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