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ADDO PROGRAM AT GLANCE

Background

Tanzania National Health Policy and Health Sector Reforms aim to improve access to quality health care, including provision of pharmaceutical services, to all population in urban and rural areas in an equitable manner. Furthermore, Public Private Partnership is emphasized in order to enable private sector to compliment health service delivered by the public sector (MOHSW 2003).

In rural and peri-urban areas where almost 70% of Tanzanians live, accessibility to health services through public health facilities is often limited due to, among other factors, poor infrastructure, long distance a person has to travel in seeking medical care and frequent stock out of basic medicines at public health facilities. This has caused health seeking behaviour for basic medicines for common diseases to be inclined toward attending small community-based Part II drug shops, popularly known as Duka la dawa baridi (DLDBs) .  It is estimated that about 35% - 40% of the population use DLDBs for this purpose (CPM, 2003).

Even though these drug shops compliment the government efforts to improve access of quality medicines and pharmaceutical service to those at high risk, there are problems associated with their operations.  A pharmaceutical sector assessment conducted by the Ministry of Health and Social Welfare (MOHSW), in collaboration with Management Sciences for Health (MSH) in 2001 and also  countrywide inspections of medicine outlets by Tanzania Food and Drugs Authority (TFDA) and Regional Authorities and Local Governments found the following problems:

• Uneven distribution of DLDBs
• Poor dispensing practice and indiscriminate sale of drugs especially antibiotics
• Inadequate and/or poor storage condition for medicines 
• Dispensers having fragmented knowledge, lacking skills, and competence in respect to good dispensing practice and in some cases were totally unqualified  
• Sale of sub-standard, unregistered or expired medicines  and
• Inadequate and ineffective regulatory system as medicine outlets were not frequently inspected. This situation was attributed by the fact that inspections were normally carried out by central level. 

This state of affair poses a danger to achievement of the goal of the National Health Policy of ensuring delivery of quality, safe and effective health services to the population.
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In response to the above situation, the MOHSW through TFDA in collaboration with Management Sciences for Health and Regional and Local Government Authorities piloted a Program in Ruvuma from 2002 to 2005 with the support from Bill and Melinda Gates Foundation. The Program established a network of Accredited Drug Dispensing Outlets (ADDOs) also known in swahili as “Duka la Dawa Muhimu (DLDM)” to provide selected basic medicines and other medical supplies in rural and peri-urban areas.