Accredited Drug Dispensing Outlet (ADDO)

{Photo credit: Michael Paydos/MSH}Photo credit: Michael Paydos/MSH

This week, Devex and Management Sciences for Health (MSH) are discussing innovations for access to medicines in low- and middle-income countries. Public-private partnerships are key to ensuring innovations help medicines affordably reach the people who need them most.

From communities to global policy: Innovations to access to medicines underway

Devex reporter Andrew Green writes:

In Tanzania in 2002, MSH realized the medicines needed for basic treatment are in the government system, but not available to patients -- either because health facilities ran out of stock or were too far away.

Instead, patients turn to private dispensaries in high numbers. MSH reports that 82 percent of people in sub-Saharan Africa seek health care and medicines from retail drug shops -- even though the people staffing them often have little knowledge or training.

In Tanzania, MSH decided to try to change that, conceptualizing a program in 2002 to set government standards for the accredited drug dispensing outlets, or ADDOs, and upping the knowledge of the people running them. ...

 {Photo credit: MSH staff}A woman and child visit an accredited dispenser in Tanzania.Photo credit: MSH staff

There are ways to make informal outlets fit for quality care in poor areas, say Jafary Hassan Liana and Martha Embrey.

 {Photo credit: MSH}A woman and her child consult with an ADDO dispenser in Tanzania.Photo credit: MSH

Cross-posted with permission from the Bill & Melinda Gates Foundation Blog, Impatient Optimists.

Primary health care has many different definitions, but can be defined simply as the first place where people seek care. Within this definition, private sector providers constitute an important source of primary health care in many parts of the world.

Private providers of primary health

Private providers can run the spectrum–from private hospitals, pharmacies, and non-profit clinics, to informal providers such as faith-based healers and drug shops. A 2013 review suggests that informal providers account for as much as two-thirds of health care visits in Bangladesh and Thailand, and a substantial percentage of visits in Nigeria and Kenya as well.[1]

 {Photo credit: Jon Jay/MSH.}FROM LEFT: Joanne Manrique, Center for Global Health and Diplomacy; Sheila Tlou, UNAIDS (Eastern and Southern Africa), Former MOH Bostwana; Irene Kiwia, Tanzania Women of Achievement; Catharine Taylor, MSH; Kate Gilmore, UNFPA; Raymonde Goudou Coffie, MOH, Cote d'Ivoire; Language interpreter.Photo credit: Jon Jay/MSH.

Experience the 69th UN General Assembly (UNGA) and Clinton Global Initiative (CGI) Annual Meeting as we take you through some of the key events in photos, videos, and tweets. More than a dozen Management Sciences for Health (MSH) representatives led or participated in UNGA and CGI activities in New York City, New York, last week.

{Photo credit: Warren Zelman.}Photo credit: Warren Zelman.

MSH spoke with Fabio Castaño, MD, MPH, global technical lead of family planning and reproductive health about MSH’s approach to family planning and what will define the future of family planning and global health. Below is part one of the conversation. 

What is MSH’s approach to family planning and reproductive health?

[Dr. Fabio Castaño.]Dr. Fabio Castaño.Fabio:

First of all, I have to tell you that MSH has been working on family planning [FP] for over 40 years. Our first-ever international program was working with Korea! We supported their successful story of making FP an essential part of public health activities. At that time, we worked on FP from a standpoint of population control. Then, to help improve the health situation, and also contributing to reducing poverty. So, that is an interesting piece of history for MSH.

 {Photo credit: Rachel Lieber/MSH.}ADDO owners and dispensers in Mafia Island, Tanzania, learn to use the mobile applications developed by SDSI. The applications allow ADDO personnel to access an SMS-based Pharmacy Council helpline, send service utilization reports to the Pharmacy Council, and to pay annual licensing fees via mobile money.Photo credit: Rachel Lieber/MSH.

Cross-posted with permission from mHealthKnowledge.org.

In the private sector, Tanzania has more than 1,000 pharmacies, 2,500 pharmaceutical personnel, 6,000 accredited drug dispensing outlets (ADDOs), and more than 18,000 ADDO dispensers. The Pharmacy Council of Tanzania has overseen these facilities and personnel since 2011, but lacked a comprehensive system to manage regulatory information. Without such a system, basic facility and personnel information was inaccessible, the locations of rural ADDO facilities were unclear, and tracking business and professional licensing status, including fees collection, was difficult. Furthermore, the Pharmacy Council had no way to efficiently communicate directly with the outlets.

