Figure 1
Nature of the pharmaceutical system showing the position of faith-based healthcare providers
Table 1
Research inclusion and exclusions
| Inclusion | Exclusion |
|---|---|
| Discuss the nature and function of FB-DSOs in pharmaceutical supply chain | Discuss FBHPs in healthcare but not pharmaceutical supply chain |
| Contains information on drug financing, access, regulation, and human resources in FB-DSOs pharmaceutical supply chain | FB-DSOs and government pharmaceutical supply chain considered as one entity |
| Africa | Outside Africa |
| English | Non-English |
Table 2
Geographic distribution of included studies (Source: Author)
| Region | Number | Distribution within region |
|---|---|---|
| West Africa | 11 | Burkina Faso (1), Ghana (6), ivory coast (1), Mali (1), Nigeria (2), |
| Southern Africa | 7 | Malawi (4), South Africa (1), Zambia (2) |
| East Africa | 4 | Kenya (1), Uganda (4), Rwanda (1), Tanzania (1) |
| Central Africa | 5 | Cameroon (3), Democratic Republic of Congo (2) |
[i] Note. Some studies reported on more than once country, hence the disparity in number.
Table 3
Summary of included studies (N=20)
| Reference | Country / region | Role/position in pharmaceutical supply chain | Themes Financing | Access, affordability, and availability | Regulation and quality assurance | Human resource and training | Stock outs |
|---|---|---|---|---|---|---|---|
| Lambert et al. 1984 | Ghana | Dispensing, procurement | Donor funding, drug sales | Supply in rural areas | |||
| Asenso-Okyere 1995 | Ghana | Medicines supplied in rural areas | Poor do not pay for medicines | ||||
| Gilson et al 1995 | Tanzania | Dispensing | Not specified | High stock levels of medicines and medical supplies, no contraceptives | Understaffed | Irregular supply of vaccines | |
| Grimaud 1998 | Ivory Coast | Dispensing | Consultation fees, drug sales, reduced government support donor support | Decrease in patient turn out due to high cost | Drug shortages | ||
| Aids action 1999 | Burkina Faso | Procurement dispensing | Donor funding | ARVs and related medicines dispensed for free | |||
| Kawasaki et al. 2002 | Kenya, Uganda | Procurement, supply | Donor funding, medicines sales | Good stock level, better access, expensive | Training by MEDS | ||
| Andrews 2004 | Ghana | Procurement, dispensing | Dispense for free for poor, dispense at affordable cost | Adheres to prescribing regulation | |||
| Banda et al. 2006 | Multi-country | Supplied in rural areas | Donor funding, medicine sales | Medicines dispensed at affordable cost or free | Non-compliance with drug regulatory body | ||
| Lum et al. 2007 | Nigeria | ART, related medicines supply, home care visit | Donor funding | Medicines supplied for free | |||
| Ballou Allou-Aaeres et al. 2008 | Ghana, Zambia | Dispensing | Donor funding, Government support, medicines sale | Medicines supply in rural areas at no cost | |||
| Carlucci et al. 2008 | Zambia | Dispensing | Government support, donor funding | Supply ART free | |||
| Njozing et al. 2010 | Cameroon | Dispensing | Medicines sale | Supply ART and Cotrimoxazole | |||
| Rookes 2010 | Developing countries | Dispensing | Donor funding, government support, medicines sale | Medicines supplied at no cost | Irregularity of medicines supply | ||
| McCabe et al. 2011 | Ghana, Malawi, Mali | Procurement, dispensing | Donor funding, government, medicines sale | Supply drugs free, co-payment by medical insurance schemes | |||
| EPN 2016 | Africa | Capacity building, advocacy | Supply medicines and related commodities to faith-based and public facilities at affordable cost | Quality assurance testing, on adherence to treatment guidelines | Training of pharmacy staff | ||
| Kareen Shawa-Durand 2017 | Africa | Training | Improved access to medicines due to increase trained personnel | Training of pharmacy personnel | |||
| Khuluza et al. 2017 | Malawi | Procurement, dispensing | Donor funding, medicines sales | High stock level, free medicines for poor, drug costly | Pass quality assurance test | Low stock of antibiotics, stocks out of quinine injection | |
| Khuluza et al. 2017 | Malawi | Quality assurance testing | Pass quality assurance test | ||||
| Kibira et al. 2017 | Uganda | Stock level | Medicines sales | Medicines are supplied at a lower price than in government facilities | High number of stock outs | ||
| Petersen et al. 2017 | LMIC/multi-County | Quality assurance testing | Donor funding | Falsified and substandard antimalarial medicines found in Cameroon, DRC and Nigeria private sectors | Training of pharmacy personnel |
Figure 2
Search flow chart
Table 4
Faith-based drug supply organizations in Africa
| Name of network/organization and country | Date of establishment | Ownership | Known pharma supply (default self-estimated market share of linked facilities) | Funding sources (all partial) | References |
