@article {Mwencha399, author = {Marasi Mwencha and James E Rosen and Cary Spisak and Noel Watson and Noela Kisoka and Happiness Mberesero}, title = {Upgrading Supply Chain Management Systems to Improve Availability of Medicines in Tanzania: Evaluation of Performance and Cost Effects}, volume = {5}, number = {3}, pages = {399--411}, year = {2017}, doi = {10.9745/GHSP-D-16-00395}, publisher = {Global Health: Science and Practice}, abstract = {Investments in a national logistics management unit and electronic logistics management information system resulted in better data use and improvements in some, but not all, management practices. After 1 year, key improvements included reduced stock-out rates, stock-out duration, and expiry rates. Although the upgraded systems were not inexpensive, they contributed to greater system efficiency and generated modest savings that defrayed much of the investment and maintenance costs.Background: To address challenges in public health supply chain performance, Tanzania invested in a national logistics management unit (LMU) and a national electronic logistics management information system (eLMIS). This evaluation examined the impact of those 2 key management upgrades approximately 1 year after they were introduced.Methods: We used a nonexperimental pre-post study design to compare the previous system with the upgraded management system. We collected baseline data from August to November 2013. We conducted round 1 of post-implementation data collection during April and May 2015, about 1 year after implementation of the upgrades. We evaluated key indicators of data use and reporting; supply chain management practices such as storage and supervision; supply chain performance including stock-out and expiry rates; and supply chain cost and savings. We analyzed the data using a range of techniques including statistical testing of baseline and round-1 results, and cost, cost-effectiveness, and return on investment analysis.Results: The upgrades were associated with improvements in data use, accessibility, visibility, and transparency; planning, control, and monitoring; support for quantification; stock-out rates; stock-out duration; commodity expiry; and forecast error. The upgraded system was more costly, but it was also more efficient, particularly when adjusting for the performance improvements. The upgrades also generated substantial savings that defrayed some, but not all, of the investment costs.Conclusion: Upgrades to Tanzania{\textquoteright}s supply chain management systems created multiple and complex pathways to impact. One year after implementation, the LMU and eLMIS brought about performance improvements through better data use and through improvements in some, but not all, management practices. Furthermore, the upgrades{\textemdash}while not inexpensive{\textemdash}contributed to greater system efficiency and modest savings.}, URL = {https://www.ghspjournal.org/content/5/3/399}, eprint = {https://www.ghspjournal.org/content/5/3/399.full.pdf}, journal = {Global Health: Science and Practice} }