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Accredited Drug Dispensing Outlets (ADDOs): Improving Access to Quality Drugs and Services in Rural and Peri-urban Areas

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. Setting Characteristics & Problems.

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Accredited Drug Dispensing Outlets (ADDOs): Improving Access to Quality Drugs and Services in Rural and Peri-urban Areas

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  1. 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

  2. Setting Characteristics & Problems • Public Primary Health Stock Outs – up to 30% • High demand for private pharmacy services • > 4,000 non-pharmacy drug (Part II) shops • 80% of population have access to Part II shops Problems • Chronic violation of regulation • Unqualified Staff • Unknown drug quality • Selling PoM • High drug prices • Inadequate regulation

  3. Intervention Approach • Baseline Survey: Quality, Availability, Affordability, Regulatory adherence • Modified legal and regulatory framework, including expanded drug list & decentralization • Accreditation standards established by TFDA • Training – dispensers, owners, local inspectors • Social Marketing program to promote behaviour change – consumers and owners • Commercial incentives • Supportive supervision

  4. Interim Results • Evidence of Behaviour Change • Owners • All tracer drugs TFDA registered or approved • Inventory expanded • Regulatory adherence: Improved • Patient registers • Licencing • Consumers • Sales and customer data indicative of community acceptance

  5. Key Lessons • Elements of Sustainability • Holistic approach addressing interests of all stakeholders • Government regulatory and public health concerns • Involvement of Local Government in licensing and inspection: Health and non-health officials • Commercial interests of owners • Education and status of dispensers • Consumer needs for quality, service and reasonable prices • Range of partners required for implementation – government & NGOs • Country realities • Public sector can’t meet consumer demand • Drug shops providing an important service • Labour market not producing enough pharmacy technicians and assistants • National Regulatory Authority insufficient resources to oversee drug shop activities

  6. Policy and Legal Framework • Legal & regulatory framework must be attuned to intervention needs – Review of law • Political Support • Comprehensive and customized package of commercial incentives • Decentralization of licencing and regulatory authority

  7. Research areas • Opening ADDO in urban areas where there is full-service pharmacies • Do ADDOs improve health outcomes and Rational Drug Use • ADDO is a complex and costly progamme • Scaling up- huge training and supervision, limited institutional capacity • is it worth it?

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