An assessment of the Influence of procurement methods on medicine prices in Burundi. A cross-sectional study

An assessment of the Influence of procurement methods on medicine prices in Burundi. 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A cross-sectional study Ernest Bizabishaka, François Niragire This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8307258/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The increasing of medicine prices particularly in low and middle income countries is currently a concern in the health care sytem. In Burundi, to make medicines available and accessible at the right prices, centralized procurement methods have been implemented, however, despite much effort in improving the access of medicines in the public health facilities, the accessibility and affordability of medicines throughout the whole country remains a major challenge. This study sought to assess the influence of procurement methods on medicine prices in Burundi. Methods This study adopted a quantitative cross-sectional design. A data collection form was used to collect data and the SPSS was used to analyse data and determine the relationship between medicine prices and procurement methods. Results The descriptive statistics showed the median of $ 0.0376 indicating that 50% of medicine cost less than 0.0376, suggesting a skewed distribution with generally low prices. The high standard deviation of $ 0.2942 and a range of $ 1.30034 between the minimum ( $ 0.00133) and maximum ( $ 1.30167) prices revealed a large variability of medicine prices, highlighting a significant difference between the types of medicines. Findings from multivariate logistics regression revealed that there was signifance relationship between procurement methods and medicine prices. The Odds Ratios (OR) of 0.10 in centralized method and p-value of 0.003 showed that medicines procured by centralized procurement method were 90% less likely to fail to meet the right price compared to medicine procured by decentralized procurement method. Conclusion The results from study revealed that the centralized procurement method is the method allowing the Health Districts to procure the medicines with the right price comparing to the medicine prices from decentralised method. Procurement procedures Procurement methods centralized method decentralized method Background The increasing of medicine prices particularly in low and middle-income countries is currently a major concern for its effect on accessibility to quality public health care[ 1 ] [ 2 ]. A study conducted by Health Action International in Burundi showed that the prices of basic medicines, notably medicines used in the Sexually Transmitted Infections treatment (STIs) still high, especially in the private sectors[ 3 ]. The results of Elissa Levenger et al revealed that the medicine prices in Burundi still significantly expensive with the average of 54% higher than the international reference for the medicine procured by unplanned orders while the prices of medicine procured using international tendering varied overall from 8% to above international reference prices[ 4 ]. In Kenya, the study conducted by WHO found that overall private sector prices were 36% higher than those in the public sector. The findings of Dr.Thomas BIZIMANA et al in Rwanda showed that the prices of generic medicines in the public sector and faith-based health facilities were remarkably low with median price ratios of 1.0 while in the private sector the median prices were twice as high in comparison to the international procurement prices[ 5 ]. Surveys carried out in India have shown that the prices of medicines in the public sector was very advantageous compared to the prices in the private sector where the prices were almost twice as high as the international reference prices[ 6 ]. Several factors including pharmaceutical pricing policies, regulatory approach, pharmaceutical tendering, trading strategies of either buyers or sellers, etc were identified influencing the medicine prices[ 7 ] [ 8 ]. One way to increase the efficiency and the effectiveness of medicine procurement is the choice between a centralization procurement method where there is a central body in charge of handling the procurement activity for local units and a decentralization procurement method, where local units procure on their own[ 6 ]. In Burundi, one of the strategies adopted to ensure medicine availability with the right price was the implementation of centralized procurement methods from peripheral level to the central level with possibility to use the decentralized method in accordance with the public procurement procedures[ 9 ] [ 10 ] [ 11 ]. Despite all these strategies in place, the main objective to make medicine available, accessible with the right prices still not achieved in Burundi. Indeed, while the objective set by the Health Sector Strategy (2021–2027) sets the availability rate of essential medicines at 80% and tracer medicines at 85% [ 12 ], the statistical yearbook 2023 published in 2024 indicates that, the average of order fulfilment rate from Burundi Medical Procurement Center was 58.8% for essential medicines and 66% of tracer medicines[ 13 ]. This low order satisfaction rate by Burundi Medical Procurement Center leads public health facilities to procure medicines from private wholesale pharmacies using different methods mainly Request for Quotation[ 11 ] [ 14 ]. Although each method has advantages and disadvantages, studies realized in some countries have shown that the centralized method is more advantageous than the decentralized method. Tanzania’s experience showed that even health procurement system is mostly hybrid; centralized procurement system is the best method allowing public sectors to procure medicine with right prices[ 15 ]. Studies carried out by Simona Baldi in Italy hospitals[ 6 ], Githinji et al in Kenya[ 7 ], Wouters et al In South Africa[ 8 ] showed that the centralized and the open tendering methods had a significant influence on the medicine prices decrease. In Burundi, there has not been currently an investigation to establish the relationship between procurement methods and medecine prices. It is for this reason that we realized a present study assessing the relationship between procurement methods and medicine prices in Burundi Health Districts”. Methods Design and location This study adopted a cross-sectional approach. The Burundi Health Districts playing the intermediate role between the central level and health facilities by procuring medicines directly from Burundi Medical Procurement Center or from private wholesale pharmacies, they were choisen as study area. Study population and sample The target population for this study was the 44 tracer medines listed on National List of Essential Medicines, last version was reviewed in 2022[ 16 ]. The choice of these medicines was motivated by the fact that they are essential and mandatory health products that must not be out of stock in health facilities. Among the 44 tracer medicines, we retained 38 medicines (86.4%), the six medicines (13.6%) were excluded because of missing data. Data collection Prices and characteristcs of medicines procured by Health Districts were collected using data collection forms. Data from centralized procurement method were gathered from delivery notes and data from decentralized procurement method were gathered from invoices and purchase orders available in the Health Districts and at Burundi Medicine Regulation Authority (ABREMA). International Median prices of medicines studied were collected from the International Medical Products price Guide MSH-IRP[ 17 ]. The survey methods were based on the medicine price survey methodology WHO/HAI, 2008 second edition[ 18 ]. The data collection was conducted from February 10, 2025 to March 3, 2025. From the purchase orders and delivery notes, we extracted the information of the tracer medicines procured by the Health Districts from January1, 2025 to January 31, 2025. This period was chosen because it preceded the active distribution made by CAMEBU after which the