Building capacity for pharmaceutical services where pharmacies do not exist: The ADDO experience in Tanzania

In Tanzania, people's source for medicines is often the private drug shop—especially in rural areas. However, drug dispensers in informal shops lack training and supervision. Addressing this problem is difficult due to limited resources, need for deployment in remote regions, and the sheer number of existing shops (over 6,000). The Strategies for Enhancing Access to Medicines (SEAM) Program and the Tanzanian government introduced a program to improve access to pharmaceutical services by creating a new class of private-sector health care provider trained to identify and treat common illnesses according to accepted standards with selected prescription medicines.

The ADDO program expands the human resource base for pharmaceutical services by combining training, economic incentives, monitoring, and inspection under an umbrella of new national regulations and standards. After the pilot, government representatives determined that the ADDO program contributed significantly to improving access to and rational use of essential medicines, and the government committed to expanding the concept nationwide. Since then, and with the support of the RPM Plus Program, the number of accredited shops has risen to over 600 from 150. In addition, donors are using ADDOs as a platform to increase access to malaria drugs, including subsidized artemisinin-based combination therapies, and to build additional capacity in ADDO dispensers to treat childhood illnesses and provide a resource for HIV/AIDS prevention and care initiatives.

Through a complex strategy of regulation, training, incentives, and monitoring, the ADDO initiative created a new class of health care provider that offers basic standardized services to previously underserved populations.