Expanding Regulated Private Sector Medicines Access - Experiences with Accredited Drug Dispensing Outlets

Romuald Mbwasi, PhD

What is Wrong with Drug Sellers?

Build private sector capacity Business skills of owners Dispensing and communication skills

Provide incentives Ability to sell expanded range of legally sold medicines Loans

Enhance availability and quality of products Products in stock approved by national drug authorities Local suppliers

Ensure quality of pharmaceutical services Record keeping Mentoring and supervision

Increase patient and consumer awareness Marketing Information and education

ADDO program takes a holistic approach to address drug seller problem through a “package of interventions”

Decrease in Inappropriate Recommendation of Antibiotics for Upper Respiratory Tract Infection (URTI)

39%

14%

25%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

SEAM 2001Assessment (DLDB

Countrywide)

Ruvuma ADDOsEndline

Singida DLDBEndline

Source: Management Sciences for Health. 2005. SEAM Tanzania Final ADDO Report.

Endline data of inappropriate antibiotic dispensing for URTI by

ADDOs in the pilot region was 14% compared with 39% at baseline. At endline in the control region, 25 percent

inappropriate dispensing was found.

Quality of Service (1)Percent of Drug Outlets Dispensing Malaria Treatment

According to STG-Ruvuma

2002 2004 2010

6%

24%

63%Chart Title

Outcome measure: sustainability of quality of services

Quality of Pharmaceutical Products: Percent of products available in ADDOs that were Not Registered with TFDA

Baseline 2001 Endline 2004 ADDOs 2010

26%

2%0%

Availability of Antimalarial Products in ADS Uganda

Kibaale Mpigi Kibaale Mpigi Kibaale MpigiALU Chloroquine SP

5% 6%

80%73%

100% 100%

87% 90%

2%

32%

7%

85%

BaselineEndline

Outcome measure: dramatic decline of SP and CQ which are not recommended

in the STG for uncomplicated malaria following accreditation in Kibaale

Challenges and Opportunities• Although overall dramatic improvement in rational use is observed,

gaps exists in management of certain conditions, like diarrhea• Lack or minimal consumer education and advocacy is a challenge• Collaboration with different health programs offers opportunities for

improving rational medicines use • The insurance schemes such as NHIF which has accredited ADDO is

another opportunity for quality of services monitoring including rational medicines use

• While market can help in reducing price and improving availability, this should not be done at the expense of rational use of medicines and quality of services