Table 4 ADDO program standards for accreditation

Accreditation application process

A Council Food and Drug Committee is responsible for a four-part application process for shops: an application form, initial inspection of the existing facility, re-inspection after any premise upgrades required for accreditation, and ongoing inspection after accreditation.

Incentives for owners

Owner incentives focus on improved shop profitability and approval to sell a range of prescription medications. Incentives for owners who commit to standards include access to micro-financing for stock purchases, a marketing campaign encouraging consumers to buy medicines at ADDO, and more reliable sources of affordable, quality wholesale goods.

Premises infrastructure

The standards provide instructions for building size, layout, identification, dispensing and services areas, storage, and security.

Staff qualification

The grade levels of ADDO dispensers include nurses, nurse-midwives, clinical officers, assistant medical officers, pharmaceutical assistants, and pharmaceutical technicians. The most common qualification of ADDO dispensers prior to ADDO training is nurse assistant.

Training

All dispensers must be accredited by the TFDA, display their accreditation certificate, and have their photo identification on their coats when working. Accreditation involves completing a TFDA-approved dispensers’ course. Course topics include in-depth information on ADDO drugs in their generic and brand forms; illness indications and contraindications; drug dosages, side effects, and patient information; laws governing dispensers’ work; basic management, record-keeping, and business ethics; and communications skills. ADDO training for shop owners focuses on ethics, regulations, and improvement of business management skills.

Drug quality and availability

The ADDO list of approved pharmaceuticals includes a full range of over-the-counter drugs and a limited list of prescription drugs, including common antibiotics and oral contraceptives. ADDOs may sell only those drugs registered with and approved by the TFDA. ADDO-restricted wholesalers can receive a license to sell nonprescription and ADDO-restricted approved prescription drugs under the supervision of a full-time pharmaceutical wholesaler’s technician.

Record keeping

ADDOs must keep records of all prescription drugs sold and their selling prices, financial and sales information, customer complaints, and expired medications. These records may be used for supervision purposes and must be available for review by inspectors.

Regulation, inspection, and sanctions

Local government officials receive a basic inspection training course from the TFDA and are certified as local inspectors. They work with the TFDA to conduct a minimum of two inspections of each shop annually. The program also carries out inspections of remaining unaccredited shops, and can issue sanctions against those that illegally sell prescription drugs. A channel exists for registering any customers’ complaints against ADDOs or any shops’ complaints about harassment by inspectors or other problems.