Health Districts are authorized to procure in private wholesale pharmacies for only the medicines out of stock at CAMEBU. The informations collected were the purchase unit prices, the characteristics of medicine and the procurement method used. II.4. Data management and analysis Before data analyzing, data checking during and after collection was done to ensure data quality. Data were first cleaned and entered in Excel on daily based. Using SPSS version 21, descriptive analysis was done to present distribution of the variables whereas logistic regression was applied to assess the significance relationship between dependent and independents variables. II.5. Variables and their measurement The independent variables in our case were the procurement methods and the characteristics of the medicines procured. In accordance with MSH-IRP[ 17 ], the unit medicine prices from centralized and decentralized methods were calculated by dividing the drug pack-selling price by the smallest unit of measurement. The dependent variable in this study was medicine prices at the reference level. Basing to the WHO formula, the Price Performance ratio level= ((Average price paid for a product) / (International reference price of the same product)) X 100. In accordance with WHO, the ratio equal or less to 105% is the right price whereas the ratio greater than 105% is the high[ 19 ]. To facilitate the comparison and interpretation, the local unit for each tracer medicine prices from both centralized and decentralized methods were converted into US dollars by division of the official exchange rate of the first day of data collection (2944.6805 exchange rate of February 10, 2025)[ 20 ]. Results Table 1 Medicine distribution by characteristics Medicine distribution by characteristic Frequency Percentage Form Tablet 11 28,9% Capsule 1 2,6% Inhalation 1 2,6% Injectable 17 44,7% Sirup 5 13,2% Solution 2 5,3% Supositories 1 2,6% Total 38 100% Medicine Administration mode Externe 1 2,6% Injectable 14 36,8% Orale 23 60,5% Total 38 100% Therapeutic class Not anti-infectious 22 57,9% Anti-infectious 16 42,1% Total 38 100% Procurement methods Centralised 24 63,2% Decentralised 14 36,8% Total 38 100% According the right price Not Rigth price 18 47,4% Rigth price 20 52,6% Total 38 100% Table 1 presents the medicine distribution by characteristics. We note that the injection form is predominant, representing 44.7%. Tablets follow with 28.9%, while other forms, such as syrup represent (13.2%) and solutions have lower numbers (5.3%). Less common forms, such as capsules and suppositories, each represent 2.6%, suggesting that they are not frequently used. For administration mode, the oral administration predominates with 60.5%, which indicates a marked preference in health facilities. The injection follows with 36.8%, suggesting that it is also commonly more used, particularly for treatments requiring rapid or effective absorption. On the other hand, the external administration is very poorly represented, reaching only 2.6%. Concerning distribution by therapeutic class, the main cause of death in Burundi being the infectious diseases (malaria, diarrheal diseases, HIV, tuberculosis) representing 63%[ 21 ], the anti-infectious and not anti-infectious medicines are two classes condered. In the table, it can be seen that 42.1% of tracer medicines procured are medicines used to treat infectious diseases and 57.9% of medicines are not used to treat infectious diseases. This distribution highlights the importance of the procurement of medicines adapted to the treatment needs of infectious diseases, while emphasizing the need to evaluate the resources allocated to the purchase of these types of medicines. For procurement methods, the Table 1 , shows that the centralized procurement method is predominant, with 63.2%, which suggests a trend towards a centralized system for medicine supply and distribution in Burundi Health Districts. The decentralized method representing 36.8% indicates that the stock shortage at CAMEBU conducting the public health facilties to procure medicines in private wholesale pharmacies. This procurement methods can have important implications on logistical efficiency, availability, accessibility, affordability and quality of medicines and ultimately the quality of health care provided to populations. A thorough understanding of these methods is essential to optimize the management of medical resources. Finally, the distribution of medicine by price shows that 47.4% of medicines do not meet the right price, while 52.6% of medicines comply with right price. This indicates that approximately 50% of the medicines studied are sold at a price that could be considered non-affordable according to WHO criteria. Table 2 Descriptive statistics of medicine prices Statistic Price in USD Number of medicines 38 Mean price .1513077 Median price .0375952 Standard deviation(SD) .29421480 Interval 1.30034 Minimum .00133 Maximum 1.30167 Table 2 presents descriptive statistics of 38 medicine prices studied. The median of $ 0.0376 indicates that 50% of medicine cost less than 0.0376, suggesting a skewed distribution with generally low prices. The high standard deviation of $ 0.2942 and a range of $ 1.30034 between the minimum ( $ 0.00133) and maximum ( $ 1.30167) prices reveal a large variability in prices, highlighting significant differences between the types of medicine. These results highlight the issues of price differences, affordability, and could help understand the factors influencing price variations in the context of medicine procurement. Table 3 Distribution of the studied medines according to the right price recommended by WHO. Medicine Characteristics Compliance with the right price proposed by WHO Yes Non Frequency % Frequency % Form Tablet 6 54,5% 5 45,5% Capsule 0 0% 1 100% Inhalation 0 0% 1 100% Injectable 11 64,7% 6 35,3% Sirup 2 40% 3 60% Solution 0 0,0% 2 100% Supositories 1 100% 0 0% Administration mode Externe 0 0% 1 100% Injectable 9 64,3% 5 35,7% Orale 11 47,8% 12 52,2% Therapeutic class Not anti-infectious 14 63,6% 8 36,4% Anti-infectious 6 37,5% 10 62,5% Procurement methods Centralised 17 70,8% 7 29,2% Decentralised 3 21,4% 11 78,6% Table 3 presents the distribution of the studied medines according to the right price. For medicine form, tablets show good compliance with 54, 5% against 45, 5% non-compliant, while capsules and inhalations do not meet the standards of right price. Injectables display acceptable performance with 64,7% compliant and 35,3% non-compliant. The syrups reveal a mixed situation, with 40% right price and 60% non-right price. The solutions are completely non-compliant, and the suppositories completely meet the conition of right price. Overall, these results highlight significant disparities in the financial accessibility of medicines depending on the form, highlighting the importance of improving compliance with standards to guarantee better access to treatments. Regarding administration mode, external medicines do not meet the right price standards at all, while injectables and oral medicines show mixed results respectively 64.3% and 47.8%. For therapeutic class, it is notable that medicine not related to infectious diseases show a compliance rate of 63.6%, while medicine related to anti-infectious meet only 37.5% of the standard, with 62.5% failing to meet it. Overall, 52.6% of medicines according therapeutic class met the standard, revealing a significant disparity between treatments and highlighting the need to improve compliance to ensure better access to infectious disease treatments. For procurement methods, the results show that the medicine procured by centralized procurement method are largely procured with the right price, with 70.8%, with only 29,2% failing to meet the right price while decentralized procurement method shows a much lower compliance rate of just 21.4%, with 78.6% failing to meet the right price. In total, 52.6% of medicines are procured with right price, highlighting the superior effectiveness of centralized procurement method and highlighting the need to improve decentralized