1. Increasing access to family planning commodities through accredited drug shops: the Uganda experience
Aziz Maija
MSH Uganda
October 12, 2016

2. Drug sellers – the opportunity
Majority of people purchase medicines from drug shops
Most live within 5 km of a drug shop
Service perceived as more personal; flexible payment
Many more drug shops than licensed pharmacies in rural areas
Public facilities often experience stock-outs

3. Accredited drug shops: background
Since 2000, MSH projects have focused on creating and implementing public-private partnerships using government accreditation to increase access to quality pharmaceutical products and services in underserved areas of Tanzania, Uganda, and Liberia—just starting in Zambia and Bangladesh
Tanzania
Uganda
Liberia
Pilot
2003: 1 region
2009: 1 district
2011: 1 county
Current Scale
25 regions (full-scale)
5 districts
1 county
# Accredited shops
11,000+ ADDOs
777 ADS
120 AMS
Population of catchment areas
52,482,726
3,847,797
1,386,618

4. Accredited drug seller initiative objectives
Increase the availability of essential medicines to the rural communities where majority of the people live
Improve the quality of medicines that people buy from drug sellers
Improve the quality of dispensing services from both technical and consumer perspectives

5. Overall strategy for change
National and local authorities, professional associations
Participatory approach to project design and implementation
Gain broad-based support from all stakeholders
Create accreditation standards
Decentralized inspection strategy; central oversight
Products in stock registered by NDA
Develop requirements and build stewardship and governance capacity
Business skills of owners
Case management and communication skills of sellers
Mentoring and supervision
Record keeping
Build private sector capacity
Ability to sell expanded range of medicines legally
Loans
Mobile technology applications (e.g., mobile money)
Provide incentives
Key message: ADSI is the only program that takes a holistic approach to address drug seller problem through a “package of interventions” that includes regulatory enhancement, providers skills and behavior, incentives and consumer education

6. Public health interventions integrated into accredited drug seller initiatives
Counseling on family planning; initiating oral contraceptive/condom use
Supporting integrated community case management of childhood illness (malaria, diarrhea, pneumonia)
Counseling mothers on newborn care and nutrition
Providing access to ACTs and insecticide-treated nets
TB case finding and referral

7. Accredited Drug Shops in Uganda
National Drug Authority collaborated with MSH to conceptualize and implement an initiative that transformed Class C drug shops into regulated, profitable Accredited Drug Shops (ADS)
ADS were piloted in Kibaale district (2009–2011)
MSH’s STRIDES program broadened ADS’s family planning services and expanded ADS to the Kyenjojo, Kamwenge, Kamuli, and Mityana districts (June 2012)
Roll out of ADS part of the NDA strategic plan and NDA annual budget
NDA rolled out ADS to four new districts without donor support: Isingiro, Kiruhura, Kyegegwa, and Rukungiri in 2015
Drug shops are required to upgrade to ADS standards

8. Approach to expanding family planning in ADS
Incorporate family planning into the ADS training curriculum
Train drug sellers to counsel women on family planning, initiate oral contraceptives or condoms, and refer to nearby health facilities for other methods
Accredit ADS sellers and premises that meet ADS standards
Conduct supportive supervision of ADS sellers
Provide family planning registers for sellers to maintain

9. Results of family planning expansion
Between June-December 2012, drug sellers were trained and accredited in the four districts
Kyenjojo—56 shops
Kamwenge—40 shops
Kamuli—88 shops
Mityana—97 shops

10. Kyenjojo: July–December 2012

11. Kamwenge: September 2012–March 2013

12. Kamuli: October 2012–May 2013

13. Mityana: September 2012–April 2013

14. Challenges and potential solutions
Challenge: Supportive supervision is critical to maintaining the skills of ADS sellers; however, sustainability is difficult due to reliance on the public health structure
Solution: Support formation of ADS provider associations and build their capacity to conduct peer supervision
Challenge: Relying only on medicine sales decreases business sustainability
Solution: Stocking additional items, such as cosmetics and home care products, reduces dependence on medicine sales

15. Conclusion
Linking ADS shops to the provision of family planning products is a natural fit because the vast majority of ADS attendants are women who live in the communities they serve.