Abstract
BackgroundTo improve access to treatment in the private retail sector a new class of outlets known as accredited drug dispensing outlets (ADDO) was created in Tanzania. Tanzania changed its first-line treatment for malaria from sulphadoxine-pyrimethamine (SP) to artemether-lumefantrine (ALu) in 2007. Subsidized ALu was made available in both health facilities and ADDOs. The effect of these interventions on access to malaria treatment was studied in rural Tanzania.MethodsThe study was carried out in the villages of Kilombero and Ulanga Demographic Surveillance System (DSS) and in Ifakara town. Data collection consisted of: 1) yearly censuses of shops selling drugs; 2) collection of monthly data on availability of anti-malarials in public health facilities; and 3) retail audits to measure anti-malarial sales volumes in all public, mission and private outlets. The data were complemented with DSS population data.ResultsBetween 2004 and 2008 access to malaria treatment greatly improved and the number of anti-malarial treatment doses dispensed increased by 78%. Particular improvements were observed in the availability (from 0.24 shops per 1,000 people in 2004 to 0.39 in 2008) and accessibility (from 71% of households within 5 km of a shop in 2004 to 87% in 2008) of drug shops. Despite no improvements in affordability this resulted in an increase of the market share from 49% of anti-malarial sales 2005 to 59% in 2008. The change of treatment policy from SP to ALu led to severe stock-outs of SP in health facilities in the months leading up to the introduction of ALu (only 40% months in stock), but these were compensated by the wide availability of SP in shops. After the introduction of ALu stock levels of the drug were relatively high in public health facilities (over 80% months in stock), but the drug could only be found in 30% of drug shops and in no general shops. This resulted in a low overall utilization of the drug (19% of all anti-malarial sales)ConclusionsThe public health and private retail sector are important complementary sources of treatment in rural Tanzania. Ensuring the availability of ALu in the private retail sector is important for its successful uptake.
Highlights
To improve access to treatment in the private retail sector a new class of outlets known as accredited drug dispensing outlets (ADDO) was created in Tanzania
Availability and accessibility of anti-malarials in public health facilities Drug availability data were collected for ten facilities over four years for four drugs i.e. 1,680 facility-months but only 1,380 facility-months of observation could be included in the analysis
The findings presented here are highly relevant to the imminent roll-out of the Affordable Medicines Facility for malaria (AMFm) and confirm that ensuring wide availability of ALu in the private retail sector is paramount to its uptake
Summary
To improve access to treatment in the private retail sector a new class of outlets known as accredited drug dispensing outlets (ADDO) was created in Tanzania. It is increasingly recognized that the Roll Back Malaria (RBM) Partnership target of ‘80% of malaria patients receiving effective treatment within 24 hours’ cannot be achieved in sub-Saharan Africa unless anti-malarial drugs are made available outside the formal health with fever were treated with artemisinin combination therapy (ACT) [4]. It has been argued that the delivery of anti-malarials needs to be supplemented by additional distribution mechanisms. This can be achieved through: 1) community case management and 2) strengthening the role of the private retail sector. The misuse of ACT and the use of artemisinin monotherapies could contribute to the emergence and spread of artemisinin resistance
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