supply practices to ensure better access and compliance with price standards. Table 4 Multivariate logistic regression of factors influencing medicine prices Characteristic OR 1 95% CI 1 p-value Medicine Form 0.5 Capsule — — Others 1.94 0.27, 15.4 Procurement method 0.003 Decentralised — — Centralised 0.1 0.02, 0.50 Therapeutic class 0.3 Anti-infectious — — Not anti-infectious 0.47 0.10, 2.23 Administration mode 0.2 Oral — — Others 0.33 0.05, 1.96 1 OR = Odds Ratio, CI = Confidence Interval The results of the logistic regression show that the medicine prices procured by Burundi Health Districts are strongly influenced by the procurement methods. The Odds Ratio (OR) of 0.1 of medicines procured by centralized method with a confidence interval of 0.02 to 0.50 and a p-value of 0.003 indicating that they are much more likely to comply with the right price than those procured by decentralized procurement method. This result means that medicines procured by centralized procurement method are 90% less likely to fail to meet the right price compared to medicine procured by decentralized procurement method. The p-value of 0.003 less than 0.05 underlines the statistical significance of this association, suggesting that procurement the medicine by centralized method is a suitable method to make medicines available at the right price. In contrast, other factors such as the medicine form (OR = 1.94, CI: 0.27–15.4), therapeutic class (OR = 0.47, CI: 0.10–2.23), and administration mode (OR = 0.33, CI: 0.05–1.96) with p-value above 0,005 means that their influence is not statistically significant, suggesting that these factors have no clear impact on medicine prices. This highlights the importance of favoring centralized procurement method to improve adherence to the medicine right price. Discussion Our findings were compared with other studies carried out in developed and developing countries. The findings are similar to the results of Simona Baldi in Italy [ 6 ], Wouters et al in South Africa[ 8 ], Githinji, M., & Moronge in Kenya[ 7 ] etc. Simona Baldi study found that the decentralization system in Italy conducted the supplying of medicine at expensive prices compared to centralized system. Wouters et al in South Africa and Githinji, M., & Moronge in Kenya, found the same results showing the significant difference between the prices of medicines procured using request for quotation methods and medicine procured using international tendering method. Both concluded that thanks to the economy of scale, suppliers and manifacturers were interested in the supplies quantity in reducing the prices of supplies (More quantity, the more suppliers and less price). These results are then similar to our results. Indeed, Burundi Medical Procurement Center by centralizing the needs of all health districts, it requests large quantities that interest several manufacturers and international suppliers and in this case, they offer the products at competitive prices following the economy of scale. Another reason that could explain the increase prices in the decentralized system is the speculation of local wholesale pharmacies that take advantage of the stock shortage at CAMEBU and sell at exorbitant prices. While this study provides very useful information, it also presents some limitations. The study was conducted in Health Districts with only tracer medicines, other medicines were not evaluated due to a lack of financial resources and insufficient time. Other possible biases was that there are some factors like political, fluctuation of local currency, etc. that can influence medicine prices, but due to the lack of official data, these factors remain difficult to assess. For this, a much more comprehensive study is required to investigate the causes of the high prices. Conclusion The study showed a signifant relationship between prices and procurement methods of medicines procured by health districts in Burundi. The data showed that the centralized method allowed the Health Districts to procure the medicine with right price compared to medicine procured by decentralised method. Given that the supply of medicines in private wholesale pharmacies is due to the stockout at Burundi Medical Procurement Center, we suggest that the centralized method can be strengthened by taking all possible measures so that the Burundi Medical Procurement Center has the possibility and capacity to supply all medicines to health facilities. This would improve the availability, accessibility, affordability, the security, and quality of medicines in Burundi. Abbreviations ABREMA Burundi Medicine Regulatory Authority CAMEBU Centrale d’Achat des Medicaments Essentiels du Burundi CI Confidence Interval FAO Food and Agriculture Organisation of the United Nations GDP Gross Domestic Product HD Health District MoH Ministry of Health MSH Management Sciences for Health OR Odds Ratios SCMS Supply Chain Management System SD Standard Deviation SPSS Statistical Package for Social Sciences STIs Sexually Transmitted Infections WHO Wolrd Health Organistion Declarations Ethics approval and consent to participate This study was authorized by the Ministry of Public Health in Burundi (Approval notice 630/7909/CAB/2024 of November 21, 2024). Consent for publication Not applicable. Availability of data and materials The data used in this study are included in the manuscript and dataset is available from the corresponding author upon reasonable request. Competing interests The authors declare that they have no competing interests. Funding No funding was received for writing and publishing this manuscript. Authors’ contributions EB and FN conceptualized the study and wrote this manuscript. EB performed data collection and their preliminary analysis. FN, and EB finalized the data analysis and critically reviewed the manuscript. All authors read and approved this manuscript for publication. Acknowledgments The authors gratefully acknowledge the support from the Masters of Health Supply Chain Management program that is offered by the East African Community Regional Center of Excellence for Vaccines, Immunization, and Health Supply Chain Management, College of Medicine and Health Sciences, University of Rwanda. The Center is funded by the German Federal Ministry for Economic Cooperation and Development (BMZ) through KfW Development Bank. References WHO, « Prices and accessibility of medicines in the Eastern Mediterranean Region ». 2007. G. Russo et B. McPake, « Medicine prices in urban Mozambique: a public health and economic study of pharmaceutical markets and price determinants in low-income settings », Health Policy and Planning , vol. 25, n o 1, p. 70‑84, janv. 2010, doi: 10.1093/heapol/czp042. Health Action International, « Baseline study on the measurement of prices, financial accessibility and availability of sexual and reproductive health products in Burundi ». Health Action International, 2023. Melissa Levenger, Tobey Busch, Pierre-Corneille Namahoro, et Claude Bahati, « Burundi National Supply Chain Assessment Results, Capability and Performance ». 2014. T. Bizimana, P. C. Kayumba, et L. Heide, « Prices, availability and affordability of medicines in Rwanda », PLoS ONE , vol. 15, n o 8, p. e0236411, août 2020, doi: 10.1371/journal.pone.0236411. S. Baldi et D. Vannoni, « The impact of centralization on pharmaceutical procurement prices: the role of institutional quality and corruption », Regional Studies , vol. 51, n o 3, p. 426‑438, mars 2017, doi: 10.1080/00343404.2015.1101517. M. Githinji, « Influence of procurement methods on procurement performance in public hospitals in Kenya. A case of Kenyatta national hospital », strategicjournals.com , vol. 5, n o 2, 2018, doi: 10.61426/sjbcm.v5i2.766. O. J. Wouters, D. M. Sandberg, A. Pillay, et P. G. Kanavos, « The impact of pharmaceutical tendering on prices and market concentration in South Africa over a 14-year period », Social Science & Medicine , vol. 220, p. 362‑370, janv. 2019, doi: 10.1016/j.socscimed.2018.11.029. Ministry of Public Health and AIDS control et Ministry of Finances, « Joint order Minister defining the medicine procurement Method ». 