Primary healthcare facilities readiness for animal-related injuries: Availability, stock-Outs, and affordability of essential commodities in rural public health facilities, Tanzania
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Background
In Tanzania, reported cases for animal-related injuries is approximated to be 200-40,000, where most of deaths and complications from these cases are entirely preventable when safe, affordable and effective medications are available and administered in a timely manner.
Methodology/Principal findings
This study analyzed the availability, stockouts, and affordability of essential animal-related injury health commodities at primary healthcare (PHC) facilities in rural settings in Tanzania. A retrospective cross-sectional study was conducted in February 2024, using health facility data covering the period from 2019 to 2023. Availability, stockouts, and price of the selected 33 health commodities were extracted from hospital pharmaceutical ledgers at 29 selected public PHC facilities in Mkinga District, Tanga region comprising 26 dispensaries and three health centers. Affordability was calculated using the wage of the lowest-paid government worker per day approach. Overall availability remained below the WHO target of > 80% and dispensaries were more affected than health centers. Notable incremental availability was observed in 2023; however, differences were observed between dispensaries and health centers; snake antivenom (34.6% vs 100%), antirabies (23.1% vs 66.7%), adrenaline injection (73.1% vs 100%), and dexamethasone injection (0% vs 66.7%). Across the five years, dispensaries had more stockouts between 2019 and 2021, reporting up to a 53.8% stockout rate for chlorpheniramine tablets, with the longest stockout period of 218 days for an IV giving set in 2019. The health centers had higher stockouts between 2021 and 2022, reporting up to a 66.7% stockout rate for hydrocortisone injection in 2021 and the longest stockout period of 102 days for dexamethasone injection in 2020. Using the affordability threshold of 7% of daily income for healthcare expenditure, nearly all assessed commodities were classified as unaffordable.
Conclusions/Significance
Essential commodities for managing animal-related injuries remain inadequately available, frequently out of stock, and largely unaffordable in rural PHC facilities in Tanzania, particularly anti-rabies biologicals and snake antivenom. Strengthening surveillance, forecasting, procurement, financing, and supply chain systems, alongside expanding financial risk protection through health insurance and targeted subsidies, is essential to improve equitable access to life-saving commodities.
Author Summary
Most of deaths and complications from animal-related cases are entirely preventable when safe, affordable and effective medications are available and administered in a timely manner. In this study we analyzed availability, stockout and affordability of the of essential animal-related injury health commodities at primary healthcare facilities in rural settings in Tanzania. Essential health commodities for managing animal-related injuries were available below the WHO-recommended target, with anti-rabies biologicals and snake antivenoms showing the poorest availability. Frequent and prolonged stockouts, particularly in dispensaries, substantially limited continuous access to life-saving medicines and medical supplies for animal-related injuries. Nearly all assessed commodities were unaffordable using the lowest-paid government worker benchmark, highlighting the need to strengthen supply chain systems, forecasting, and sustainable financing to improve equitable access.
