Sustainable Drug Seller Initiatives
April 2011-May 2014 Funded by the Bill & Melinda Gates Foundation The Sustainable Drug Seller Initiatives (SDSI) program builds on MSH’s Strategies for Enhancing Access to Medicines (SEAM) and East African Drug Seller Initiatives (EADSI) programs. Those programs focused on creating and implementing public-private partnerships using government accreditation to increase access to quality pharmaceutical products and services in underserved areas of Tanzania and Uganda. The new program’s goal is to ensure the maintenance and sustainability of these public-private drug seller initiatives in Tanzania and Uganda and to introduce and roll out the initiative in Liberia. Through MSH’s work in the three countries, it is expected to not only expand access to medicines and treatment in additional geographical areas, but to solidify the global view that initiatives to strengthen the quality of pharmaceutical products and services provided by private sector drug sellers are feasible, effective, and sustainable in multiple settings. The project’s objectives are to:
- Enhance accredited drug seller initiatives’ long-term sustainability, contributions to community-based access to medicines and care, and ability to adapt to changing health needs and health system context.
- Facilitate the spread of private-sector drug seller initiatives.
- Define and characterize information related to consumer access to and use of medicines and facilitate its use in developing public health policy, regulatory standards, and treatment guidelines.
Zambia Access to ACT Initiative
February 2010-April 2011 Funded by the World Bank MSH worked with Zambia’s Pharmaceutical Regulatory Authority (PRA) and other stakeholders, including other implementing partners, to define the elements of a Zambian drug seller accreditation and regulation program. The initiative was implemented in four districts. The private sector component of the Zambia Access to ACT Initiative (ZAAI) had three main objectives:
- Increase access (availability and affordability) to quality medicines, including artemisinin-based combination therapies and rapid diagnostic tests (RDTs), in underserved areas of Zambia through the private sector
- Reduce the distribution of ineffective antimalarials in the private sector
- Improve diagnostic capacity in the private sector
- Conducting four advocacy and promotion workshops for drug shop owners.
- Designing a training program for the shop owners, dispensers, and the local health management.
- Conducting eight training workshops and training 181 shop owners and dispensers.
- Collaborating with PRA and the local health leadership to accredit 57 health shops out of estimated 80. In these shops.
- Over 7,764 people were treated with an effective antimalarial drug, Coartem.
- Ineffective antimalarial medicines such as chloroquine were no longer made available to patients who tested positive for malaria.
- Supervising, inspecting, monitoring, and evaluating the accredited health shops for adherence to the accreditation standards.
- Building capacity of local health leadership to supervise and inspect the operations of the health shops.
The full report of the accreditation activities is here.
East African Drug Seller Initiative
October 2007-June 2011 Funded by the Bill & Melinda Gates Foundation The East African Drug Seller Initiative (EADSI) worked with Tanzania’s accredited drug dispensing outlet (ADDO) program to create a sustainable model for scaling up private-sector drug seller initiatives and explored the model’s transferability to another East African country. The initiative addressed the problem of people in developing countries seeking advice and medicines from retail drug sellers who are largely untrained and unregulated. As a result, customers are less likely to receive quality pharmaceutical care and products or to be counseled on proper medicines and their correct use. To achieve the initiative’s goal, MSH focused on three objectives that relied on collaboration with regional and country partners:
- helping a regional organization become an advocate and facilitator for the implementation of private-sector drug seller initiatives in member countries;
- revising the current ADDO model in Tanzania to strengthen its financial sustainability and institutionalize the public-private partnership roles to provide a scalable model for Tanzania and other countries;
- developing a plan to adapt the Tanzania model for replication in a second East African country (Uganda) and demonstrating the adapted model in one district.
This grant builds on earlier MSH accomplishments with the Strategies for Enhancing Access to Medicines (SEAM) Program, also funded by the Gates Foundation. From 2000 to 2005, the program worked to improve access to quality medicines and services at retail drug outlets that often provide first-line health care, especially for those who live in remote, undeserved areas.