2021. Ministry of Public Health and AIDS control, « Operational plan of the logistics management and information system automation project (e-LMIS) in BURUNDI 2022-2024 ». Ministry of Finances, « Ministerial Order establishing the threshold for awarding public contracts for personalized State administrations ». 2018. Ministry of Public Health and AIDS control, « Health sector strategy 2021-2027 ». 2022. Ministry of Public Health and AIDS control, « Statistical Yearbook, 2023 ». 2024. Ministry of Finances et Ministry of Public Health and AIDS control, « Joint Ministerial Order 630 540 134 of 29 01 2024 establishing the tariffs and fees for services offered on medicines and other health products by ABREMA ». 2024. B. Israel, « Centralised medical supplies procurement and health service delivery in Arusha and Kilimanjaro regions, Tanzania », vol. 1, n o 1, 2019. Ministry of Public Health and AIDS control, « National list of essential medicines in Burundi », 2022. MSH, « International Medical Products Price Guide », 2015. WHO et HAI, « Measuring medicine prices, availability, affordability and price components. 2nd Edition ». 2008. USAID, « Key Performance Indicators ». 2018. Burundi Republic Bank, « Exchange rate ». 10 février 2025. Confederartion Suisse, « Burundi medicine traitment system », 2024. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8307258","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"comment","associatedPublications":[],"authors":[{"id":561179204,"identity":"82ef6d80-8bd7-4f23-aaa4-8e704d5f5a05","order_by":0,"name":"Ernest Bizabishaka","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAx0lEQVRIiWNgGAWjYDACCebjHz7+sQGyGBsPEKmFLY1xZkMaSEsDsVp4zJh5Gw6D2cRp4ZfuMXvAu+O83dr2w0BbamyiCWqRnHOs3EDyzO3kbWcSgVqOpeU2ENJicCN5g4QB2+1kswNALYwNhwlrsb+RYCCRwHYu2ez8QyK1GEikmEkcbDtgZ3aDWFsk7hxLNmw4k5xgdgNoSwIxfuGf3Xzw8Z8KO3uz8+kPH3yosSGsBQYSwSoTiFUOAvakKB4Fo2AUjIIRBgBUDkudT+E/twAAAABJRU5ErkJggg==","orcid":"","institution":"University of Rwanda","correspondingAuthor":true,"prefix":"","firstName":"Ernest","middleName":"","lastName":"Bizabishaka","suffix":""},{"id":561179205,"identity":"9846119c-622b-4b12-812b-0e4c3be0b95e","order_by":1,"name":"François Niragire","email":"","orcid":"","institution":"University of Rwanda","correspondingAuthor":false,"prefix":"","firstName":"François","middleName":"","lastName":"Niragire","suffix":""}],"badges":[],"createdAt":"2025-12-08 11:38:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8307258/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8307258/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":98774607,"identity":"950984f9-e89c-41bd-897a-c159f38eca25","added_by":"auto","created_at":"2025-12-22 12:04:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":722672,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8307258/v1/9855eebc-906d-4ed9-95ce-e0158c42995a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"An assessment of the Influence of procurement methods on medicine prices in Burundi. A cross-sectional study","fulltext":[{"header":"Background","content":"\u003cp\u003eThe increasing of medicine prices particularly in low and middle-income countries is currently a major concern for its effect on accessibility to quality public health care[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. A study conducted by Health Action International in Burundi showed that the prices of basic medicines, notably medicines used in the Sexually Transmitted Infections treatment (STIs) still high, especially in the private sectors[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The results of Elissa Levenger et al revealed that the medicine prices in Burundi still significantly expensive with the average of 54% higher than the international reference for the medicine procured by unplanned orders while the prices of medicine procured using international tendering varied overall from 8% to above international reference prices[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In Kenya, the study conducted by WHO found that overall private sector prices were 36% higher than those in the public sector. The findings of Dr.Thomas BIZIMANA et al in Rwanda showed that the prices of generic medicines in the public sector and faith-based health facilities were remarkably low with median price ratios of 1.0 while in the private sector the median prices were twice as high in comparison to the international procurement prices[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Surveys carried out in India have shown that the prices of medicines in the public sector was very advantageous compared to the prices in the private sector where the prices were almost twice as high as the international reference prices[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Several factors including pharmaceutical pricing policies, regulatory approach, pharmaceutical tendering, trading strategies of either buyers or sellers, etc were identified influencing the medicine prices[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOne way to increase the efficiency and the effectiveness of medicine procurement is the choice between a centralization procurement method where there is a central body in charge of handling the procurement activity for local units and a decentralization procurement method, where local units procure on their own[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In Burundi, one of the strategies adopted to ensure medicine availability with the right price was the implementation of centralized procurement methods from peripheral level to the central level with possibility to use the decentralized method in accordance with the public procurement procedures[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Despite all these strategies in place, the main objective to make medicine available, accessible with the right prices still not achieved in Burundi. Indeed, while the objective set by the Health Sector Strategy (2021\u0026ndash;2027) sets the availability rate of essential medicines at 80% and tracer medicines at 85% [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], the statistical yearbook 2023 published in 2024 indicates that, the average of order fulfilment rate from Burundi Medical Procurement Center was 58.8% for essential medicines and 66% of tracer medicines[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. This low order satisfaction rate by Burundi Medical Procurement Center leads public health facilities to procure medicines from private wholesale pharmacies using different methods mainly Request for Quotation[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough each method has advantages and disadvantages, studies realized in some countries have shown that the centralized method is more advantageous than the decentralized method. Tanzania\u0026rsquo;s experience showed that even health procurement system is mostly hybrid; centralized procurement system is the best method allowing public sectors to procure medicine with right prices[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Studies carried out by Simona Baldi in Italy hospitals[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], Githinji et al in Kenya[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], Wouters et al In South Africa[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] showed that the centralized and the open tendering methods had a significant influence on the medicine prices decrease. In Burundi, there has not been currently an investigation to establish the relationship between procurement methods and medecine prices. It is for this reason that we realized a present study assessing the relationship between procurement methods and medicine prices in Burundi Health Districts\u0026rdquo;.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDesign and location\u003c/h2\u003e \u003cp\u003eThis study adopted a cross-sectional approach. The Burundi Health Districts playing the intermediate role between the central level and health facilities by procuring medicines directly from Burundi Medical Procurement Center or from private wholesale pharmacies, they were choisen as study area.