RESEARCHER’S DECLARATION PAGE

This project paper titled ‘Challenges Facing Private Health Service Providers in Tanzania: A

Case of Ilala ward’ is the original work prepared by Atika Said under the guidance of my

supervisor Prof..J.Nkonoki IRDP staff.

SIGNATURE………………………………………..

DATE……………………………………………….

i
 COPYRIGHT

This document of special paper prepared by Atika Said should not be produced or transmitted to

anywhere and by any method without consulting with the owner of this document or the Institute

of Rural Development Planning in that behalf.

ii
 RESEARCH SUPERVISOR’S CERTIFICATION

I certify that this entitled “Challenges Facing Private Health Service Providers in Tanzania: A

Case of Ilala ward”. Submitted to the Institute of Rural Development Planning for the awards of

Diploma in Development Planning is an independent research work carried out by Atika Said a

student in Diploma course under my supervision and guidance.

Signature: ……………………………………….

Date: ………………………………………………

Researcher supervisor

iii
 ACKNOWLEDGEMENT

First, I would like to thank God for his tender protection and provision chance to survive in this

world of today. Other thanks should go to my father Mr. and Mrs.Said for his financial support,

advice and encouragement concerned with my studies.

I would like to thank my supervisor Prof . J.Nkonoki for his support during preparation of field

attachment report.

Lastly thanks to my field station supervisor Mr. Mariam Akram for instructing me to perform

different activities in the Village and giving me details for my field attachment report.

Sincerely thanks to IRDP- LZC for enabling me to acquire knowledge and skills up to this

moment. Also I would like to give thanks to my course coordinator Mrs.Consolanta Lukuvi for

his support.

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 TABLE OF CONTENTS

RESEARCHER’S DECLARATION PAGE....................................................................................i

COPYRIGHT..................................................................................................................................ii

RESEARCH SUPERVISOR’S CERTIFICATION.......................................................................iii

ACKNOWLEDGEMENT..............................................................................................................iv

LIST OF TABLES........................................................................................................................vii

LIST OF APPENDICES..............................................................................................................viii

ABSTRACT...................................................................................................................................ix

LIST OF ABBREVIATIONS..........................................................................................................x

DEFINITION OF TERMS............................................................................................................xii

CHAPTER ONE..............................................................................................................................1

1.0 INTRODUCTION.....................................................................................................................1

1.1 Background information............................................................................................................1

1.2 Problem statement.....................................................................................................................4

1.3 Objectives of the Study..............................................................................................................4

1.3.1 General objectives..................................................................................................................4

1.4 Scope of the Study.....................................................................................................................5

1.5 Significance of the Study...........................................................................................................5

CHAPTER TWO.............................................................................................................................6

LITERATURE REVIEW................................................................................................................6

CHAPTER THREE.......................................................................................................................11

3.0 RESEARCH METHODOLOGY............................................................................................11

3.1 Source of data..........................................................................................................................11

3.2 Sampling plan..........................................................................................................................11

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3.3 Data collection instruments.....................................................................................................11

Questionnaire.................................................................................................................................12

Checklist........................................................................................................................................12

3.4 Data processing and data analysis...........................................................................................12

3.5 Limitations of the study...........................................................................................................12

CHAPTER FOUR.........................................................................................................................13

4.0 FINDINGS AND DISCUSSION............................................................................................13

4.1 Challenges Facing the Private Accredited Drug Dispensing Outlets in the provision of
Services in IlalaWard.....................................................................................................................16

4.2 Causes of challenges facing the private Accredited Drug Dispensing Outlets in the provision
ofservices in Ilala ward..................................................................................................................18

CHAPTER FIVE...........................................................................................................................22

5.0 CONCLUSION AND RECOMMENDATIONS....................................................................22

5.1 Conclusion...............................................................................................................................22

REFERENCES..............................................................................................................................24

APPENDICES...............................................................................................................................25

QUESTIONNAIRE.......................................................................................................................25

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 LIST OF TABLES

Table 1: Sex...............................................................................................................................................13

Table 2: Age group....................................................................................................................................14

Table 3: Occupation..................................................................................................................................14

