Accredited Drug Dispensing Outlets (ADDOs): Improving Access to Quality Drugs and Services in Rural and Peri-urban Areas with Few or No Pharmacies Authors: M. Ndomondo-Sigonda, R. Mbwasi, R. Shirima, N. Heltzer, M. Clark

ADDO Background (1) MSH/SEAM Tanzania Survey 2001 Assess drug supply and access issues Initiatives developed to address access issues Accredited Drug Dispensing Outlets (ADDOs)

ADDO Background (2) Problems with Part II Shops Chronic violation of Regulations Unqualified Staff Unknown drug quality Selling PoM High drug prices Inadequate regulation

ADDO Background (3) Where People Buy Medicines 339 Part I drug outlets (pharmacies) Most Part I shops located in urban areas while 80% of population in rural areas > than 4000 Part II drug shops Population is largely rural - only 17% have access to private pharmacies Part II shops (DLDBs) more accessible to population than all other public or private drug outlets Drug Outlets Per Capita Population: 33.97 million   # Facilities Facilities Per Capita Part II Shops (DLDB) 4,627 7,343 Public facilities 2,907 11,687 Voluntary/ religious 772 44,009 Private 934 36,375 Private Pharmacies 339 102,026 Parastatal 211 161,017

ADDO Objective Objective: Transform existing Part II shops into a regulated system of profitable ADDOS that will improve availability and quality of drugs and services in communities where there are few or no pharmacies

ADDO Strategies Strategies Training – dispensers, owners, local inspectors Social Marketing program to promote behaviour change – consumers and owners Commercial incentives Supportive supervision Modified legal and regulatory framework

ADDO Implementation Pilot and control Regions/Districts selected, then Formative Research Advocacy: Government and Private Sector Regulatory Activities: Regulations and Code of Ethics Approved Part I (Prescription) Drug List Training: inspector, dispenser, owner Commercial Incentives Communications / Marketing Campaign

Baseline Research Baseline assessments in pilot and control districts Drug quality, availability, affordability Dispenser knowledge and practice for diagnosing and treating malaria, diarrhea and acute respiratory infections Dispenser dispensing practices (record keeping, storage, prescription packaging and labeling, etc.) Dispenser knowledge of drug quality Characteristics of premises Dispenser training/educational background

Key Interim Results (1) DRUG QUALITY All tracer drugs TFDA registered or approved

Key Interim Results (2) AVAILABILITY Essential drug availability: Improved

Key Interim Results (3) AFFORDABILITY Affordability: Stable despite increased owner expenses (ex. personnel, premises, expanded inventory)

Key Interim Results (4) REGUALTORY ADHERENCE Regulatory adherence: Improved

Key Interim results (5) CONSUMER ACCEPTANCE Sales and customer data indicative of community acceptance

ADDOs: Conclusions Knowledge gaps documented Strategies developed and interventions implemented Importance of drug shops Additional research Do ADDOs improve health outcomes and rational drug use Cost-benefit analysis Scaling up of the programme Rural Urban

Thank You! Discussion