January 2009-December 2010 Funded by the Rockefeller Foundation The Accredited Drug Dispensing Outlet (ADDO) Association determined how ADDO associations can contribute to the long-term sustainability of private sector drug seller initiatives and to help ensure that drug sellers continuously provide quality medicines and pharmaceutical services for poor and vulnerable people in Tanzania. Specific objectives included:
- Provide a situational analysis report based on the literature review and data collected from nine districts.
- Present an option analysis for establishing ADDO owners’ associations.
- Create a strategy for establishing ADDO associations and a defined set of functions and roles that associations would play in the short- and long-term.
- Develop a “how-to” guide for establishing and successful managing associations.
Rational Pharmaceutical Management Plus
September 2000-September 2008 Funded by the United States Agency for International Development (USAID) Changing the ways in which providers, patients, and the public view and use pharmaceuticals and essential health commodities is a complex challenge, especially in resource-limited environments where essential health commodities are needed to combat wide-spread diseases such as tuberculosis (TB), malaria, and HIV/AIDS. In recognition of this challenge, in 2000, USAID awarded Management Sciences for Health (MSH) funding for the Rational Pharmaceutical Management (RPM) Plus—a program designed to follow the RPM Project that ended earlier that same year. Through the RPM Plus’ private sector initiatives in maternal and child health, the program developed a strategy for interventions in the private sector. A child health component was integrated into the Accredited Drug Dispensing Outlet (ADDO) program in Tanzania. The ADDO program, which is administered by the Tanzanian Food and Drugs Authority (TFDA), created retail medicine outlets, called Duka La Dawa Muhimu (Swahili for “essential drug shop”) that must adhere to standards related to product and service quality to achieve and maintain government accreditation. The child health intervention package, which was created in partnership with the Basic Support for the Institutionalizing Child Survival (BASICS) projetc, sought to maintain and improve the quality of care provided by the ADDOs with a particular focus on child health. It included a module for ADDO training and mechanisms to strengthen community demand creation, oversight, regulation and monitoring and evaluation.
Strategies for Enhancing Access to Medicines
September 2000-December 2006 Funded by the Bill & Melinda Gates Foundation The Strategies for Enhancing Access to Medicines (SEAM) Program, created by Management Sciences for Health (MSH) and funded by the Bill & Melinda Gates Foundation, aimed to improve access to and use of essential medicines, vaccines, and other health commodities in the developing world. In September 2000, MSH implemented the SEAM Program to respond to the challenge of improving access to essential medicines. The program focused on increasing access through innovative public-private sector partnerships to improve pharmaceutical supply systems, as well as on the quality of the products and pharmaceutical services provided to consumers in developing countries. Based on the results of comprehensive pharmaceutical sector assessments in five countries, SEAM implemented full-scale country programs in Ghana and Tanzania, and carried out a targeted initiative in El Salvador. Specific initiatives included: El Salvador:
- Developed a modified prime vendor–based inventory management and distribution model for improving supply of pharmaceuticals in the public sector
- Developed a private–sector business model for a franchise of chemical sellers’ shops in rural areas
- Created programs to improve drug procurement, information systems, and drug use in the Catholic mission hospital sector
- Created a new category of private accredited drug dispensing outlets to provide quality medicines and services at affordable prices in underserved regions
- Devised a tiered product-testing strategy and implemented a screening technology–based quality assurance pharmaceutical surveillance program
- Helped establish a prime vendor-based drug procurement system and improved quantification and information systems in the mission hospital sector of Northern Tanzania
Other SEAM Program initiatives focused on:
- Providing technical assistance to global health initiatives to maximize their impact in the field by ensuring that appropriate pharmaceutical management mechanisms were included
- Developing and disseminating pharmaceutical management software programs and information that are based on “best practices” for resource-limited environments
- Facilitating discussion of cutting-edge issues related to pharmaceutical management through the organization of high-level technical meetings and conferences