The make or buy debate: Considering the limitations of domestic production in Tanzania

This paper considers the ‘make-or-buy’ dilemma by using Tanzania as a case study. Key informant interviews, event-driven observation, and purposive sampling of documents were used to evaluate the case study. The case study focused on Tanzania’s imitation technology transfer agreement to locally manufacture a first-line ARV (3TC？+？d4T？+？NVP), reverse engineering the ARV.Tanzania is limited by weak political support for the use of TRIPS flexibilities, limited production capacity for ARVs and limited competitiveness in both domestic and regional markets. The Ministry of Health and Social Welfare encourages the use of flexibilities while others push for increased IP protection. Insufficient production capacity and lack of access to donor-financed tenders make it difficult to obtain economies of scale and provide competitive prices.Within the “make-or-buy” context, it was determined that there are significant limitations in domestic manufacturing for developing countries. The case study highlights the difficulty of governments to make use of economies of scale and produce low-cost medicines, attract technology transfer, and utilize the flexibilities of the WTO Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS). The results demonstrate the importance of evaluating barriers to the use of TRIPS flexibilities and long-term planning across sectors in future technology transfer and manufacturing initiatives.Global efforts to lower ARV prices and scale-up treatment access in Sub-Saharan Africa have fortunately resulted in price decreases from approximately US$10,000 per person per year (pppy) in 2000 to less than US$100 in 2007 [1]. Although treatment cost is not the only factor affecting access to medicines, it is obviously important. Access to ARV therapy in Tanzania has been steadily rising since 2004, with a coverage rate of 32% by 2010 guidelines (49% by 2009 guidelines) [2]. Still, the situation is not positive for all.Treatment rates throughout Su