MMV Access Symposium Getting Antimalarials to Patients Kampala, Uganda. Accredited Drug Dispensing Outlets: Tanzania Experience

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1 MMV Access Symposium Getting Antimalarials to Patients Kampala, Uganda Accredited Drug Dispensing Outlets: Tanzania Experience Dr. Sikubwabo S. Ngendabanka Director, Business Support - TFDA 9 May

2 Outline of Presentation A short profile of Tanzania The Pharmaceutical Sector ADDO Programme Major Programme components Programme achievements Rollout Progress Way Forward 2

3 A SHORT PROFILE OF TANZANIA Location: East Africa Bordered: 9 countries Size: 945,000sq km Population: approx. 35 mil. (2002 census) Administration (Mainland Tanzania): 21 regions 120 districts 2,539 wards Malaria is No. 1 killer 3

4 The Pharmaceutical Sector 1. The Tanzania National Drug Policy, 1991 To improve availability of essential drugs with proven effectiveness, quality and acceptable safety at affordable price for prevention or cure of illness to the community The policy is now under review 2. Medicines Legislation Pharmaceuticals & Poisons Act, 1978 Tanzania Food, Drugs and Cosmetics Act, 2003 Establishes Tanzania Food and Drugs Authority The Pharmacy Act, 2002 Establishes Pharmacy Council 4

5 Pharmaceutical Sector (2) 3. Pharmaceutical Services 369 retail pharmacies and 208 wholesalers/importers with about 76% located in major towns. More than 6,000 Part II Poisons shops (OTC only) mostly located in peri-urban and rural areas. 7 Local Pharmaceutical Industries contributing about 30% national medicines needs 4. Human Resources 700 pharmacists 300 pharmaceutical technicians 250 pharmaceutical assistants Pharmacist per population ratio ~ 1:50,000 5

6 The ADDO Programme Pharmaceutical sector assessment by MoH & SW and SEAM / MSH in 2001 revealed; Poorly regulated part II poisons shops/drug outlets Limited access to safe and efficacious essential medicines of acceptable quality in rural and peri-urban areas Lack of skilled drug dispensers at these outlets The ADDO Concept - improved access to essential medicines & pharmaceutical services to rural and periurban areas through comprehensive well regulated outlets Piloted in Ruvuma region from

7 Pilot Intervention Components Top down approach Sensitization of stakeholders Mapping of existing drug shops Training of inspectors at district and ward levels Training of dispensers and owners Pre-accreditation inspections of outlets Accreditation of outlets Expanded list of medicines in ADDOs including PoM Launching Decentralized supervision and inspections Monitoring and evaluation 7

8 Programme Achievements in Pilot Quality of products and services Presence of unapproved products dropped from 26% to 2% % of facilities that dispensed any antimalarials according to precise STG was 6% at baseline vs 32% at endline Average availability of antimalarials increased from 74 to 90% in intervention region vs 60 to 71 % in control region Improved drug regulatory functions and reporting 8

9 Rollout Progress Currently being rolled out in three regions: Rukwa, Mtwara & Morogoro (263 ADDOs) 210 ADDO shops operational in Ruvuma - pilot region Strategy to rollout to remaining 17 regions by 2012 Challenges have been experienced Cost of rollout is high Private sector contribution is minimal Duration of implementation is long 9

10 New approaches to overcome challenges Involvement of local authorities in implementation of the programme Implementation manual already in place Involvement of Zonal Health Training Institutes TOTs,training manual and guide already in place Review of ADDO Regulations, 2004 now in final stage Cost sharing with ADDO owners and dispensers Coordination and quality assurance at national level by TFDA 10

11 Current Programme Components Bottom up approach Sensitization and training of District Drugs Technical Committee (DDTC), Ward Inspectors and drug shop owners Mapping and preliminary pre-accreditation inspections Training of drug dispensers by TOTs Final pre-accreditation inspection Accreditation Routine supervision and inspections local authority Monitoring and evaluation - TFDA 11

12 ADDO SHOP 12

13 Other potential interventions & Future Strategies Potential interventions Integrated Management of Child Illness (IMCI) Home Based Care for HIV/AIDS Link to health insurance schemes e.g. National Health Insurance Fund & Community Health Fund Subsidized ACT distribution Future Strategies Increase enrollment of pharmaceutical personnel in Universities and other health training institutions Promotion of local pharmaceutical production Limit ADDOs to rural and peri- urban areas Institutionalized career path for ADDO Dispensers 13

14 Take Home Message ADDO Programme provides for; Appropriate approach to improved access to essential medicines in rural and peri-urban areas under limited pharmaceutical human resources Improved decentralized medicines regulation Innovative public-private partnership to increase access to essential medicines Improved quality of pharmaceutical services A window for other health interventions 14

15 THANK YOU VERY MUCH 15

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