Accrediting retail drug shops to strengthen Tanzania’s public health system: an ADDO case study

Abstract

IntroductionRetail drug sellers are a major source of health care and medicines in many countries. In Tanzania, drug shops are widely used, particularly in rural and underserved areas. Previously, the shops were allowed to sell only over-the-counter medicines, but sellers who were untrained and unqualified often illegally sold prescription drugs of questionable quality.Case descriptionIn 2003, we worked with Tanzania’s Ministry of Health and Social Welfare to develop a public-private partnership based on a holistic approach that builds the capacity of owners, dispensers, and institutions that regulate, own, or work in retail drug shops. For shop owners and dispensers, this was achieved by combining training, business incentives, supervision, and regulatory enforcement with efforts to increase client demand for and expectations of quality products and services. The accredited drug dispensing outlet (ADDO) program’s goal is to improve access to affordable, quality medicines and pharmaceutical services in retail drug outlets in rural or peri-urban areas with few or no registered pharmacies. The case study characterizes how the ADDO program achieved that goal based on the World Health Organization’s health system strengthening building blocks: 1) service delivery, 2) health workforce, 3) health information systems, 4) access to essential medicines, 5) financing, and 6) leadership and governance.Discussion and evaluationThe ADDO program has proven to be scalable, sustainable, and transferable: Tanzania has rolled out the program nationwide; the ADDO program has been institutionalized as part of the country’s health system; shops are profitable and meeting consumer demands; and the ADDO model has been adapted and implemented in Uganda and Liberia. The critical element that was essential to the ADDO program’s success is stakeholder engagement—the successful buy-in and sustained commitment came directly from the effort, time, and resources spent to fully connect with vital stakeholders at all levels.ConclusionsBeyond improving the quality of medicines and dispensing services, availability of essential medicines, and the regulatory system, the impact of a nationwide accredited drug seller approach on the pharmaceutical sector promises to provide a model framework for private-sector pharmaceutical delivery in the developing world that is sustainable without ongoing donor support.

Stretching the Boundaries: Tanzanian Pharmacy Workers’ Views and Experiences of Providing STI Services for Men Who Have Sex with Men

“…Nevertheless, emotional commitment to clients might have created difficulties regarding the separation of the professional role from the non-professional role in decision-making situations. The Tanzanian government’s efforts to transform local drugstores, so called Duka la Dawa Baridi (Part II pharmacies), into government-accredited drug dispensing outlets (also called the ADDO programme) is a step towards increasing professionalism by sensitising staff on best practices for treatment [21, 42]. Such training should also attempt to increase pharmacy workers’ factual knowledge of STI treatment guidelines to address knowledge gaps leading to incorrect drugs, dosages and duration, as found in previous studies [43–45].…”

“…Over- and misuse of antibiotics have been attributed to antimicrobial susceptibility at a global level [48], and an increasing trend of drug resistance has been observed in Tanzania [49]. The attempt to support pharmacy workers to make joint procurements of drugs to reduce unit costs, as outlined in the ADDO programme [42], could be a step towards decreasing expenditures and aiding them in achieving financial sustainability. In the wider perspective this may contribute to reduce financial incentives related to unsupervised drug provision.…”

Community knowledge and attitudes on antibiotic use in Moshi Urban, Northern Tanzania: Findings from a cross sectional study

“…Medicines are more available to communities in the drug-specific retailers through the prescription-only and over-the-counter dispensing mechanisms (Battersby et al, 2003). The Tanzania Food, Drugs and Cosmetics Act (TFDA, 2003) has done recommendable efforts through the Tanzania"s accredited drug dispensing outlet (ADDO) program in training dispensers followed by regulation to achieve quality standards (Alba et al, 2010;Rutta et al, 2015), and registered over 3,500 functioning ADDOs in 2013 (HSSP-IV, 2015).…”

The Quality of Selected Essential Medicines Sold in Accredited Drug Dispensing Outlets and Pharmacies in Tanzania

“…Unfortunately, however, access to quality-assured medicines remains a challenge for many low- and middle-income countries [1]. An initiative that addresses access to essential medicines and pharmaceutical services is the accredited drug dispensing outlet (ADDO) program, which was scaled-up successfully in Tanzania and also adapted for Uganda and Liberia [2]. The program, launched in 2003, is a public-private partnership where the privately owned shops have to meet a set of government standards related to personnel training and premises infrastructure to achieve accreditation.…”