title: Costing the supply chain for delivery of ACT and RDTs in the public sector in Benin and Kenya.
abstract: BACKGROUND
  Studies have shown that supply chain costs are a significant proportion of total programme costs. Nevertheless, the costs of delivering specific products are poorly understood and ballpark estimates are often used to inadequately plan for the budgetary implications of supply chain expenses. The purpose of this research was to estimate the country level costs of the public sector supply chain for artemisinin-based combination therapy (ACT) and rapid diagnostic tests (RDTs) from the central to the peripheral levels in Benin and Kenya.
  
  
  METHODS
  A micro-costing approach was used and primary data on the various cost components of the supply chain was collected at the central, intermediate, and facility levels between September and November 2013. Information sources included central warehouse databases, health facility records, transport schedules, and expenditure reports. Data from document reviews and semi-structured interviews were used to identify cost inputs and estimate actual costs. Sampling was purposive to isolate key variables of interest. Survey guides were developed and administered electronically. Data were extracted into Microsoft Excel, and the supply chain cost per unit of ACT and RDT distributed by function and level of system was calculated.
  
  
  RESULTS
  In Benin, supply chain costs added USD 0.2011 to the initial acquisition cost of ACT and USD 0.3375 to RDTs (normalized to USD 1). In Kenya, they added USD 0.2443 to the acquisition cost of ACT and USD 0.1895 to RDTs (normalized to USD 1). Total supply chain costs accounted for more than 30% of the initial acquisition cost of the products in some cases and these costs were highly sensitive to product volumes. The major cost drivers were found to be labour, transport, and utilities with health facilities carrying the majority of the cost per unit of product.
  
  
  CONCLUSIONS
  Accurate cost estimates are needed to ensure adequate resources are available for supply chain activities. Product volumes should be considered when costing supply chain functions rather than dollar value. Further work is needed to develop extrapolative costing models that can be applied at country level without extensive micro-costing exercises. This will allow other countries to generate more accurate estimates in the future.
authors: Systems for Improved Access to Pharmaceuticals and Services (SIAPS), Management Sciences for Health (MSH), 4301 North Fairfax Drive, Suite 400, Arlington, VA, 22203, USA. Rima.shretta@ucsf.edu.|Global Health Group, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, 94158, USA. Rima.shretta@ucsf.edu.|Swiss Tropical and Public Health Institute, Socinstrasse 57, PO Box 4002, Basel, Switzerland. Rima.shretta@ucsf.edu.|University of Basel, Petersplatz 1, 4001, Basel, Switzerland. Rima.shretta@ucsf.edu.
authors: Rima
authors: R
authors: Shretta
authors: William Davidson Institute (WDI), University of Michigan, 724 East University Avenue, Ann Arbor, MI, 48109, USA. bgjohn@umich.edu.
authors: Brittany
authors: B
authors: Johnson
authors: William Davidson Institute (WDI), University of Michigan, 724 East University Avenue, Ann Arbor, MI, 48109, USA. lisacsmi@umich.edu.
authors: Lisa
authors: L
authors: Smith
authors: Systems for Improved Access to Pharmaceuticals and Services (SIAPS), Management Sciences for Health (MSH), 4301 North Fairfax Drive, Suite 400, Arlington, VA, 22203, USA. sdoumbia@msh.org.
authors: Seydou
authors: S
authors: Doumbia
authors: Swiss Tropical and Public Health Institute, Socinstrasse 57, PO Box 4002, Basel, Switzerland. d.desavigny@unibas.ch.|University of Basel, Petersplatz 1, 4001, Basel, Switzerland. d.desavigny@unibas.ch.
authors: Don
authors: D
authors: de Savigny
authors: Ross School of Business, University of Michigan, 701 Tappan Street, Ann Arbor, MI, 48109, USA. anupindi@umich.edu.
authors: Ravi
authors: R
authors: Anupindi
authors: William Davidson Institute (WDI), University of Michigan, 724 East University Avenue, Ann Arbor, MI, 48109, USA. yadavp@umich.edu.|Ross School of Business, University of Michigan, 701 Tappan Street, Ann Arbor, MI, 48109, USA. yadavp@umich.edu.|School of Public Health, University of Michigan, Ann Arbor, MI, 48109, USA. yadavp@umich.edu.
authors: Prashant
authors: P
authors: Yadav
mesh_terms: D000962:Antimalarials / Q000191:economics / Q000600:supply & distribution; D037621:Artemisinins / Q000191:economics / Q000600:supply & distribution; D001541:Benin; D006297:Health Services Accessibility; D006801:Humans; D007630:Kenya; D017150:Public Sector / Q000191:economics; D011933:Reagent Kits, Diagnostic / Q000191:economics / Q000600:supply & distribution; D014186:Transportation / Q000191:economics
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D011933:Reagent Kits, Diagnostic; C031327:artemisinin
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