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Tanzania 1
Tanzania 2
Tanzania Assessment
Gabriel Upunda
Tanzania 3
Demographics Tanzania
Area (sq km) 945,100
Population
32,900,000
25% urban
GNP per capita US $240
Human
Development Index
0.358
(150/174)
Literacy rate
Male: 84%
Female: 65.7%
Infant mortality rate 94.8 per 1,000
Life expectancy 47 years
UNDP, 1999; World Bank, 1999
Tanzania
Tanzania 4
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
Tanzania 5
Geographic Accessibility
0
4
8
12
16
20
24
Public
Private Clinics
Private Pharmacy
Duka La Dawa
NGO
Hou
rsDistance to Health Facility
•14% more than 10km of public facility
•6% more than 10km of private drug retailer
Average number of facility operating hours per day
Tanzania 6
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
Tanzania 7
AvailabilityPublic Private
ClinicsPrivate
PharmacyDuka La
DawaNGO
Set of un-expired tracer items in stock
72% 67% 79% 45% 84%
Time out
of stock
30.17%(26.5%)*
0% 0% 0% 18.5% (5.5%)*
Prescribed items dispensed
73% 91% 0% 0% 98%
* Excluding items normally stocked
Tanzania 8
Affordability
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
Public Private Clinics Private Pharmacy Duka La Dawa NGO
Co-trimoxazoleAmoxicillin
Malaria ARI ARI Round worm Conjunctivitis Diarrhea
Da
ys
Number of days worked by lowest paid government employee to pay for treatment
Tanzania 9
Acceptability
• DHS Survey 1999: 58% reporting quality of health facility as good or very good
Tanzania 10
Quality of Products and Services
0
10
20
30
40
50
Public Sector - All SamplesPrivate Sector - All SamplesPrivate Sector - SP Samples
Substandard Samples
Per
cent
Tanzania 11
0102030405060708090
100
Public Private Clinics Private Pharmacy Duka La Dawa
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
Per
cent
Tanzania 12
Quality of Products and Services (3)Average number of drugs prescribed per encounter:
MOH 1.6NGO 2.3Private 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%
Tanzania 13
Access Gaps
• Availability, especially in public sector
• Quality and affordability of products and services, especially in the private sector serving rural areas
Tanzania 14
Potential Strategy
• Approving additional sources of supply to Medical Stores Department for public sector
• A regulated network of Accredited Drug Dispensing Outlets (ADDO’s)
• A quality assurance strategy to permit improved screening of drugs entering and circulating in the market
Tanzania 15
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
Tanzania 16
Viability (2)
• Accredited Drug Dispensing Outlets (ADDO’s) Facilitators:
Broad support by Pharmacy Board and MOH New pharmacy legislation passing through parliament
amended to permit the establishment of ADDO’s Professional pharmacy association (Pharmaceutical Society
of Tanzania) supportive Support from major donors
Barriers: Regulation
Tanzania 17
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
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