An assessment of the pharmaceutical sector carried out in 2001 by the government in collaboration with Management Sciences for Health (MSH) revealed significant problems associated with the operations and conduct of small community-based Part II drug shops (DLDBs) into Accredited Drug Dispensing Outlets (ADDO).
The problems included uneven distribution of DLDBs, poor dispensing practices, indiscriminate sale of drugs especially antibiotics and poor storage conditions for medicines in DLDBs.
It was discovered that many DLDB dispensers had insufficient knowledge, skills and competences with regard to good dispensing practices and in some cases, they totally lacked qualifications in the health and particularly pharmaceutical sector discipline.
Substandard, counterfeit, unregistered and expired medicines were also found in these DLDBs. All these make the National Health Policy’s goal of ensuring delivery of quality, safe and effective health services to all Tanzanians unattainable.
In response to this, the Ministry of Health and Social Welfare through the Tanzania Food and Drugs Authority (TFDA) in collaboration with MSH came up with the ADDO programme initiative which was piloted in Ruvuma from 2002-2005 with the support from the Bill and Melinda Gates Foundation.
The programme established advanced medicine outlets to provide selected basic medicines and other medical supplies particularly in rural and peri-urban areas.
The aim was to ensure over 80 per cent of rural and peri-urban areas in Tanzania mainland purchased quality basic medicines from well-regulated and properly operated private medicine outlets manned by trained personnel by 2010.
The programme focused on improving the quality of medicines that people bought from drug sellers, increasing the availability of essential medicines throughout the country, the quality of dispensing services from both technical and consumer perspectives and making essential medicines and pharmaceutical services affordable and accessible to people in the rural and peri-urban areas.
As a result, there was a need for sensitisation and mobilization of stakeholders at different levels on the ADDO programme initiative, identification of locations where ADDO shall be positioned and preliminary inspections, before training of ADDO drug dispensers, owners and inspectors and finally accredit drug outlets followed by supervision, monitoring and evaluation.
The first ADDOs were launched in Ruvuma in August 2003 and evaluation of the pilot project revealed a significant improvement in access to quality and safe medicines.
By June 2012, 18 regions had been covered and in seven other regions the programme is at various stages of implementation where by 11, 872 dispensers have been trained countrywide.
On April 21st, 1,366 medicine dispensers from Temeke, Ilala and Kinondoni municipalities were awarded ADDO certificates by Dar -es- Salaam Administrative Secretary Ms. Theresia Mbando, after having attended and successfully completed a five-week ADDO training programme since March 5 to April 19, 2012.
This training was an outcome of a meeting conducted by TFDA in collaboration with the Pharmacy Council, district municipalities of Ilala, Kinondoni and Temeke and owners of DLDBs in Dar es Salaam on January 17, 2012. The meeting deliberated on training costs sharing whereby shop owners contributed 30,000/- for the training which lasted for five days while drug dispensers paid 250,000/- for a 35 days training. The funds were collected and supervised by the responsible municipalities.
The owners training took place at PTA Hall at the Trade Fair grounds (SabaSaba), Dar-es-Salaam while that of dispensers were conducted in their respective district municipals.
The same was done in other districts including Kahama, Meatu, Bariadi, Tunduru, Songea Urban and Rural, Namtumbo, Mbinga, Kilosa, Morogoro Urban, Kilombero and Mbeya Urban. Other areas include Mbarali, Moshi Urban and Rural, Kilindi, Dodoma Urban, Lindi Urban and Rural, Njombe, Kyela and Mkuranga.
“I am very happy to learn that 80 per cent of the trainees are women as we all know to educate a woman is to educate the whole society,” said TFDA Director General, Hiiti Sillo, during the closing of dispensers’ training in Dar es Salaam.
Commenting on the TFDA training programme, one of the owners who attended the training, Dr. Moza Mandwanga said, “I have been enlightened by this training. Most drug shops used to operate without following proper procedures. There are certain criteria to follow like premise inspection, clean surroundings and employing qualified drug dispensers.” She noted that only those possessing TFDA ADDO Owners training certificate will be authorised to operate drugs shops, which will be transformed into ADDOs.
Dr. Mandwanga called on TFDA to make the training programme sustainable to benefit more Tanzanians especially the youth.
Another trainee, who is proud of having attended the training programme, Amos Deogratias Makweba (from Mtoni-Kijichi, Mbagala Kuu), said the training programme has helped him increase his knowledge of what the drug shop should look like and the necessity to keep patients’ records.
He also learned on indicators of authorised good quality drugs as well as illegal, substandard and expired drugs and procedures of establishing ADDOs.
“Indicators of authorised and good quality original drugs include registration status by the responsible authority and having its original specifications and colour and proper expiry date as per date of registration,” he says.
ADDO trainees as per Tanzania Food and Drugs (ADDO Regulation, 2008) include nurse assistants, nurse-midwives, clinical officers, assistant clinical officers, pharmaceutical assistants and pharmaceutical technicians.
After enactment of the Pharmacy Act, 2011, it has been directed that ADDO programme activities shall be coordinated by the Pharmacy Council of Tanzania right after the roll-out has been completed by TFDA throughout the country.
To date, the handing over of ADDO activities regions where the programme is under implementation has been done to the Pharmacy Council with exceptional of six regions namely Dar es Salaam, Mwanza, Kagera, Arusha, Tabora and Kilimanjaro where the rollout is in the final stage of implementation.