Engaging the private sector to improve antimicrobial use in the community: experience from accredited drug dispensing outlets in Tanzania

Abstract

ObjectivesA public-private partnership in Tanzania launched the accredited drug dispensing outlet (ADDO) program to improve access to quality medicines and pharmaceutical services in rural areas. ADDO dispensers play a potentially important role in promoting the rational use of antimicrobials, which helps control antimicrobial resistance (AMR). The study objectives were to 1) improve dispensing practices of antimicrobials, 2) build ADDO dispensers’ awareness of the consequences of misusing antimicrobials, and 3) educate consumers on the correct use of antimicrobials through the use of printed materials and counseling.MethodsOur intervention targeted ADDO dispensers and community members in Kilosa district. We promoted AMR awareness using posters hung in public places, health facilities, and ADDOs; sensitizing 84 health care providers on AMR issues; and providing training and on-site support for 124 ADDO dispensers to increase their AMR knowledge and dispensing skills. Baseline and endline assessments included direct observation of dispensers’ practices; interviews with ADDO dispensers (71 at baseline and 68 at endline) regarding dispensing experiences; 230 exit interviews with ADDO customers regarding use of antimicrobials during monitoring visits; and review of ADDO records. Indicators were based on product availability, dispensing practices, customers’ knowledge of how to take their medicines, and dispenser and public awareness of the AMR threat.ResultsAvailability of tracer antimicrobials increased by 26% (p = 0.0088), and the proportion of ADDOs with unauthorized items decreased from 53% to 13% (p = 0.0001). The percentage of ADDO dispensers following good dispensing practices increased from an average of 67% in the first monitoring visit to an average of 91% during the last visit (p = 0.0001). After the intervention, more dispensers could name more factors contributing to AMR and negative consequences of inappropriate antimicrobial use, and over 95% of ADDO customers knew important information about the medicines they were dispensed.ConclusionsProviding educational materials and equipping ADDO dispensers with knowledge and tools helps significantly improve community medicine use and possibly reduces AMR. The number of community members who learned about AMR from ADDO dispensers indicates that they are an important source of information on medicine use.

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

“…As the ADDO program took off, many recognized the potential of these shops to not only increase access to essential medicines, but also to serve as a platform for community-based public health interventions; for example, a child health training module for dispensers is based on the Integrated Management of Childhood Illness initiative and includes danger signs of pneumonia in children and the appropriate action, co-trimoxazole treatment or referral, depending on the situation [ 11 ]. Other programs that have been integrated include tuberculosis case identification and referrals, distribution of subsidized artemisinin-based combination therapies, and knowledge and control of antimicrobial resistance [ 12 – 14 ]. Other public health interventions that are being pursued include creating a system of referral linkages between community health workers, ADDOs, and health facilities relating to maternal and child health and family planning and the incorporation of rapid diagnostic testing for malaria into ADDO services.…”

Measuring antibiotic consumption in low-income countries: a systematic review and integrative approach

“…The results included the percentage of antibiotics sold without a prescription and the percentage of antibiotic DDDs dispensed without a prescription. The exit interview method has also been used in other settings to investigate doctor prescription patterns or to evaluate interventions [32,33].…”

Performance of retail pharmacies in low- and middle-income Asian settings: a systematic review

“…Asides from training and regulation, other schemes that have been implemented include peer review, accreditation (such as the Accredited Drug Dispensing Outlets scheme in Tanzania) and social franchising ( Chalker et al 2005 ; Wafula and Goodman 2010 ). However, the evidence on the impact and sustainability of these strategies remains quite limited, highlighting this area as an important priority for future research ( Center for Pharmaceutical Management 2008 ; Wafula and Goodman 2010 ; Valimb et al 2014 ).…”