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy population and sample\u003c/h3\u003e\n\u003cp\u003eThe target population for this study was the 44 tracer medines listed on National List of Essential Medicines, last version was reviewed in 2022[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The choice of these medicines was motivated by the fact that they are essential and mandatory health products that must not be out of stock in health facilities. Among the 44 tracer medicines, we retained 38 medicines (86.4%), the six medicines (13.6%) were excluded because of missing data.\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003ePrices and characteristcs of medicines procured by Health Districts were collected using data collection forms. Data from centralized procurement method were gathered from delivery notes and data from decentralized procurement method were gathered from invoices and purchase orders available in the Health Districts and at Burundi Medicine Regulation Authority (ABREMA). International Median prices of medicines studied were collected from the International Medical Products price Guide MSH-IRP[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The survey methods were based on the medicine price survey methodology WHO/HAI, 2008 second edition[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The data collection was conducted from February 10, 2025 to March 3, 2025. From the purchase orders and delivery notes, we extracted the information of the tracer medicines procured by the Health Districts from January1, 2025 to January 31, 2025. This period was chosen because it preceded the active distribution made by CAMEBU after which the Health Districts are authorized to procure in private wholesale pharmacies for only the medicines out of stock at CAMEBU. The informations collected were the purchase unit prices, the characteristics of medicine and the procurement method used.\u003c/p\u003e \u003cp\u003e \u003cb\u003eII.4. Data management and analysis\u003c/b\u003e \u003c/p\u003e \u003cp\u003eBefore data analyzing, data checking during and after collection was done to ensure data quality. Data were first cleaned and entered in Excel on daily based. Using SPSS version 21, descriptive analysis was done to present distribution of the variables whereas logistic regression was applied to assess the significance relationship between dependent and independents variables.\u003c/p\u003e \u003cp\u003e \u003cb\u003eII.5. Variables and their measurement\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe independent variables in our case were the procurement methods and the characteristics of the medicines procured. In accordance with MSH-IRP[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], the unit medicine prices from centralized and decentralized methods were calculated by dividing the drug pack-selling price by the smallest unit of measurement. The dependent variable in this study was medicine prices at the reference level. Basing to the WHO formula, the \u003cb\u003ePrice Performance ratio level=\u003c/b\u003e ((Average price paid for a product) / (International reference price of the same product)) X 100. In accordance with WHO, the ratio equal or less to 105% is the right price whereas the ratio greater than 105% is the high[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. To facilitate the comparison and interpretation, the local unit for each tracer medicine prices from both centralized and decentralized methods were converted into US dollars by division of the official exchange rate of the first day of data collection (2944.6805 exchange rate of February 10, 2025)[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMedicine distribution by characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMedicine distribution by characteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003eForm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTablet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28,9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCapsule\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2,6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInhalation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2,6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInjectable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44,7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSirup\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13,2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSolution\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5,3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSupositories\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2,6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e38\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e100%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eMedicine Administration mode\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExterne\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2,6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInjectable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36,8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOrale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60,5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e38\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e100%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eTherapeutic class\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot anti-infectious\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57,9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnti-infectious\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42,1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e38\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e100%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eProcurement methods\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCentralised\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63,2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDecentralised\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36,8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e38\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e100%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAccording the right price\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot Rigth price\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47,4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRigth price\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52,6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e38\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e100%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the medicine distribution by characteristics. We note that the injection form is predominant, representing 44.7%. Tablets follow with 28.9%, while other forms, such as syrup represent (13.2%) and solutions have lower numbers (5.3%). Less common forms, such as capsules and suppositories, each represent 2.6%, suggesting that they are not frequently used.\u003c/p\u003e \u003cp\u003eFor administration mode, the oral administration predominates with 60.5%, which indicates a marked preference in health facilities. The injection follows with 36.8%, suggesting that it is also commonly more used, particularly for treatments requiring rapid or effective absorption. On the other hand, the external administration is very poorly represented, reaching only 2.6%.\u003c/p\u003e \u003cp\u003eConcerning distribution by therapeutic class, the main cause of death in Burundi being the infectious diseases (malaria, diarrheal diseases, HIV, tuberculosis) representing 63%[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], the anti-infectious and not anti-infectious medicines are two classes condered. In the table, it can be seen that 42.1% of tracer medicines procured are medicines used to treat infectious diseases and 57.9% of medicines are not used to treat infectious diseases. This distribution highlights the importance of the procurement of medicines adapted to the treatment needs of infectious diseases, while emphasizing the need to evaluate the resources allocated to the purchase of these types of medicines.