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Table 3 ADDO program milestones: 2003–2013

From: Accrediting retail drug shops to strengthen Tanzania’s public health system: an ADDO case study

ADDO program phase Year Description
Assessment, program design, conceptualization and planning 2001–2003 The Strategies for Enhancing Access to Medicines (SEAM) Program, MOHSW, TFDA, and multisectoral stakeholders assessed access to essential medicines, recommended a public-private sector approach to improving access, and designed and reached a consensus on the ADDO model with Ruvuma as a pilot region. Program funding provided by the Bill & Melinda Gates Foundation.
Pilot program development and implementation—Ruvuma region 2003–2005 SEAM Program and TFDA design and launch the ADDO program in the Ruvuma region—210 outlets accredited. (Gates Foundation).
Private sector contribution (210 owners’ investment for premises construction or upgrade to meet accreditation standards).
Pilot program M&E 2003–2005 SEAM commissioned monitoring and evaluation of the ADDO program in Ruvuma (Gates Foundation).
2006 Danida sponsored an independent evaluation of the ADDO program in Ruvuma by HERA.
Program scale-up (centralized approach) 2006–2008 Government of Tanzania, through the MOHSW, approves TFDA plan to rollout ADDOs to Tanzanian mainland.
U.S. Agency for International Development (USAID), through MSH’s Rational Pharmaceutical Management Plus Program, funds ADDO rollout in Morogoro region using resources from the President’s Emergency Plan for AIDS Relief—553 ADDOs.
Government of Tanzania funds rollout in Mtwara and Rukwa regions—122 ADDOs.
Private sector contribution (675 owners costs investment for premises construction or upgrade to meet accreditation standards) in Morogoro, Rukwa, and Mtwara.
  2007–2008 Danida supports TFDA to conduct training of trainers and district inspectors, develop and print training materials used for scale-up, and carry out national sensitization seminars with local governments.
Program scale-up (decentralized approach) 2007–2011 Gates Foundation funds the East African Drug Seller Initiative (EADSI) to work with TFDA to review and revise the existing ADDO model to make nationwide scale-up more cost-efficient and to help ensure the long-term sustainability of ADDOs and to evaluate effect of changes made on access to medicines and quality of products and services provided.
2008 Tanzanian stakeholders agreed to decentralize implementation model to improve efficiency of scale-up and sustainability of program at consensus meetings in Dodoma and Morogoro.
2008 Global Fund to Fight AIDS, Tuberculosis and Malaria agrees to fund ADDO rollout in six to eight high-impact malaria regions to improve access to antimalarials for children under five; Danida and government of Tanzania also contribute funding for rollout.
2009 Clinton Health Access Initiative funds initial implementation activities in Shinyanga and Dodoma
2008–2009 Local governments in Shinyanga, Tabora, Iringa, Arusha, Kagera, and Kilimanjaro took initiative on their own to mobilize funds to introduce ADDOs.
2011 Cost of training in Dar es Salaam for the urban ADDO model funded by ADDO dispenser and owner contributions (~1,300 dispensers and ~1,700 owners).
2013 Last region, Mwanza, launches the ADDO program in June 2013. Officially, ADDO program coverage is nationwide.
Program maintenance and sustainability; public health intervention integration into the ADDO program 2006 National Malaria Control Programme adopts the ADDO concept as part of its national strategy to increase access to malaria treatment.
2006 MSH’s Rational Pharmaceutical Management Plus Program collaborates with the Basic Support for Institutionalizing Child Survival Project to add a child health component to ADDO services (USAID funded FY07, FY08, FY09).
2007 Tanzania’s National Health Insurance Fund initiates plan that allows members to fill prescriptions at ADDOs.
2007 MSH’s Strengthening Pharmaceutical Services Program uses President’s Malaria Initiative funds to provide subsidized artemisinin-based combination therapy through ADDOs (FY06, FY07, FY08).
2008 The Prime Minister’s Office for Regional Administration and Local Government mandates local governments to incorporate ADDO program implementation into their planning and budgets.
2009 Rockefeller Foundation funds MSH to develop a strategy to promote program sustainability and quality through the establishment of ADDO owner and dispenser associations.
2009 Government of Tanzania regulation is revised to phase out unaccredited drug shops (duka la dawa baridi) by 2011.
2011 Legislative change mandates the transition of program oversight from TFDA to Pharmacy Council.
2010–2012 As a pilot, MSH’s Systems for Improved Access to Pharmaceuticals and Services Program collaborates with National TB and Leprosy Control Program to integrate interventions to engage 550 ADDOs in Morogoro to improve early detection of people with TB symptoms (USAID).
2011–2015 Gates Foundation funds the Sustainable Drug Seller Initiative 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.