Accredited Drug Dispensing Outlets in Tanzania: An Example of Successful Private-Public Sector Collaboration and Leveraging
Many people in rural Tanzania seek health care and medicines from retail drug shops, called duka la dawa baridi, for reasons such as convenience. Historically, the Tanzania Food and Drugs Authority (TFDA) authorized duka la dawa baridi to provide nonprescription medicines; however, a 2001 assessment showed that many shops sold prescription drugs illegally and that the drug sellers were generally unqualified and untrained.
In response, MSH’s Strategies for Enhancing Access to Medicines (SEAM) Program, funded by the Bill & Melinda Gates Foundation, collaborated with TFDA to develop and launch the country’s successful accredited drug dispensing outlet (ADDO) program in 2003. The goal was to improve access to affordable, quality medicines and pharmaceutical services in retail drug outlets in areas where few or no registered pharmacies exist.
|To achieve this goal, the SEAM Program took a holistic approach that combined training, accreditation, business incentives, and regulatory enforcement with efforts to increase consumer demand for quality products and services.||This video clip gives a brief overview of the ADDO program, including interviews with owners, dispensers, and local government supporters of the program.
>> Download in Windows Media streaming format (18 MB)
By the end of the SEAM Program in 2005, the TFDA had accredited over 150 shops in Ruvuma. Results of the pilot in the Ruvuma region provided proof-of-concept that ADDOs could improve access to quality medicines and pharmaceutical services. The next year, the Danish Agency for International Development Assistance (Danida) conducted an independent evaluation of the program and confirmed SEAM’s findings. Based on the SEAM and Danida evaluations, the Ministry of Health and Social Welfare approved a plan to roll out the ADDO concept to mainland Tanzania.
As the program has taken off, many have recognized the potential of ADDOs not only to increase access to essential medicines, but also to serve as a platform for community-based public health interventions, such as improving child health. As a result, numerous organizations and programs have played a role in expanding both the services that ADDOs provide and their geographic reach—about 900 ADDOs are currently serving four regions.
To be successful, efforts of this magnitude require creative partnerships and solid commitment to productive collaboration. The timeline below illustrates the range of partners who have contributed to the success of the ADDO program.
|2003||SEAM Program, funded by the Gates Foundation, and TFDA design and launch the ADDO program as a pilot in the Ruvuma region|
|2005||SEAM Program evaluates pilot program in Ruvuma|
|2006||Danida sponsored an independent evaluation of the ADDO program in Ruvuma|
|2006||Ministry of Health and Social Welfare approves TFDA plan to roll out ADDOs to Tanzanian mainland|
|2006||U.S. Agency for International Development through MSH’s Rational Pharmaceutical Management Plus Program funds ADDO rollout in Morogoro region using President’s Emergency Plan resources|
|2006||Government of Tanzania funds rollout in Mtwara and Rukwa regions|
|2006||RPM Plus Program collaborates with the Basic Support for Institutionalizing Child Survival project to add a child health component to ADDO services|
|2006||National Malaria Control Programme adopts the ADDO concept as part of its national strategy to increase access to malaria treatment|
|2007||Tanzania’s National Health Insurance Fund initiates plan that allows members to fill prescriptions at ADDOs|
|2007||MSH’s SPS Program uses President’s Malaria Initiative funds to provide subsidized artemisinin-based combination therapy through ADDOs|
|2007||Global Fund agrees to fund ADDO rollout in six to eight high-impact malaria regions to improve access to ACTs to children under five; Danida also contributes funding for rollout|
|2007||Gates Foundation funds the East African Drug Seller Initiative (EADSI) to work with TFDA to review and revise the existing ADDO model to make nationwide scale-up more cost-efficient and to help ensure the long-term sustainability of ADDOs|
|2008||Gates Foundation provides EADSI with supplemental funding to evaluate ADDO rollout in Tanzania and long-term sustainability in existing ADDO regions|
|2009||Rockefeller Foundation funds MSH to develop a strategy to help ensure program sustainability and quality through the establishment of ADDO owner and dispenser associations|
|2009||Local governments in Arusha, Iringa, Kagera, and Kilimanjaro took initiative on their own to mobilize funds to introduce ADDOs|
|2009||Government of Tanzania starts rolling out ADDOs to six of the eight Global Fund- and Danida-supported regions and developing a strategy to open ADDOs in urban areas|
|2009||Tanzania passes a law that withdraws recognition of duka la dawa baridi and requires unaccredited shop phase-out within two years|
For additional information, the Center for Global Development features the ADDO program in the August 2009 issue of its Drug Resistance & Global Health newsletter.