1. EDM STRATEGY FOR WORKING WITH COUNTRIES-TANZANIA Rose Shija EDM NPO TANZANIA

2. Indicators for Tanzania Population 34.5 million GNP/Capita $260 Per capita health expenditure $9 Pharmaceutical annual expenditure per capita public+private $2 Allocated public expenditure per capita-Pharm $1.30 (02/03) Infant mortality 102 <5 mortality 154 Maternal mortality 530 Access to health facilities 93% (1 hr) Population / health facility 7,431 Immunization coverage 83%

3. Why monitor and evaluate: Evidence-based planning 1. Assess and Monitor 2. Plan 3. Implement Monitoring and assessing the pharmaceutical situation in Tanzania is important so as to know more about current levels of access to essential drugs that are of good quality, efficacious and are being used rationally so efforts to improve access can be targeted most effectively.

4. Objectives of Level II survey To collect baseline information on the pharmaceutical sector in Tanzania from the facility to the central level that can inform prioritisation of plans and interventions. To monitor the outcomes of the implementation of various components of the NDP and the Pharmaceutical Master Plan to see if the objectives are achieved.

5. Survey Methodology Study Design: Prospective and retrospective cross-sectional survey including face to face interviews Survey Area: 4 randomly selected regions (Dar es salaam, Kilimanjaro, Mwanza and Mbeya) Randomly selected per region: 5 public health facilities with pharmacies 5 private pharmacies 1 central/district warehouse 75 households (15 around each HF = 300)

6. WHO Medicines Strategy 2000-2003 Four strategic objectives: 1. Access - selection, affordability, financing, supply strategies 2. Rational use - health professionals and consumers, public and private 3. Quality and safety - standards, effective drug regulation, information 4. National drug policy - framework for collective action

7. Access Availability of key drugs for treating the top ten diseases (list of 15 drugs) shows that on the average 87% of key drugs are available in the public Health facilities. Affordability On average 51% and 86% of the lowest daily government salary (or 4-7 hours of work) was spent to purchase drugs for mild/moderate pneumonia from private pharmacies for children and adult patients respectively Stock-out duration The average stock-out duration for key drugs is 28 days (Median 21.2, Maximum 67.1 days, Minimum 3 days).

8. Access interventions Interventions to look at pricing mechanisms of pharmaceuticals Further strengthening of the Medical Store Department and its zonal warehouses Continuing education in drug management for all pharmaceutical staff in health facilities

9. Rational use of medicines Prescribing indicators Average number of drugs per encounter: 1.8 Percentage of encounters with an antibiotic prescribed: 42% Percentage of encounters with an injection prescribed: 14% Percentage of drugs prescribed from EDL: 98.5%

10. Rational use of medicines (cont) Patient care indicators Percentage of prescribed drugs dispensed: 80% Percentage of drugs adequately labelled: 76% Patients’ knowledge of correct dosage: 80% Availability of copy of EDL or STG: 25%

11. Rational use interventions Revision of Standard treatment guidelines, developed with end-users, with active dissemination and follow-up Revision of Essential Medicines lists, linked to treatment guidelines and used for training and supply Support to Hospital Drugs and Therapeutic Committees Training in RDU

12. Quality and safety Of the 83% of key essential medicines for the top 10 diseases which were on the shelves in public health facility pharmacies, 13% were expired 11 basic minimum criteria for adequate storage of medicines were met by 82% of warehouses and 64% of public pharmacies

13. Quality interventions -HF Drug management training includes good storage practice

14. Quality interventions TFDA (cont) Update existing guidelines, procedures, forms and develop new ones, including SOP´s for inspection, ADR monitoring and drug advertising and promotion Purchase and network computers Create website Provide dissolution apparatus Purchase reference standards Post-marketing surveillance of drugs

15. Quality interventions (cont) Train staff locally in drug registration, drug information development and dissemination and monitoring of promotion materials Train staff abroad in QC Laboratory management, validation of analytical methods, and developing reference standards Train inspectors in GMP Organize workshop on GMP and GDP for manufacturers, importers and wholesalers Organize workshop for drug regulators for the lab, police and customs and prosecutors Consumer education campaign using radio/TV spots, posters and brochures

16. Future priorities Continue support strengthening of health systems and human resources Monitor impact- re assess and adjust plans according to needs and performance