Center for Health Market Innovations (CHMI)

Programs

Accredited Drug Dispensing Outlets (ADDO)

last updated Mar 2, 2012

Overview

Implementation Partner(s): 
Tanzania Food and Drugs Authority (TFDA, which is the National Pharmaceutical Regulatory Authority), the Mennonite Economic Development Associates (MEDA), the Summa Foundation, the Muhimbili University School of Pharmacy, Scanad, HealthScope
Legal Status: 
Public-private partnership
Year Launched: 
2003
Stage: 
Existing/expansion stage

Funding

Primary Source of Funding: 
Government
Additional Source(s) of Funding: 
Donor
Funders: 
Bill & Melinda Gates Foundation, Danish International Development Agency, government of Tanzania, Rockefeller Foundation, The Global Fund, USAID
Summary: 

ADDO is a donor-supported initiative led by the Tanzanian Food and Drug Authority to train and license small, privately operated retail outlets in rural and poor areas to sell a set list of essential medicines, including selected prescription drugs.

Program goals/rationale: 

For many common medical problems, such as malaria and diarrhea, a variety of factors encourage people to self-diagnose and medicate before visiting a government health facility. These factors include distance to the facility, seriousness of the illness, medicine availability in the public facility, cash availability, and perceptions of privacy and quality of the health care providers, health facilities, and medicines.

Since pharmacies are located almost exclusively in major urban areas (60% in Dar es Salaam alone), DLDBs - small drug shops mandated to sell non-prescription medication - are often the most convenient retail outlet from which to buy medicines for the approximately 75% of the population that lives in rural and periurban communities. Moreover, with stock-out rates of 20 to 30% in public primary health care facilities, as seen in the 2001 SEAM assessment, patients often turn to DLDBs to obtain medicines and supplies prescribed by government health workers. Given the absence of pharmacies in rural areas and the extreme shortage in poor urban areas, it is evident that DLDBs play an important role in providing access to essential medicines for a significant proportion of the population.

Thus, the goal of the ADDO Program is to better equip DLDN shops to provide affordable, quality medicines and pharmaceutical services in rural and periurban areas of the country.

Key program components: 

The initiative employs a holistic approach to change the behavior and expectations of individuals who buy from, own, regulate, or work in retail drug shops.For shop owners and dispensing staff, this approach was achieved by combining training, incentives, consumer pressure, and regulatory pressure with efforts to affect client demand for and expectations of quality products and services.

Key program components include:

  • Broad-based stakeholder support: The initiative uses a participatory approach in designing and implementing the program, including identifying the “owner” of the initiative as well as involving national and local authorities and professional and commercial associations.

  • Provider accreditation program: ADDO introduced an accreditation program for community-based drug shops based on Ministry of Health’s standards and regulations and in accordance with the goals of the National Health Policy and Health Sector Reforms Program. Accredited drug shops are called Duka la Dawa Muhimu (DLDM)—or essential drugs shop. Inspectors conduct mapping and preliminary preaccreditation inspections of community-based drug shops to assess individual needs. The initiative aims to develop quality standard requirements and build stewardship and governance capacity at the local and central levels.

  • Provider training and consumer awareness: ADDO provides training in business skills, documentation, recordkeeping and commercial incentives such as loans to drug dispensers. It also promotes customer awareness of the quality of medicines and services through public education and marketing efforts (such as posters, flyers, billboards, and radio spots).

  • Monitoring and evaluation: Ward and district inspectors conduct monitoring and evaluation inspections, and the initiative is working to strengthen local regulatory capacity. It also aims to ensure the availability and quality of products distributed by requiring accurate recordkeeping and regular supervision of shop operations.

Program history: 

The SEAM Tanzania country program ended in 2005, but because of its success in Ruvuma and the Government of Tanzania’s decision to adopt the ADDO model for the entire country (along with some budgetary allocation), the MoH, through the TFDA and with support from MSH/RPM Plus and the Mennonite Economic Development Associates (MEDA), is expanding the model into other regions of Tanzania. The TFDA, with technical assistance from MSH, is providing program planning and regulatory oversight; MEDA is directing business development and training and facilitating linkages between ADDO shops and Microfinancing institutions (MFIs). The ADDO program rollout is funded by USAID in the Morogoro region, the Government of Tanzania in Rukwa and Mtwara regions. Funding for integrating child health, malaria and HIV/AIDS components into already established ADDOs comes from USAID. Additional program support is also provided through the Danish International Development Agency (DANIDA).

Additional Information:

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