CLICK TO ADD TITLE [DATE][SPEAKERS NAMES] The 5th Global Health Supply Chain Summit November , 2013 Addis Ababa, Ethiopia Understanding Distribution of Medicines to Private Sector Drug Shops and Pharmacies Prashant Yadav

Understanding Distribution of Medicines to Private Sector Drug Shops and Pharmacies Prashant Yadav, Jessica Cohen, Jean Arkedis, Sarah Alphs, Pete Larson, Julius Massaga, Oliver Sabot

3 Tanzania: Understanding Remote Distribution N = 356 accredited drug shops Inventory and stock audits every other month for 12 months

How do the drug shops obtain their medicines? 4

5 Where do the drug shops obtain their medicines?

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Joint work with Pete Larson8 Road, trade networks and product availability

9 Source: Yadav P, J. L Cohen, S. Alphs, J. Arkedis, P. L Larson, J. Massaga and O. Sabot. Trends in availability and prices of subsidized ACT over the first year of the AMFm : evidence from remote regions of Tanzania, Malaria Journal 2012, 11:299 Understanding product diffusion in remote areas

Source: P.S. Larson, P. Yadav, J. L Cohen, S. Alphs, J. Arkedis, J. Massaga Stocking Patterns, Market Competition, and Customer Demand of Subsidized ACTs in Private Drug Shops in Tanzania. 2012

Traditional measures of competition do not help understand stocking behavior 11 Source: P.S. Larson, P. Yadav, J. L Cohen, S. Alphs, J. Arkedis, J. Massaga Stocking Patterns, Market Competition, and Customer Demand of Subsidized ACTs in Private Drug Shops in Tanzania Traditional measures of competition do not help understand stocking behavior

12 Competition/Wholesaler Network. Colors represent city of supplier, size represents degree of centrality (number of connections each shop has with other shops through perceived competition) Source: P.S. Larson, P. Yadav, J. L Cohen, S. Alphs, J. Arkedis, J. Massaga Stocking Patterns, Market Competition, and Customer Demand of Subsidized ACTs in Private Drug Shops in Tanzania New models for understanding retail competition in a network

13 Source: P.S. Larson, P. Yadav, J. L Cohen, S. Alphs, J. Arkedis, J. Massaga Stocking Patterns, Market Competition, and Customer Demand of Subsidized ACTs in Private Drug Shops in Tanzania New models for understanding retail competition in a network

Other issues impacting private sector medicine availability and price

15 Source: Joint study with CHAI and UNZA in Zambia Understanding retail competition (or lack of)

16 P value = Study of over 100 outlets in 4 districts in Zambia Retail competition impacts retail markups and thus sales volume Stocking your product in a wider number of retail outlets helps reduce retail markups

Manufacturer Importer/ Distributor (URBAN) Retail WholesalerSub -Wholesaler (RURAL) Retail Wholesaler distributes Incentivizing distributors to distribute to underserved markets Many new models such as Consolidated drop-off point, Van sales, Coca-Cola like MDC allow wholesaler distribution to small shop clusters at reasonable costs Demand aggregation with technology

18 Access to capital constraints at the retail level P. Yadav, L. Smith & S. Alphs Enhancing Access to Medicines through Innovations in Working Capital Financing for Drug Shops. Technical report for SDSI, MSH

Manufacturer Importer/ Distributor (URBAN) Retail WholesalerSub -Wholesaler (RURAL) Retail Days Letter of Credit Delivery - 30 Days CreditCash &Carry / Cash Van Sales Higher Working Capital Needs Lower Product Availability Higher Prices Lower Sustainability Lack of working capital in the overall system