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Improving Access to Quality Drugs in Rural Areas: The ADDO Initiative

This article discusses the Accredited Drug Dispensing Outlets (ADDOs) program, which aims to improve access to quality drugs and services in rural and peri-urban areas with limited pharmacy options. It examines the problems faced in these areas, intervention approaches, interim results, key lessons learned, and the policy and legal framework required for sustainability. The article also highlights research areas for further exploration.

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Improving Access to Quality Drugs in Rural Areas: The ADDO Initiative

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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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