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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. ADDO Background (1).
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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
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)
ADDO Background (2)Problems with Part II Shops • Chronic violation of Regulations • Unqualified Staff • Unknown drug quality • Selling PoM • High drug prices • Inadequate regulation
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
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
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
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
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
Key Interim Results (1)DRUG QUALITY • All tracer drugs TFDA registered or approved
Key Interim Results (2)AVAILABILITY Essential drug availability: Improved
Key Interim Results (3)AFFORDABILITY Affordability: Stable despite increased owner expenses (ex. personnel, premises, expanded inventory)
Key Interim Results (4)REGUALTORY ADHERENCE Regulatory adherence: Improved
Key Interim results (5)CONSUMER ACCEPTANCE • Sales and customer data indicative of community acceptance
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