of health system governance shaping its links to the wider
economy. This article uses fieldwork in Tanzania and Kenya in 2012-15 to analyse
procurement of essential medicines and supplies as a governance process for the health
system and its industrial links, drawing on aspects of global value chain theory. We
describe procurement work processes as experienced by front line staff in public, faithbased and private sectors, linking these experiences to wholesale funding sources and
purchasing practices, and examining their implications for medicines access and for local
industrial development within these East African countries. We show that in a context of
poor access to reliable medicines, extensive reliance on private medicines purchase, and
increasing globalisation of procurement systems, domestic linkages between health and
industrial sectors have been weakened, especially in Tanzania. We argue in consequence
for a more developmental perspective on health sector procurement design, including
closer policy attention to strengthening vertical and horizontal relational working within
local health-industry value chains, in the interests of both wider access to treatment and
improved industrial development in Africa. |
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