\u003c/p\u003e \u003cp\u003eFor procurement methods, the Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, shows that the centralized procurement method is predominant, with 63.2%, which suggests a trend towards a centralized system for medicine supply and distribution in Burundi Health Districts. The decentralized method representing 36.8% indicates that the stock shortage at CAMEBU conducting the public health facilties to procure medicines in private wholesale pharmacies. This procurement methods can have important implications on logistical efficiency, availability, accessibility, affordability and quality of medicines and ultimately the quality of health care provided to populations. A thorough understanding of these methods is essential to optimize the management of medical resources.\u003c/p\u003e \u003cp\u003eFinally, the distribution of medicine by price shows that 47.4% of medicines do not meet the right price, while 52.6% of medicines comply with right price. This indicates that approximately 50% of the medicines studied are sold at a price that could be considered non-affordable according to WHO criteria.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescriptive statistics of medicine prices\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStatistic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrice in USD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of medicines\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean price\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.1513077\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian price\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.0375952\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStandard deviation(SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.29421480\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInterval\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.30034\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMinimum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.00133\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaximum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.30167\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents descriptive statistics of 38 medicine prices studied. The median of \u003cspan\u003e$\u003c/span\u003e0.0376 indicates that 50% of medicine cost less than 0.0376, suggesting a skewed distribution with generally low prices. The high standard deviation of \u003cspan\u003e$\u003c/span\u003e0.2942 and a range of \u003cspan\u003e$\u003c/span\u003e1.30034 between the minimum (\u003cspan\u003e$\u003c/span\u003e0.00133) and maximum (\u003cspan\u003e$\u003c/span\u003e1.30167) prices reveal a large variability in prices, highlighting significant differences between the types of medicine. These results highlight the issues of price differences, affordability, and could help understand the factors influencing price variations in the context of medicine procurement.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of the studied medines according to the right price recommended by WHO.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c2\" namest=\"c1\" rowspan=\"3\"\u003e \u003cp\u003eMedicine Characteristics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e \u003cp\u003eCompliance with the right price proposed by WHO\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eNon\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003eForm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTablet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54,5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e45,5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCapsule\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInhalation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInjectable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64,7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e35,3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSirup\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e60%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSolution\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSupositories\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAdministration mode\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExterne\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInjectable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64,3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e35,7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOrale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47,8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e52,2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTherapeutic class\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot anti-infectious\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63,6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e36,4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnti-infectious\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37,5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e62,5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eProcurement methods\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCentralised\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e70,8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e29,2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDecentralised\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21,4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e78,6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e presents the distribution of the studied medines according to the right price. For medicine form, tablets show good compliance with 54, 5% against 45, 5% non-compliant, while capsules and inhalations do not meet the standards of right price. Injectables display acceptable performance with 64,7% compliant and 35,3% non-compliant. The syrups reveal a mixed situation, with 40% right price and 60% non-right price. The solutions are completely non-compliant, and the suppositories completely meet the conition of right price. Overall, these results highlight significant disparities in the financial accessibility of medicines depending on the form, highlighting the importance of improving compliance with standards to guarantee better access to treatments.\u003c/p\u003e \u003cp\u003eRegarding administration mode, external medicines do not meet the right price standards at all, while injectables and oral medicines show mixed results respectively 64.3% and 47.8%. For therapeutic class, it is notable that medicine not related to infectious diseases show a compliance rate of 63.6%, while medicine related to anti-infectious meet only 37.5% of the standard, with 62.5% failing to meet it. Overall, 52.6% of medicines according therapeutic class met the standard, revealing a significant disparity between treatments and highlighting the need to improve compliance to ensure better access to infectious disease treatments.\u003c/p\u003e \u003cp\u003eFor procurement methods, the results show that the medicine procured by centralized procurement method are largely procured with the right price, with 70.8%, with only 29,2% failing to meet the right price while decentralized procurement method shows a much lower compliance rate of just 21.4%, with 78.6% failing to meet the right price. In total, 52.6% of medicines are procured with right price, highlighting the superior effectiveness of centralized procurement method and highlighting the need to improve decentralized supply practices to ensure better access and compliance with price standards.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate logistic regression of factors influencing medicine prices\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% CI\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedicine Form\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCapsule\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.27, 15.