Table 4: Education level............................................................................................................................15

Table 5: Marital status...............................................................................................................................15

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 LIST OF APPENDICES

Appendix 1: Questionnaires…………………………………………...…………………………38

Appendix 2: Map of Ilala ward………………………………………………………………....39

viii
 ABSTRACT

The study aimed at examining the Challenges facing private health service providers in

Tanzania. Specifically the study focused at examining the Performance of private Accredited

Drug Dispensing Outlets (ADDO), the challenges facing private Accredited Drug Dispensing

Outlets in the provision of heath services, the causes of the challenges facing the private

Accredited Drug Dispensing Outlets in the provision of services and measures in improving the

performance of private Accredited Drug Dispensing Outlets in provision of service in Ilala

District. This study applied a case study design, which targeted ADDO owners in Ilala District

Council as the private health service providers. A sample size of 100 respondents was drawn by

using purposive and simple random sampling techniques. Questionnaire, Interview and

Observation methods were applied in collection of primary data, whereas documentary review

method was adopted for collecting secondary data. The collected data were analyzed by using

description statistics together with Statistical Package for Social Sciences (SPSS), Excel

Software and Content Analysis results were presented in tables, figures and texts. The findings

from the study revealed that; Unavailability of qualified staff, Poor storage facilities, shortage of

required drugs, Low purchasing power, difficult drug policy, poor Government support, selling

expired drugs and high training costs reported by respondents are the challenges facing ADDO.

To overcome the challenges facing ADDO, the study suggests; adherence to the Government

medical policies, Proper Dispensing of required drugs, effective and efficiency drug planning,

improving drug storage and dispensing enough of the required drug.

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 LIST OF ABBREVIATIONS

AIS-LAC Action International’s Coordinating Office for Latin America and the Caribbean

ADDO Accredited Drug Dispensing Outlets

APHFTA Association of Private Health Facilities in Tanzania

CMS Central Medical Store

CSSC Christian Social Services Commission

HSSP Health Sector Strategic Plan

MEO District Environmental Officer

MHC District Health Secretary

MHISO District Health Management and Information System Officer

MLT District Laboratory Technician

MIVC District Immunization and Vaccine Coordinator

MoF Ministry of Finance

MoH District Officer of Health

MoHSW Ministry of Health and Social Welfare

MoSTHE Ministry of Science, Technology, and Higher Education

NDP National Drug Policy

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NEDLIT National Essential Drug List for Tanzania

PFP Private For Profit

PHC Primary Health Care

PMO-RALG Prime Minister’s Office- Regional Administration and Local Government

PNFP Private Non For Profit PPP - Public Private Partnership

REPOA Research on Poverty Alleviation

SPSS Statistical Package for Social Sciences

STG Standard Treatment Guidelines

TFDA Tanzania Food and Drugs Authority URT - United Republic of Tanzania

WHO World Health Organization

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 DEFINITION OF TERMS

Health promotion Is a discipline that seeks to improve the health of

individuals and communities through education, behavioral

change and environmental improvement. Elliott, J. (2005).

“Duka la Dawa Muhimu” (DLDM), Is the drug outlet registered by TFDA to store and sell

medicine that do not need prescription and some essential

medicine that needs prescription. Elliott, J. (2005).

Policy Is a set of interrelated decisions concerning the selection of

goals and the means of achieving them Baruch, Y. (2004).

Policy implementation Is an iterative process in which ideas, expressed as policy,

are transformed into behavior, expressed as social action”.

Accessibility means the quantity of drugs delivered and used by the

public. Baruch, Y. (2004).

