Tanzania experience:

Agreed to a formal memorandum of understanding between Ministry of Health and Social Welfare (MoHSW) and Strategies for Enhancing Access to Medicines (SEAM) for all aspects of the country program

Held discussions with wholesalers to explain the ADDO program and encourage them to provide a wholesaling service to the new ADDOs in Ruvuma region. Two companies opened outlets in or close to Songea, the regional capital of Ruvuma.

Tanzania experience:

Completed data collection and options analysis for the Tanzanian pharmaceutical sector for creation of an accreditation/regulation model for private sector medicine sellers.

Tanzania experience:

Traveled to Ruvuma to map locations of DLDB in region and collect information on existing DLDB.

Tanzania experience:

Held three workshops to brief regional and district officials and promote advocacy for the program; held 20 workshops with stakeholders in Ruvuma region to develop advocacy and support for the ADDO concept and solicit views on what standards should be included in the ADDO Program.

– TFDA
– Local government officials
– Owners and dispensers

Tanzania experience:

Developed and used a formal method for selecting intervention and control districts for the ADDO program.

Tanzania experience:

Reviewed and revised draft standards, which were approved by TFDA technical committees. The TFDA approved standards for ADDO facilities, including inspection and sanctions, personnel requirements, training and continuing education, formulary development and use, medicine quality, record-keeping, code of business ethics, dispensing practice, reference materials, and wholesalers. TFDA approval was the final step before the standards were approved by the Minister of Health and Social Welfare and signed into law.

The TFDA had clauses placed in the Tanzania Food and Drug Bill, as it passed through Parliament that empower TFDA to establish ADDOs and the regulations governing them. The Minister of Health and Social Welfare approved and signed into law legally enforceable standards and a code of ethics. The ADDO standards and code of ethics were developed with the active involvement of all stakeholders, who were sought out and included through a comprehensive, wide-ranging consultative process. Altogether, nearly 400 people participated, including regional and district medical officers, members of parliament, councilors, and owners of DLDB.

Tanzania experience:

First set of DLDBs enter applications to become ADDOs; first shops selected for training and accreditation.

Conduct pre-accreditation inspection to let shop owners know what they needed to do to become accredited.

Conducted a final inspection to assure that premises meet prescribed standards to receive certificate to operate as an ADDO.

Tanzania experience:

An important change in the regulations was giving ADDOs permission to sell some prescription medicines at TFDA’s discretion to make it easier to fill gaps in public sector availability. The expanded medicine list for ADDOs includes some prescription and basic lifesaving medicines based on what is approved for primary health care facilities in the public sector.

Tanzania experience:

Summa Foundation assessed the financing and business skills training needs of medicine shops that may participate in the ADDO program and identified potential partners in the microfinance and business training industries.

Tanzania experience:

The Muhimbili University School of Pharmacy, with guidance from the TFDA and SEAM, drafted an ADDO dispenser and shop owner curriculum, together with dispenser and owner training materials and a teacher facilitator manual.

Tanzania experience:

The Muhimbili University School of Pharmacy, with guidance from the TFDA and SEAM, drafted an ADDO dispenser and shop owner curriculum, together with dispenser and owner training materials and a teacher facilitator manual. Personnel possessing the minimum requirement of nurse assistant or above are required to complete a four-week TFDA-approved training course. Trainee competency and training effectiveness are evaluated at the end of the course; those who pass are awarded a TFDA ADDO dispensing certificate. An ADDO dispensers’ reference manual is distributed to students who complete training successfully.

Dispensers’ training covers:

– Laws, regulations, and dispensers ethics.
– Good dispensing practices and rational medicines use.
– Common medical conditions in the community.
– Reproductive health and HIV/AIDS.
– Communication skills and counseling.
– Child health.

MEDA conducted a training needs assessment, then developed and provided a three-day business skills training session for ADDO owners. Training covers basic bookkeeping and financial management, inventory control, record-keeping, and marketing. Attendance at the course is a requirement for all ADDO owners and is also necessary to access the microloans.

