Accredited Drug Dispensing Outlets (ADDO) - Results for ...

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Accredited Drug Dispensing Outlets (ADDO) - Results for ...

Accredited Drug Dispensing Outlets(ADDO) Program: Innovative Public‐Private Health Delivery ModelEdmund Rutta, MD, MPH2009 U.S.‐Africa Business Summit30 September 20091


Private Drug Sellers are ImportantSources of Medicines in Africa• In Africa, people usually buy medicines from mostconvenient source, generally the local drug shop—inTanzania, duka la dawa baridi (DLDB)• DLDBs authorized by the Tanzania Food and DrugsAuthority (TFDA) to sell nonprescription medicines inthe private sector• DLDBs dot the country, especially in rural areas wherelicensed pharmacies are scarce2


Problems with Duka La Dawa Baridi3


ADDO Program Objective• Transform loosely regulated DLDBs intoprofitable, government‐accredited drugdispensing outlets (ADDOs) that provide qualitydrugs and pharmaceutical services tounderserved populations• ADDO approach combines training, marketing,commercial incentives, regulation and localinspection, and support strategies4


ADDO Timeline (1)2003 SEAM Program (funded by the Bill and Melinda GatesFoundation)and TFDA launch ADDO pilot in Ruvuma2006 Ministry of Health and Social Welfare approves nationwideprogram rollout and funds rollout in Mtwara and Rukwa2006 DANIDA sponsors independent evaluation of ADDO program inRuvuma2006 USAID, through MSH’s Rational Pharmaceutical ManagementPlus Program, funds ADDO rollout in Morogoro usingPresident’s Emergency Plan resources2006 National Malaria Control Programme incorporates ADDOs intostrategy to increase access to malaria treatment5


ADDO Timeline (2)2007 USAID through MSH’s Strengthening Pharmaceutical SystemProgram funds distribution of subsidized artemisinin‐basedcombination therapies (ACTs) through ADDO using President’sMalaria Initiative resources.2007 Global Fund funds ADDO rollout in six to eight regions; DANIDAalso contributes funding for rollout2007 Gates Foundation funds East African Drug Seller Initiative towork with TFDA to revise existing ADDO implementation model2009 Rockefeller Foundation funds MSH to promote ADDO ownerand dispenser associations2009 Local governments in Arusha, Iringa, Kagera, Tabora andKilimanjaro take initiative on their own to mobilize funds tointroduce ADDOs6


ADDO Program Scale up Status as ofSeptember 2009KageraMaraKigoma12%MwanzaShinyangaArushaKilimanjaroManyaraTangaRukwaTaboraMbeyaSingidaDodomaIringaMorogoroPwaniLindiRegions previouslycovered with ADDOprogramRegions where localgovernments mobilizedfunds for expansionADDO expansion 08/09funding available fromGlobal Fund, Danida,and Clinton FoundationRuvumaMtwaraRegion sensitizationcompleted but no scaleup funding yet8


Reviewing the Tanzania ADDO Model forScalability and SustainabilityOld ImplementationModel• Centralized implementation with a national teamcovering one region at time•Estimated cost to implement one district is TZS163 million (US$126,00)•Rollout time for one region estimated at 18monthsNewImplementationModel• Decentralized approach using district teamssimultaneously implementing in multiple districts•Estimated cost to implement one district is TZS 73million (US$ 57,000)•Rollout time for one region estimated at less than12 months9


Integrating Insurance Scheme intothe ADDOAccredited more than 150ADDOs in four regions• Reduced complaints from NHIFmembers on medicineavailability in areas withADDOs• By July 2008, 13,148 NHIFmembers had received servicefrom ADDOs with totalpayment of TZS 25 million (US$20,000)10


Opportunities for Rural Women• Provides secure jobopportunities for ruralwomen• As of October 2007,women comprised 24%of ADDO owners inMorogoro region and38% in Ruvuma region• In both regions, about90% of the 1,148licensed dispensers arewomen“By opening a Duka La DawaMuhimu, I have improved myincome, and I can now help myfamily by paying for my nieces’and nephews’ school fees.”—Frieda Komba, ADDO owner12


Contribution of Private Sector• Contribution to national health priorities and healthsector reform– Create additional outlets for specific public healthinterventions (e.g., child health, ACT distribution,community‐based care for HIV/AIDS)– Compliment to improved services by reducingpressure on public sector health facilities– More trained human resources• Improved access to quality medicines andservices, especially in remote and underservedareas14

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