Primary Health Care Means Community involvement and the use of local and

physical resources to provide a range of curative and

preventive services and health promotion measures that are

both accessible and affordable to the local population

Baruch, Y. (2004).

xii
 CHAPTER ONE

1.0 INTRODUCTION

1.1 Background information

Since independence the government of Tanzania has made efforts to improve access to quality

essential medicine and pharmaceutical services to its citizens. Currently all pharmaceutical

services are under Food, Drug and C. The Act gives power to Tanzania Food and Drug Authority

(TFDA) to regulate the quality, safety and effectiveness of medicine, food, cosmetics and

medical devices. Furthermore, this Act is in line with National health Policy which emphasizes

availability of quality health services to all Tanzanians Baruch, Y. (2004). . The private

Accredited Drug Dispensing Outlets (ADDO) popularly known in Swahili as “Duka la Dawa

Muhimu” (DLDM), is the drug outlet registered by TFDA to store and sell medicine that do not

need prescription and some essential medicine that needs prescription. The ADDO program was

initiated in Ruvuma region in 2003, and as of April 2007, the program scaled up in Dar es

Salaam,(funded by US Agency for International Development [USAID]), as well as Rukwa and

Mtwara (funded by the Government of Tanzania). Based upon the success of the pilot program,

the Government of Tanzania initiated plans in 2005 to expand the ADDO program to all other

regions in the country.

The medicine outlets for human beings and livestock have been established to resolve the

problems encountered in the Part II Poison shops popularly known as duka la dawa baridi

(DLDB). The problems encountered in the DLDBs included the Drug sellers with no

qualifications dispense medicines that were not permitted following:- Most DLDBs were

located in the urban area instead of rural areas, and this is not under the Guideline for Operating

Part II Poison Shops, 1998. Most DLDBs (72 percent) found to stock and sell both prescription

1
and in line with the aim of establishing them. nonprescription medicines. This was a threat to the

safety of general public’s Medicine quality was not assured because most DLDBs found to sell

expired health. According to the Act, DLDBs were supposed to stock and sell non- prescription

medicines only. Some of the DLDBs sold medicines stolen from public health facilities and

from and/or unregistered medicines. other health-related projects.

So as to solve these problems, the Ministry of Health and Social Welfare (MoHSW) through the

TFDA made some essential amendments to DLDBs operations. These amendments were

targeting the knowledge and the skills of the dispensers, supportive supervision of these outlets,

the quantity and type of medicines that are allowed to be stocked in the outlet, improvement of

the quality of the premises, and conditions for keeping and storing medicines. The objective of

these changes was to improve the services rendered by DLDBs through accrediting and

upgrading them to become ADDO (Duka la Dawa Muhimu) after meeting criteria as established

by ADDO regulations. To assist individuals who wanted to establish an ADDO, and also to help

program implementers to understand the procedures for establishing and operating these outlets,

TFDA prepared a Guideline for Establishing and Operating ADDO. This guideline, which covers

both people and livestock ADDO, identifies areas that the owners and the dispensers need to

abide by. The owners, dispensers, and overseers of the Act should use always this guideline as a

reference book when establishing and operating or when supervising and inspecting these

outlets. All partners dealing with the ADDO are encouraged to understand the Food, Drugs and

Cosmetics Act, 2003; the ADDO regulations of 2004, and its 2008 amendments. Although

Private sector has been so much encouraged by the government in health services provision, its

implementation has not been uniform across the country. There are areas where private health

service has proved to be a success while in others the progress has been slow. In Ilala for

2
example, such health service which includes health centers, dispensaries and private medical

shops have not been performing well which is an indicator of challenges existence. Elliott, J.

(2005).conducted an assessment on availability and management of medicines and medical

supplies. The assessment aimed to assess the availability of essential medicines (i.e. the extent of

the problem) as well as to identify bottlenecks that lead to unavailability of medicines. Major

bottlenecks were twofold: Incomplete supply by Medical Store Department of medicines

requests from health facilities and Health facilities’ lack of capacity to order medicines correctly

including predicting medicine needs and to manage stock keeping. Medicines Access and Use in

Districts Served by private Accredited Drug Dispensing Baruch, Y. (2004). is an assessment

conducted by Harvard Medical School Department of Population Medicine at Harvard Pilgrim

Health Care Institute and Sustainable Drug Seller Initiatives Program. The goal of this

assessment was to conduct a holistic assessment of health care seeking behaviour, medicines

availability, medicines use, and stakeholder perceptions in communities served by private

ADDO in Tanzania. Private sector delivery of health care in Tanzania is another study conducted

by Baruch, Y. (2004). . The purpose of this study was to provide baseline information and

analysis that the Ministry of Health and Social Welfare (MOHSW) can use to further elaborate

policies to enhance public-private partnerships in order to expand coverage, strengthen quality

and efficiency of health services, and improve health status in Tanzania.

