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Macro environment determinants affecting the availability of artemisinin-based combination therapies in Uganda

Pross Oluka Nagitta (Department of Economics and Managerial Sciences, Uganda Management Institute, Kampala, Uganda)
Marcia Mkansi (Department of Operations Management, University of South Africa, Pretoria, South Africa)

International Journal of Pharmaceutical and Healthcare Marketing

ISSN: 1750-6123

Article publication date: 19 December 2022

Issue publication date: 22 March 2023




Artemisinin-based combination therapies (ACTs) have been developed to treat uncomplicated malaria. However, scanty studies exist to inform the role of macro factors in explaining the nonavailability of ACT in developing countries. Therefore, this paper aims to evaluate the different macro-environment factors affecting the availability of ACTs in the public hospital setting.


This study applied a quantitative methodological approach and structural equation modeling (SEM) to test hypotheses statistically. SEM examines linear causal relationships among variables while accounting for measurement error. Confirmatory factor analysis (CFA) was used to assess model reliability. CFA and SEM were used to determine the shared variance-covariance of variables, define the latent construct and provide a more precise way to account for the error variances associated with the variables, which, if untested, could lead to biased parameter estimates. This was guided by the data collected from 40 general public hospitals with 283 respondents.


This study’s results support a model for promoting social-cultural, technological and legal factors. The availability of ACTs is significantly affected by legal factors. Improving legal aspects by a unit can enhance ACT availability by 0.59. Political factors scored the least, and they do not influence the availability of malaria drugs.

Research limitations/implications

The design was quantitative and cross-sectional. Future research could be longitudinal with a mixed-method approach and consider other external stakeholders.

Practical implications

Reducing the impact of the nonavailability of antimalarial drugs in general public hospitals requires a holistic concerted and coordinated supply chain approach that tackles the political, economic, social-cultural norms, technological and legal factors.


The authors develop and test a model using macro factors: political, economic, social, cultural, technological and legal factors. This model is relevant for many developing countries to supply chain coordination perpetually experiencing medicine shortages.



The authors thank the DTMC members in the 40 general hospitals for participating in this project.

Conflict of interest: The authors declare no competing interests.

Availability of data and materials: The data sets supporting the conclusions of this paper are available at reasonable request from the authors.

Consent for publication: All coauthors agree to a joint publication.

Publisher’s note: The authors remain neutral to any institutional affiliations claims.


Oluka Nagitta, P. and Mkansi, M. (2023), "Macro environment determinants affecting the availability of artemisinin-based combination therapies in Uganda", International Journal of Pharmaceutical and Healthcare Marketing, Vol. 17 No. 1, pp. 97-114.



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