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eProcurement method\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDecentralised\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCentralised\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.02, 0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTherapeutic class\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnti-infectious\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot anti-infectious\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.10, 2.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAdministration mode\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.05, 1.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u0026nbsp;OR\u0026thinsp;=\u0026thinsp;Odds Ratio, CI\u0026thinsp;=\u0026thinsp;Confidence Interval\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe results of the logistic regression show that the medicine prices procured by Burundi Health Districts are strongly influenced by the procurement methods. The Odds Ratio (OR) of 0.1 of medicines procured by centralized method with a confidence interval of 0.02 to 0.50 and a p-value of 0.003 indicating that they are much more likely to comply with the right price than those procured by decentralized procurement method. This result means that medicines procured by centralized procurement method are 90% less likely to fail to meet the right price compared to medicine procured by decentralized procurement method. The p-value of 0.003 less than 0.05 underlines the statistical significance of this association, suggesting that procurement the medicine by centralized method is a suitable method to make medicines available at the right price. In contrast, other factors such as the medicine form (OR\u0026thinsp;=\u0026thinsp;1.94, CI: 0.27\u0026ndash;15.4), therapeutic class (OR\u0026thinsp;=\u0026thinsp;0.47, CI: 0.10\u0026ndash;2.23), and administration mode (OR\u0026thinsp;=\u0026thinsp;0.33, CI: 0.05\u0026ndash;1.96) with p-value above 0,005 means that their influence is not statistically significant, suggesting that these factors have no clear impact on medicine prices. This highlights the importance of favoring centralized procurement method to improve adherence to the medicine right price.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur findings were compared with other studies carried out in developed and developing countries. The findings are similar to the results of Simona Baldi in Italy [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], Wouters et al in South Africa[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], Githinji, M., \u0026amp; Moronge in Kenya[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] etc. Simona Baldi study found that the decentralization system in Italy conducted the supplying of medicine at expensive prices compared to centralized system. Wouters et al in South Africa and Githinji, M., \u0026amp; Moronge in Kenya, found the same results showing the significant difference between the prices of medicines procured using request for quotation methods and medicine procured using international tendering method. Both concluded that thanks to the economy of scale, suppliers and manifacturers were interested in the supplies quantity in reducing the prices of supplies (More quantity, the more suppliers and less price). These results are then similar to our results. Indeed, Burundi Medical Procurement Center by centralizing the needs of all health districts, it requests large quantities that interest several manufacturers and international suppliers and in this case, they offer the products at competitive prices following the economy of scale. Another reason that could explain the increase prices in the decentralized system is the speculation of local wholesale pharmacies that take advantage of the stock shortage at CAMEBU and sell at exorbitant prices.\u003c/p\u003e \u003cp\u003eWhile this study provides very useful information, it also presents some limitations. The study was conducted in Health Districts with only tracer medicines, other medicines were not evaluated due to a lack of financial resources and insufficient time. Other possible biases was that there are some factors like political, fluctuation of local currency, etc. that can influence medicine prices, but due to the lack of official data, these factors remain difficult to assess. For this, a much more comprehensive study is required to investigate the causes of the high prices.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe study showed a signifant relationship between prices and procurement methods of medicines procured by health districts in Burundi. The data showed that the centralized method allowed the Health Districts to procure the medicine with right price compared to medicine procured by decentralised method. Given that the supply of medicines in private wholesale pharmacies is due to the stockout at Burundi Medical Procurement Center, we suggest that the centralized method can be strengthened by taking all possible measures so that the Burundi Medical Procurement Center has the possibility and capacity to supply all medicines to health facilities. This would improve the availability, accessibility, affordability, the security, and quality of medicines in Burundi.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eABREMA\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBurundi Medicine Regulatory Authority\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eCAMEBU\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCentrale d\u0026rsquo;Achat des Medicaments Essentiels du Burundi\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eCI\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConfidence Interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eFAO\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFood and Agriculture Organisation of the United Nations\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eGDP\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGross Domestic Product\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eHD\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHealth District\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eMoH\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMinistry of Health\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eMSH\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eManagement Sciences for Health\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eOR\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOdds Ratios\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eSCMS\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSupply Chain Management System\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eSD\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStandard Deviation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eSPSS\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStatistical Package for Social Sciences\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eSTIs\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSexually Transmitted Infections\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eWHO\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWolrd Health Organistion\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was authorized by the Ministry of Public Health in Burundi (Approval notice 630/7909/CAB/2024 of November 21, 2024).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data used in this study are included in the manuscript and dataset is available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received for writing and publishing this manuscript. