2. Accredited Drug Dispensing Outlets (ADDOs): Improving Access to Quality Drugs and Services in Rural and Peri-urban Areas with Few or No Pharmacies
Authors: M. Ndomondo-Sigonda, R. Mbwasi, R. Shirima, N. Heltzer, M. Clark

3. ADDO Background (1) MSH/SEAM Tanzania Survey 2001
Assess drug supply and access issues
Initiatives developed to address access issues
Accredited Drug Dispensing Outlets (ADDOs)

4. ADDO Background (2) Problems with Part II Shops
Chronic violation of Regulations
Unqualified Staff
Unknown drug quality
Selling PoM
High drug prices
Inadequate regulation

5. ADDO Background (3) Where People Buy Medicines
339 Part I drug outlets (pharmacies)
Most Part I shops located in urban areas while 80% of population in rural areas
> than 4000 Part II drug shops
Population is largely rural - only 17% have access to private pharmacies
Part II shops (DLDBs) more accessible to population than all other public or private drug outlets
Drug Outlets Per Capita
Population: million
# Facilities
Facilities
Per Capita
Part II Shops (DLDB)
4,627
7,343
Public facilities
2,907
11,687
Voluntary/
religious
772
44,009
Private
934
36,375
Private Pharmacies
339
102,026
Parastatal
211
161,017

6. ADDO Objective
Objective: Transform existing Part II shops into a regulated system of profitable ADDOS that will improve availability and quality of drugs and services in communities where there are few or no pharmacies

7. ADDO Strategies Strategies
Training – dispensers, owners, local inspectors
Social Marketing program to promote behaviour change – consumers and owners
Commercial incentives
Supportive supervision
Modified legal and regulatory framework

8. ADDO Implementation Pilot and control Regions/Districts selected, then
Formative Research
Advocacy: Government and Private Sector
Regulatory Activities: Regulations and Code of Ethics
Approved Part I (Prescription) Drug List
Training: inspector, dispenser, owner
Commercial Incentives
Communications / Marketing Campaign

9. Baseline Research Baseline assessments in pilot and control districts
Drug quality, availability, affordability
Dispenser knowledge and practice for diagnosing and treating malaria, diarrhea and acute respiratory infections
Dispenser dispensing practices (record keeping, storage, prescription packaging and labeling, etc.)
Dispenser knowledge of drug quality
Characteristics of premises
Dispenser training/educational background

10. Key Interim Results (1) DRUG QUALITY
All tracer drugs TFDA registered or approved

11. Key Interim Results (2) AVAILABILITY
Essential drug availability: Improved

12. Key Interim Results (3) AFFORDABILITY
Affordability: Stable despite increased owner expenses (ex. personnel, premises, expanded inventory)

13. Key Interim Results (4) REGUALTORY ADHERENCE
Regulatory adherence: Improved

14. Key Interim results (5) CONSUMER ACCEPTANCE
Sales and customer data indicative of community acceptance

15. ADDOs: Conclusions Knowledge gaps documented
Strategies developed and interventions implemented
Importance of drug shops
Additional research
Do ADDOs improve health outcomes and rational drug use
Cost-benefit analysis
Scaling up of the programme
Rural
Urban

16. Thank You! Discussion