Abstract
BackgroundSince 2003 Tanzania has upgraded its approximately 7000 drug stores to Accredited Drug Dispensing Outlets (ADDOs), involving dispenser training, introduction of record keeping and enhanced regulation. Prior to accreditation, drug stores could officially stock over-the-counter medicines only, though many stocked prescription-only antimalarials. ADDOs are permitted to stock 49 prescription-only medicines, including artemisinin combination therapies and one form of quinine injectable. Oral artemisinin monotherapies and other injectables were not permitted at any time. By late 2011 conversion was complete in 14 of 21 regions. We explored variation in malaria-related knowledge and practices of drug retailers in ADDO and non-ADDO regions.MethodsData were collected as part of the Independent Evaluation of the Affordable Medicines Facility - malaria (AMFm), involving a nationally representative survey of antimalarial retailers in October-December 2011. We randomly selected 49 wards and interviewed all drug stores stocking antimalarials. We compare ADDO and non-ADDO regions, excluding the largest city, Dar es Salaam, due to the unique characteristics of its market.ResultsInterviews were conducted in 133 drug stores in ADDO regions and 119 in non-ADDO regions. Staff qualifications were very similar in both areas. There was no significant difference in the availability of the first line antimalarial (68.9% in ADDO regions and 65.2% in non-ADDO regions); both areas had over 98% availability of non-artemisinin therapies and below 3.0% of artemisinin monotherapies. Staff in ADDO regions had better knowledge of the first line antimalarial than non-ADDO regions (99.5% and 91.5%, p = 0.001). There was weak evidence of a lower price and higher market share of the first line antimalarial in ADDO regions. Drug stores in ADDO regions were more likely to stock ADDO-certified injectables than those in non-ADDO regions (23.0% and 3.9%, p = 0.005).ConclusionsADDO conversion is frequently cited as a model for improving retail sector drug provision. Drug stores in ADDO regions performed better on some indicators, possibly indicating some small benefits from ADDO conversion, but also weaknesses in ADDO regulation and high staff turnover. More evidence is needed on the value-added and value for money of the ADDO roll out to inform retail policy in Tanzania and elsewhere.
Highlights
Since 2003 Tanzania has upgraded its approximately 7000 drug stores to Accredited Drug Dispensing Outlets (ADDOs), involving dispenser training, introduction of record keeping and enhanced regulation
Tanzania has only around 700 pharmacies and they are mainly found in urban areas, so the 7000-plus drug stores have been a crucial source of care in rural and peri-urban areas [9, 10]
In this paper we explore variation in drug retailer performance across ADDO and non-ADDO regions following Affordable Medicines Facility - malaria (AMFm) implementation, comparing staff knowledge of the first line drug and artemisinin based combination therapy (ACT) dosing; whether outlets stocked recommended and non-recommended malaria-related products; antimalarial retail prices and mark-ups; and the market share of recommended antimalarials
Summary
Since 2003 Tanzania has upgraded its approximately 7000 drug stores to Accredited Drug Dispensing Outlets (ADDOs), involving dispenser training, introduction of record keeping and enhanced regulation. There are concerns that drug stores are poorly monitored and may be run by under-qualified staff [3] Working with such private medicine sellers to improve their quality of care has been seen as a strategy to enhance overall health service provision [4]. Drug store staff were required to have at least 4 years of healthrelated training, and were officially allowed to stock over-the-counter medication (OTC) only, but often sold prescription only medicines (POMs) [11]. Further concerns about their operations related to evidence of inadequate facilities for storing medications, underqualified staff, and the limited supervision received from inspectors [9, 11]. A small proportion of general retailers stocked OTCs, they were not permitted to do so [12]
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