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEB and FN conceptualized the study and wrote this manuscript. EB performed data collection and their preliminary analysis. FN, and EB finalized the data analysis and critically reviewed the manuscript. All authors read and approved this manuscript for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors gratefully acknowledge the support from the Masters of Health Supply Chain Management program that is offered by the East African Community Regional Center of Excellence for Vaccines, Immunization, and Health Supply Chain Management, College of Medicine and Health Sciences, University of Rwanda. The Center is funded by the German Federal Ministry for Economic Cooperation and Development (BMZ) through KfW Development Bank.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eWHO, \u0026laquo; Prices and accessibility of medicines in the Eastern Mediterranean Region \u0026raquo;. 2007.\u003c/li\u003e\n \u003cli\u003eG. Russo et B. McPake, \u0026laquo; Medicine prices in urban Mozambique: a public health and economic study of pharmaceutical markets and price determinants in low-income settings \u0026raquo;, \u003cem\u003eHealth Policy and Planning\u003c/em\u003e, vol. 25, n\u003csup\u003eo\u003c/sup\u003e 1, p. 70‑84, janv. 2010, doi: 10.1093/heapol/czp042.\u003c/li\u003e\n \u003cli\u003eHealth Action International, \u0026laquo; Baseline study on the measurement of prices, financial accessibility and availability of sexual and reproductive health products in Burundi \u0026raquo;. Health Action International, 2023.\u003c/li\u003e\n \u003cli\u003eMelissa Levenger, Tobey Busch, Pierre-Corneille Namahoro, et Claude Bahati, \u0026laquo; Burundi National Supply Chain Assessment Results, Capability and Performance \u0026raquo;. 2014.\u003c/li\u003e\n \u003cli\u003eT. Bizimana, P. C. Kayumba, et L. Heide, \u0026laquo; Prices, availability and affordability of medicines in Rwanda \u0026raquo;, \u003cem\u003ePLoS ONE\u003c/em\u003e, vol. 15, n\u003csup\u003eo\u003c/sup\u003e 8, p. e0236411, ao\u0026ucirc;t 2020, doi: 10.1371/journal.pone.0236411.\u003c/li\u003e\n \u003cli\u003eS. Baldi et D. Vannoni, \u0026laquo; The impact of centralization on pharmaceutical procurement prices: the role of institutional quality and corruption \u0026raquo;, \u003cem\u003eRegional Studies\u003c/em\u003e, vol. 51, n\u003csup\u003eo\u003c/sup\u003e 3, p. 426‑438, mars 2017, doi: 10.1080/00343404.2015.1101517.\u003c/li\u003e\n \u003cli\u003eM. Githinji, \u0026laquo; Influence of procurement methods on procurement performance in public hospitals in Kenya. A case of Kenyatta national hospital \u0026raquo;, \u003cem\u003estrategicjournals.com\u003c/em\u003e, vol. 5, n\u003csup\u003eo\u003c/sup\u003e 2, 2018, doi: 10.61426/sjbcm.v5i2.766.\u003c/li\u003e\n \u003cli\u003eO. J. Wouters, D. M. Sandberg, A. Pillay, et P. G. Kanavos, \u0026laquo; The impact of pharmaceutical tendering on prices and market concentration in South Africa over a 14-year period \u0026raquo;, \u003cem\u003eSocial Science \u0026amp; Medicine\u003c/em\u003e, vol. 220, p. 362‑370, janv. 2019, doi: 10.1016/j.socscimed.2018.11.029.\u003c/li\u003e\n \u003cli\u003eMinistry of Public Health and AIDS control et Ministry of Finances, \u0026laquo; Joint order Minister defining the medicine procurement Method \u0026raquo;. 2021.\u003c/li\u003e\n \u003cli\u003eMinistry of Public Health and AIDS control, \u0026laquo; Operational plan of the logistics management and information system automation project (e-LMIS) in BURUNDI 2022-2024 \u0026raquo;.\u003c/li\u003e\n \u003cli\u003eMinistry of Finances, \u0026laquo; Ministerial Order establishing the threshold for awarding public contracts for personalized State administrations \u0026raquo;. 2018.\u003c/li\u003e\n \u003cli\u003eMinistry of Public Health and AIDS control, \u0026laquo; Health sector strategy 2021-2027 \u0026raquo;. 2022.\u003c/li\u003e\n \u003cli\u003eMinistry of Public Health and AIDS control, \u0026laquo; Statistical Yearbook, 2023 \u0026raquo;. 2024.\u003c/li\u003e\n \u003cli\u003eMinistry of Finances et Ministry of Public Health and AIDS control, \u0026laquo; Joint Ministerial Order 630 540 134 of 29 01 2024 establishing the tariffs and fees for services offered on medicines and other health products by ABREMA \u0026raquo;. 2024.\u003c/li\u003e\n \u003cli\u003eB. Israel, \u0026laquo; Centralised medical supplies procurement and health service delivery in Arusha and Kilimanjaro regions, Tanzania \u0026raquo;, vol. 1, n\u003csup\u003eo\u003c/sup\u003e 1, 2019.\u003c/li\u003e\n \u003cli\u003eMinistry of Public Health and AIDS control, \u0026laquo; National list of essential medicines in Burundi \u0026raquo;, 2022.\u003c/li\u003e\n \u003cli\u003eMSH, \u0026laquo; International Medical Products Price Guide \u0026raquo;, 2015.\u003c/li\u003e\n \u003cli\u003eWHO et HAI, \u0026laquo; Measuring medicine prices, availability, affordability and price components. 2nd Edition \u0026raquo;. 2008.\u003c/li\u003e\n \u003cli\u003eUSAID, \u0026laquo; Key Performance Indicators \u0026raquo;. 2018.\u003c/li\u003e\n \u003cli\u003eBurundi Republic Bank, \u0026laquo; Exchange rate \u0026raquo;. 10 f\u0026eacute;vrier 2025.\u003c/li\u003e\n \u003cli\u003eConfederartion Suisse, \u0026laquo; Burundi medicine traitment system \u0026raquo;, 2024.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Procurement procedures, Procurement methods, centralized method, decentralized method","lastPublishedDoi":"10.21203/rs.3.rs-8307258/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8307258/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe increasing of medicine prices particularly in low and middle income countries is currently a concern in the health care sytem. In Burundi, to make medicines available and accessible at the right prices, centralized procurement methods have been implemented, however, despite much effort in improving the access of medicines in the public health facilities, the accessibility and affordability of medicines throughout the whole country remains a major challenge. This study sought to assess the influence of procurement methods on medicine prices in Burundi.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis study adopted a quantitative cross-sectional design. A data collection form was used to collect data and the SPSS was used to analyse data and determine the relationship between medicine prices and procurement methods.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe descriptive statistics showed the median of \u003cspan\u003e$\u003c/span\u003e0.0376 indicating that 50% of medicine cost less than 0.0376, suggesting a skewed distribution with generally low prices. The high standard deviation of \u003cspan\u003e$\u003c/span\u003e0.2942 and a range of \u003cspan\u003e$\u003c/span\u003e1.30034 between the minimum (\u003cspan\u003e$\u003c/span\u003e0.00133) and maximum (\u003cspan\u003e$\u003c/span\u003e1.30167) prices revealed a large variability of medicine prices, highlighting a significant difference between the types of medicines. Findings from multivariate logistics regression revealed that there was signifance relationship between procurement methods and medicine prices. The Odds Ratios (OR) of 0.10 in centralized method and p-value of 0.003 showed that medicines procured by centralized procurement method were 90% less likely to fail to meet the right price compared to medicine procured by decentralized procurement method.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe results from study revealed that the centralized procurement method is the method allowing the Health Districts to procure the medicines with the right price comparing to the medicine prices from decentralised method.\u003c/p\u003e","manuscriptTitle":"An assessment of the Influence of procurement methods on medicine prices in Burundi. A cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-17 05:55:16","doi":"10.21203/rs.3.rs-8307258/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1f2ae9e4-138b-4949-a487-18af7a8038a1","owner":[],"postedDate":"December 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-17T09:59:27+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-17 05:55:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8307258","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8307258","identity":"rs-8307258","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}