|---|---|---|---|---|---|
| Eglise du Christ au Congo-Direction des Oeuvres Médicales (ECC-DOM) DRC | 1971 | Protestant medical mission | 40% health services in DRC | Not specified | Aembe et al 2017 |
| Zimbabwe Association of Churches related Hospitals (ZACH) Zimbabwe | 1974 | Head of Christian denominations | Provides 45% of healthcare services | Donations, user fees and sale of medicines | Gwati 2015 |
| Bureau des Formations Médicales Agréées duRwanda(BUFMAR) Rwanda | 1975 | Catholic and Protestant Churches | Provides ~35% of healthcare in Rwanda | Donations, government | Mustapha et al 2009 Schmid et al 2008 |
| Christian Health Association of Sierra Leone (CHASL) Sierra Leone | 1975 | Head of Churches in Sierra Leone | Provides 30% of healthcare services | Donations, drug sales | Witter et al 2012 |
| Christian Health Association of Nigeria (CHAN Pharm) Nigeria | 1979 | Catholic Bishop’s Conference, Christian Council of Nigeria, Northern Christian Medical Advisory Council | 6 drug depots [400 mission hospitals, 4000 PHC facilities] | Donations, wholesales of essential medicines & supplies | Odumosu et al 2009 Larbi et al 2004 |
| Joint Medical Stores (JMS) Uganda | 1980 | Uganda Catholic Medical Bureau (UCMB) & Uganda Protestant Medical Bureau (UPMB) | 44 dispensaries | Donations, government, drug sale | Reinikka et al 2010 Kawasaki et al 2002 |
| Catholic Drug Centre (CDC) Ghana | 1983 | Ghana Catholic Bishops Conference, Christian Council of GhanaGhana Pentecostal Council | Supply medicines to 36 hospitals and 78 clinics | Donations, drug sales, mark-ups | Dimmock et al 2017 Gilson et al 1995 McCabe et al 2011 |
| Mission for Essential Drugs and Supplies (MEDS) Kenya | 1986 | Christian health association of Kenya (CHAK) & Kenya Episcopal Conference (KEC) | 680 dispensaries | Donations, government, drug sales | Kawasaki et al 2002 Blevins et al 2014 |
| Christian Social Services Commission (CSSC) Tanzania | 1992 | Tanzania Episcopal Conference (TEC) and Christian council of Tanzania (CCT) | 697 dispensaries | Donations, drug sales | Häfele-Abah & Neuhann 2010, Samwel 2015 |
| Eglise évangélique du Cameroun, (EEC) Cameroon | 1994 | Evangelical Church of Cameroon | Serve 39 dispensaries | Not specified | Yadav et al 2011 |
| Affordable medicines for Africa (AMFA) South Africa | 1997 | No evidence | AMFA work in partnership with RTT in providing medicines and related services for communities and townships outside cape town | Owens et al 2009 | |
| Christian Health Association of Zambia (CHAZ) Zambia | 1999 | Medical Committee of the Christian Council of Zambia and the health department of the Zambia Episcopal Conference | [40% of healthcare in Zambia] | Donations, drug sales | Yadav 2007 Ballou-Aaares et al 2008 |
| Christian Health Association of Malawi (CHAM) Malawi | 2000 | Catholic and Protestant Churches in Malawi | 12 dispensaries | Donations, In-country resource mobilization, drug sale | Khuluza et al 2017 Gilson et al 1995 |
[i] Note. The text in italics are estimates based on facility coverage. Due to limited data, we were unable retrieve validated data on actual coverage for some FB-DSOs.
Figure 3
Mapping of DSOs in Africa
Table 5
Dispensaries served by public and FB-DSOs
| Country | FB-DSOs dispensaries |
|---|---|
| Kenya | 680 |
| Malawi | 12 |
| Rwanda | 39 |
| Tanzania | 680 |
| AIDS | Acquired Immune Deficiency Syndrome |
| AMFA | Affordable Medicine for Africa |
| ART | Antiretroviral therapy |
| BUFMAR | Bureau des Formations Médicales Agréées du Rwanda |
| CCT | Christian council of Tanzania |
| CDC | Catholic drug centre |
| CHA | Christian Health Association |
| CHAG | Christian Health Association of Ghana |
| CHAK | Christion Health Association Kenya |
| CHAM | Christian Health Association of Malawi |
| CHAN | Christian Health Association of Nigeria |
| CHASL | Christian Health Association of Sierra Leone |
| CHAZ | Christian Health Association of Zambia |
| KEC | Kenya Episcopal Conference |
| CINAHL | Cumulative Index to Nursing and Allied Health Literature |
| CSSC | Christian Social Services Commission |
| DRC | Democratic Republic of Congo |
| ECC-DOM | Eglise du Christ au Congo - Direction des Oeuvres Médicales |
| EEC | Eglise évangélique du Cameroun |
| EPN | Ecumenical Pharmaceutical Network |
| FBHPs | Faith-based health care providers |
| FB-DSO | Faith-based Drug Supply Organization |
| HIV | Human immunodeficiency virus |
| JMS | Joint medical stores |
| LMIC | Low and middle-income countries |
| MEDS | Mission for essential drugs and supplies |
| NGO | Non-governmental organisation |
| PFP | Private-for-profit |
| PNFP | Private-not-for-profit |
| SDG | Sustainable Development Goal |
| TEC | Tanzania Episcopal Conference |
| TRIPS | Trade Related Aspects of Intellectual Property |
| WHO | World Health Organisation |
| ZACH | Zimbabwe Association of Churches Health Services |