1. Tanzania1

2. 2 Tanzania Assessment Gabriel Upunda

3. Tanzania3 DemographicsTanzania Area (sq km)945,100 Population 32,900,000 25% urban GNP per capitaUS $240 Human Development Index 0.358 (150/174) Literacy rate Male: 84% Female: 65.7% Infant mortality rate94.8 per 1,000 Life expectancy47 years UNDP, 1999; World Bank, 1999 Tanzania

4. 4 Health Care Delivery System Decentralized to the district level Total health expenditure: US $166.5 million Public sector: 54% Mission sector: 35% of all hospitals Commercial sector: 5% Per capita expenditure: US $5.52

5. Tanzania5 Geographic Accessibility Hours Distance to Health Facility 14% more than 10km of public facility 6% more than 10km of private drug retailer Average number of facility operating hours per day

6. Tanzania6 Pharmaceutical Sector 18% to 19% of public health budget dedicated to drugs (US $12.4 million) National Drug Policy Pharmaceutical market estimated at US $50 million US $1.60 per capita

7. Tanzania7 Availability PublicPrivate Clinics Private Pharmacy Duka La Dawa NGO Set of un- expired tracer items in stock 72%67%79%45%84% Time out of stock 30.17% (26.5%)* 0% 18.5% (5.5%)* Prescribed items dispensed 73%91%0% 98% * Excluding items normally stocked

8. Tanzania8 Affordability Co-trimoxazoleAmoxicillin Malaria ARI ARI Round worm Conjunctivitis Diarrhea Days Number of days worked by lowest paid government employee to pay for treatment

9. Tanzania9 Acceptability DHS Survey 1999: 58% reporting quality of health facility as good or very good

10. Tanzania10 Quality of Products and Services Substandard Samples Percent

11. Tanzania11 Quality of Products and Services (2) EDL updated within last 5 years  Standard Treatment Guidelines (STG) and The National Essential Drug List for Tanzania (NEDLIT) - 1997 Facilities with latest formulary or list Percent

12. Tanzania12 Quality of Products and Services (3) Average number of drugs prescribed per encounter: MOH1.6 NGO2.3 Private1.8 Percent of drugs prescribed by generic name: MOH75% NGO72% Private66% Percent of prescribed drugs that were antibiotics: MOH31% NGO20% Private30%

13. Tanzania13 Access Gaps Availability, especially in public sector Quality and affordability of products and services, especially in the private sector serving rural areas

14. Tanzania14 Potential Strategy Approving additional sources of supply to Medical Stores Department for public sector A regulated network of Accredited Drug Dispensing Outlets (ADDO’s) A quality assurance strategy to permit improved screening of drugs entering and circulating in the market

15. Tanzania15 Viability Additional sources of supply to Medical Stores Department for public sector  Facilitators:  Consistent with legal and policy framework  Broad support from senior MOH officials, hospitals  Acceptance by senior Medical Stores Department board members, management  Support from major donors  Support and partnership from mission sector  Barriers:  Funding mechanism

16. Tanzania16 Viability (2) Accredited Drug Dispensing Outlets (ADDO’s)  Facilitators:  Broad support by Pharmacy Board and MOH  New pharmacy legislation passing through parliament amended to permit the establishment of ADDO’s  Professional pharmacy association (Pharmaceutical Society of Tanzania) supportive  Support from major donors  Barriers:  Regulation

17. Tanzania17 Viability (3) Quality Assurance  Facilitators:  Pharmacy Board, MOH supportive and committed to improving quality  Some trained laboratory personnel available  Barriers:  Resources to cover staff and other running costs  Insufficient number of trained people