 {Photo credit: Jafary Liana/MSH.}Gates Foundation delegates visit an Accredited Drug Dispensing Outlet in Tanzania.Photo credit: Jafary Liana/MSH.

Dr. Trevor Mundel and other senior staff of The Bill & Melinda Gates Foundation traveled to Tanzania this summer to see first-hand the successes of Accredited Drug Dispensing Outlets (ADDO). The ADDO program, which began in 2001, grew out of the need to transform the duka la dawa biridis—unlicensed retail drug shops—into profitable, government-accredited drug dispensing outlets that supply quality medicines and services to underserved populations in Tanzania.

Dr. Mundel, Gates Foundation's President of Global Health, was hosted by Management Sciences for Health’s (MSH) Sustainable Drug Seller Initiatives (SDSI) team along with Tanzania’s Ministry of Health and Social Welfare through the Tanzania Food and Drugs Authority (TFDA) and the Pharmacy Council (PC). The Bill & Melinda Gates Foundation has provided generous funding to support Tanzania’s health sector—including the piloting, sustainability, and maintenance of the ADDO program.

 {Photo credit: Jafary Liana/MSH}Germana (right), ADDO owner and dispenser in Kipara Mpakani Village with full-time accredited dispenser (left).Photo credit: Jafary Liana/MSH

In developing countries, a community medicines shop often serves as the first point of contact for health care. Empowering the drug shop owner and dispenser to provide safe, quality medicines, and referrals to a health facility for more complex care, is key to improving maternal and children’s health in rural areas.

MSH’s Jafary H. Liana and Dr. Suleiman Kimatta visited two accredited drug dispensing outlet (ADDO) owners in Mkuranga District, Tanzania. One woman owns two ADDOs, while the other owns one. Both are also trained ADDO dispensers (an estimated 90 percent of ADDO dispensers are women).

Meet Germana Firmini Mroso

Germana Firmini Mroso, 31 years old, owns an ADDO named ROSALA DUKA LA DAWA MUHIMU, which is located at Kipara Mpakani Village, Vikindu ward, in Mkuranga District. Germana is both an owner and dispenser in her outlet. Germana holds a one year nurse assistant certificate. She manages a second small business making medicine-packaging envelopes which she uses in her outlet and sells to other outlets.

Why did you become an accredited drug shop owner?

 {Photo credit: Jafary Liana/MSH}Audensia Batholomew shares her path to accreditation as an drug shop outlet owner and dispenser with Dr. Suleiman Kimatta.Photo credit: Jafary Liana/MSH

In developing countries, a community medicines shop often serves as the first point of contact for health care. Empowering the drug shop owner and dispenser to provide safe, quality medicines, and referrals to a health facility for more complex care, is key to improving maternal and children’s health in rural areas.

MSH’s Jafary H. Liana and Dr. Suleiman Kimatta visited two accredited drug dispensing outlet (ADDO) owners in Mkuranga District, Tanzania. One woman owns two ADDOs, while the other owns one. Both are also trained ADDO dispensers (an estimated 90 percent of ADDO dispensers are women).

Meet Audensia Batholomew

Audensia Batholomew, MBIGI, a 45-year-old single mother, lives in Mkuranga district headquarters with two dependents and an adult son at university. She owns two ADDOs, one located in Chamazi village (20 km from her home) and one in Njopeka village (30 km away). Audensia also holds a one-year nurse assistant certificate.

Why did you become an accredited drug shop owner?

Dr. Quick discusses Myanmar’s health system with Dr. Pe Thet Khin, the minister of health. {Photo credit: Myanmar Ministry of Health.}Photo credit: Myanmar Ministry of Health.

In Myanmar, 50 years of military dictatorship left behind a seriously underdeveloped health system, serving barely one in twenty of the country’s 60 million people. You might expect that the first minister of health under civilian rule would be despondent. But on my recent trip I found the opposite: Dr. Pe Thet Khin and his team are aligned around an ambitious vision for building a strong health system for the country.

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