Rutta Edmund, Liana Jafary, Embrey Martha, Johnson Keith, Kimatta Suleiman, Valimba Richard, Lieber Rachel, Shekalaghe Elizabeth, Sillo Hiiti
Management Sciences for Health, Arlington, VA USA.
Management Sciences for Health, Dar es Salaam, Tanzania.
J Pharm Policy Pract. 2015 Sep 25;8:23. doi: 10.1186/s40545-015-0044-4. eCollection 2015.
Retail drug sellers are a major source of health care and medicines in many countries. In Tanzania, drug shops are widely used, particularly in rural and underserved areas. Previously, the shops were allowed to sell only over-the-counter medicines, but sellers who were untrained and unqualified often illegally sold prescription drugs of questionable quality.
In 2003, we worked with Tanzania's Ministry of Health and Social Welfare to develop a public-private partnership based on a holistic approach that builds the capacity of owners, dispensers, and institutions that regulate, own, or work in retail drug shops. For shop owners and dispensers, this was achieved by combining training, business incentives, supervision, and regulatory enforcement with efforts to increase client demand for and expectations of quality products and services. The accredited drug dispensing outlet (ADDO) program's goal is to improve access to affordable, quality medicines and pharmaceutical services in retail drug outlets in rural or peri-urban areas with few or no registered pharmacies. The case study characterizes how the ADDO program achieved that goal based on the World Health Organization's health system strengthening building blocks: 1) service delivery, 2) health workforce, 3) health information systems, 4) access to essential medicines, 5) financing, and 6) leadership and governance.
The ADDO program has proven to be scalable, sustainable, and transferable: Tanzania has rolled out the program nationwide; the ADDO program has been institutionalized as part of the country's health system; shops are profitable and meeting consumer demands; and the ADDO model has been adapted and implemented in Uganda and Liberia. The critical element that was essential to the ADDO program's success is stakeholder engagement-the successful buy-in and sustained commitment came directly from the effort, time, and resources spent to fully connect with vital stakeholders at all levels.
Beyond improving the quality of medicines and dispensing services, availability of essential medicines, and the regulatory system, the impact of a nationwide accredited drug seller approach on the pharmaceutical sector promises to provide a model framework for private-sector pharmaceutical delivery in the developing world that is sustainable without ongoing donor support.
在许多国家，零售药店是医疗保健和药品的主要来源。在坦桑尼亚，药店被广泛使用，尤其是在农村和医疗服务不足的地区。以前，这些药店只允许销售非处方药，但未经培训和不合格的销售人员经常非法销售质量存疑的处方药。
2003年，我们与坦桑尼亚卫生和社会福利部合作，基于一种整体方法建立公私伙伴关系，以建设零售药店所有者、药剂师以及监管、拥有或在零售药店工作的机构的能力。对于店主和药剂师，通过将培训、商业激励、监督和监管执法与提高客户对优质产品和服务的需求及期望的努力相结合来实现这一目标。经认可的药品配药点（ADDO）计划的目标是改善农村或城市周边地区零售药店中负担得起的优质药品及制药服务的可及性，这些地区注册药店很少或没有。该案例研究描述了ADDO计划如何基于世界卫生组织的卫生系统强化要素实现这一目标：1）服务提供，2）卫生人力，3）卫生信息系统，4）基本药物获取，5）筹资，以及6）领导与治理。
ADDO计划已被证明具有可扩展性、可持续性和可转移性：坦桑尼亚已在全国范围内推广该计划；ADDO计划已被制度化，成为该国卫生系统的一部分；药店盈利且满足消费者需求；并且ADDO模式已在乌干达和利比里亚得到调整和实施。ADDO计划成功的关键要素是利益相关者参与——成功的接受和持续的承诺直接源于为与各级重要利益相关者充分联系所花费的努力、时间和资源。
除了提高药品质量和配药服务、基本药物的可及性以及监管系统外，全国认可药品销售商方法对制药部门的影响有望为发展中国家私营部门药品供应提供一个可持续且无需持续捐助支持的模式框架。