TFDA developed training program and curricula for ward inspectors and District Drug Training Committees (DDTCs)

Tanzania experience:

Developed useful job aids (in Swahili) to assist with dispenser supervision.

Tanzania experience:

Designed and conducted pharmaceutical register analysis to monitor dispensing activities at ADDO shops, which included data from September 2003 to June 2004. The assessment provided evidence of how the ADDO shops were doing in treating of illnesses of major public health concern.

TFDA assessed the ADDO regulatory activities in Ruvuma.

Tanzania experience:

Carried out supportive supervision visits quarterly using a team of selected supervisors in collaboration with each district’s council health management team; quarterly visits by ward inspectors; inspections by the DDTC biannually and as needed. TFDA receives reports from the districts and conducts periodic audits.

Tanzania experience:

Conducted a study to examine the justification and feasibility of modifying taxes and licensing fees to encourage duka la dawa baridi (DLDB) owners to convert their shops to ADDOs. Because of difficulties with tax authorities, the attempt to rationalize taxes was ultimately unsuccessful.

Commissioned a study to evaluate whether a relationship between ADDOs and the National Health Insurance Fund and/or Community Health Fund was feasible. Recommendations stemming from the study results were approved by the Tanzania Food and Drugs Authority (TFDA) and regional and local governments; held one-day workshop to discuss report.

Tanzania experience:

Summa Foundation and SEAM approved a program to make small- to medium-sized loans available for ADDO owners, mainly for working capital; Summa provided the loan financing, which Mennonite Economic Development Associates (MEDA) administered. SEAM paid the costs of MEDA administration for two years, then MEDA transferred the ADDO portfolio to the Tanzanian National Microfinance Bank.

Tanzania experience:

Conducted a situation and options analysis and toolkit to gather information from stakeholders that would help establish and sustain ADDO provider associations under a broader agenda of increasing access to quality pharmaceutical products and services.

Tanzania experience:

Conducted formative research for behavior change communication strategy development using focus group discussions:

– Defined audiences and desired behaviors.
– Prepared and tested materials for 28 focus group discussions with consumers, DLDB owners and dispensers, and community leaders.
– Conducted three focus group discussions in intervention districts.
– Conducted 15 in-depth interviews with key government informants.
– Analyzed and reported findings.
– Met to discuss findings.

Conducted focus group discussions to evaluate the ADDO brand/logo and radio scripts, with subsequent TFDA approval of the brand name Duka la Dawa Muhimu (loosely translated as “essential drugs shop”), the logo, and radio scripts. Consumer opinion drove the final decision on the name and logo.

Tanzania experience:

Contracted with a social marketing expert who provided technical leadership and developed a marketing plan including advising on selecting and advertising agency and a billboard company. The strategy was based on the results of the formative behavior change research.

Contracted with a professional advertising firm to develop logo and radio spots, help with name selection, and billboard creation, all centered on the theme of trust.

Conducted launch in each district to mobilize the community and build awareness of ADDO services; award certificates to dispensers and owners. Officially implemented ADDO Program in the Ruvuma region, with launches in Songea Urban, Songea Rural, Namtumbo, and Mbinga.

Tanzania experience:

Developed and documented ADDO Program evaluation process and plan.

Developed and tested evaluation tools:

– Simulated client visit for childhood malaria
– Background
– Pharmaceutical management
– Training
– Medicine availability and price
– Registration status of products sold.

Tanzania experience:

Conducted baseline and endline evaluation of DLDBs in the pilot (Ruvuma) and control (Singida) regions to measure aspects of medicine availability, affordability, and pharmaceutical services:

– Baseline evaluation conducted in March 2003
– Endline evaluation conducted in November 2004

Arranged to have MEDA monitor, evaluate, and report on the business performance of the ADDOs in Mbinga as part of its contract with SEAM. MEDA collected baseline data in Mbinga in April 2004 and did a follow-up assessment in January 2005.

Danida commissioned an independent evaluation of the ADDO program in 2006.

Tanzania experience:

Held local stakeholder workshops in 2005 to review evaluation findings, discuss implications, and prepare next steps.