Tanzania Assessment

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Tanzania Assessment Gabriel Upunda
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Tanzania
UNDP, 1999 World Bank, 1999
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Health Care Delivery System

• Decentralized to the district level
• Total health expenditure US 166.5 million
• Public sector 54
• Mission sector 35 of all hospitals
• Commercial sector 5
• Per capita expenditure US 5.52

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Geographic Accessibility
Average number of facility operating hours per day
Hours

• Distance to Health Facility
• 14 more than 10km of public facility
• 6 more than 10km of private drug retailer

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Pharmaceutical Sector

• 18 to 19 of public health budget dedicated to
  drugs (US 12.4 million)
• National Drug Policy
• Pharmaceutical market estimated at US 50 million
• US 1.60 per capita

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Availability
Excluding items normally stocked
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Affordability
Number of days worked by lowest paid government
employee to pay for treatment
Days
Malaria ARI ARI
Round worm Conjunctivitis Diarrhea

Co-trimoxazole
Amoxicillin
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Acceptability

• DHS Survey 1999 58 reporting quality of health
  facility as good or very good

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Quality of Products and Services
Substandard Samples
Percent
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Quality of Products and Services (2)

• EDL updated within last 5 years
• Standard Treatment Guidelines (STG) and The
  National Essential Drug List for Tanzania
  (NEDLIT) - 1997

Facilities with latest formulary or list
Percent
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Quality of Products and Services (3)
Average number of drugs prescribed per
encounter MOH 1.6 NGO 2.3 Private 1.8
Percent of drugs prescribed by generic
name MOH 75 NGO 72 Private 66
Percent of prescribed drugs that were
antibiotics MOH 31 NGO 20 Private 30
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Access Gaps

• Availability, especially in public sector
• Quality and affordability of products and
  services, especially in the private sector
  serving rural areas

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Potential Strategy

• Approving additional sources of supply to Medical
  Stores Department for public sector
• A regulated network of Accredited Drug Dispensing
  Outlets (ADDOs)
• A quality assurance strategy to permit improved
  screening of drugs entering and circulating in
  the market

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Viability

• Additional sources of supply to Medical Stores
  Department for public sector
• Facilitators
• Consistent with legal and policy framework
• Broad support from senior MOH officials,
  hospitals
• Acceptance by senior Medical Stores Department
  board members, management
• Support from major donors
• Support and partnership from mission sector
• Barriers
• Funding mechanism

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Viability (2)

• Accredited Drug Dispensing Outlets (ADDOs)
• Facilitators
• Broad support by Pharmacy Board and MOH
• New pharmacy legislation passing through
  parliament amended to permit the establishment of
  ADDOs
• Professional pharmacy association (Pharmaceutical
  Society of Tanzania) supportive
• Support from major donors
• Barriers
• Regulation

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Viability (3)

• Quality Assurance
• Facilitators
• Pharmacy Board, MOH supportive and committed to
  improving quality
• Some trained laboratory personnel available
• Barriers
• Resources to cover staff and other running costs
• Insufficient number of trained people