From Pharma to Informal Providers: Understanding the Drug Supply Chain in Chakaria, Bangladesh

Presenter: M. Hafizur Rahman, Johns Hopkins School of Public Health

Abstract

Background Drug detailers (also called medical representatives) are an important yet poorly understood link in the drug supply chain in many developing countries. In Chakaria, a rural subdistrict of Bangladesh, drug detailers mediate the distribution of drugs between manufacturers and healthcare providers, both informal and formal. Little is known about their role in the drug supply chain, including their impact in distributing medication, introducing new drugs to the market, and defining pharmaceutical uses. This study aims to describe the training, knowledge, practices, incentives and sources of drug among drug detailers, and informal and formal providers. The study will also describe the distribution of drug detailers in Chakaria, their interactions with informal and formal providers, and drug cost variations between the manufacturer and the patient.

Methods This study will be conducted in Chakaria from December 28th, 2008 through January 20th, 2009 in collaboration with the Future Health Systems (FHS) research consortium at Johns Hopkins Bloomberg School of Public Health and our in-country partner, the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B).

Focus Group Discussions and In-depth Interviews will be conducted with drug detailers, informal providers (village doctors, drug vendors, traditional birth attendants, and traditional healers) and formal providers in 5-8 villages as well as select urban areas in Chakaria. We will perform content analysis of written materials distributed by drug detailers to healthcare providers as well as systematic cataloguing of cost and medication types as provided by drug detailers, informal and formal providers. Locations of drug detailers will be recorded using hand held GPS units. Location coordinates and survey results will be merged using Geographical Information Systems (GIS) software to produce maps of drugs and drug detailer distribution in Chakaria. Data will be analyzed using standard statistical software including ATLAS.ti or Ethnograph. Changes in drug prices in the supply chain from pharmaceutical companies to drug detailers to informal and formal providers will be analyzed using statistical spreadsheets.

Results The findings from the qualitative and quantitative analyses will be summarized under each of the study objectives, and will be presented at the conference addressing the research questions of the study.

Conclusions Knowledge gained about the role of drug detailers in the pharmaceutical supply chain will help design a larger study as well as intervention to formulate locally feasible strategies to improve practice of drug detailers, and ensure safe and cost-effective pharmaceutical access by the poor in rural Bangladesh.