3
1.2 Problem statement

Despite the government efforts to involve private sector in health service provision to its citizens,

evidences from the studies by Tanzania Elliott, J. (2005), Medicines Access and Use in Districts

Served by private Accredited Drug Dispensing Outlets in Tanzania (2012), Private sector

delivery of health care in Tanzania by Elliott, J. (2005). and Improving the use and management

of information in health districts conducted by Berman, P.(2000). show that the study on

challenges facing private Accredited Drug Dispensing Outlets has not been done. This means

that there are no or limited studies on challenges facing private health service providers in

service provision specifically ADDO in Ilala District. This study intends to fill the gap by

examining the Challenges facing private health service providers in Tanzania using a case of

private Accredited Drug Dispensing Outlets in Ilala District. The study is guided by Policy

statement that aims at ensuring the availability of drugs, reagents and medical supplies and

infrastructures.

1.3 Objectives of the Study

1.3.1 General objectives

The main objective of this study is to examine Challenges facing private health service providers

in Tanzania using a case Ilala ward

1.3.2 Specific Objectives

i. To identify the Challenges facing private health service providers in Tanzania using a

case Ilala ward

ii. To examine causes of the challenges facing the private Accredited Drug Dispensing

Outlets in the provision of services Ilala Ward.

4
 iii. To suggest the measures of improving the performance of private Accredited Drug

Dispensing Outlets in provision of service in Ilala ward.

1.4 Scope of the Study

The study was being conducted at Ilala ward, in Ilala District, Dar es Salaam Region. This is

thematic area of the study focused on examining the challenges of private Accredited Drug

Dispensing Outlets in provision of health services in Ilala District Council. Although the sector

may be faced by a number of challenges, the study focused on challenges associated with sales,

preservation, technical skills and measures taken to ensure smooth provision of expected health

services. These are deemed to be the key aspects which will result into identification of

challenges in the study area. Not only that but also the study was conducted 24 th June, 2019 to

30th August, 2019.

1.5 Significance of the Study

This study specifically focused on the people of Ilala District, particularly the urban community

with the aim of studying the challenges facing private Accredited Drug Dispensing Outlets. The

study is important because it assists different development actors within and outside the district,

to apply the findings and their proposed solutions in the formulation and reviewing development

policies in their respective occupations particularly in the health services and other safety nets

programmes designed to improve the livelihood of vulnerable and low-income groups. The

findings of this study will be relevant to all stakeholders including Ilala District Council in

searching mitigation to various social economic problems facing the local society. Moreover, this

study will help other researchers to conduct other researches.

5
 CHAPTER TWO

LITERATURE REVIEW
2.1. Introduction

This section focused on defining concepts and terms of policy, drug policy, policy

implementation, and the accessibility of drugs. This section also presents a review of literature

related to the topic under investigation. The chapter presents theories and empirical studies with

a critical analysis of each. The theoretical analyses on how the private Accredited Drug

Dispensing Outlets are linked to the contribution of medical service provision as per various

scholars are presented first. The chapter also presents a conceptual framework which indicates

the relationship between independent variables and the dependent variable. Empirical literature

focuses on studies related to the study area. 2.2. Theoretical Literature Review

2.2.1. Definitions of key terms

The terms that are to be defined include: Health Promotion, Accredited Drug Dispensing Outlet

(ADDO), Policy, drug policy, accessibility of drugs and policy implementation. These terms are

key to this study that enable clear understanding of what is intended as far as this study is

concerned.

2.2.1.1 Health Promotion

Health promotion is a discipline that seeks to improve the health of individuals and communities

through education, behavioral change and environmental improvement. Health promotion draws

from a number of complementary disciplines, such as psychology, sociology, the biological and

clinical sciences, and business (marketing and management) to help individuals and communities

6
change their behaviors and improve their environments. In short, health promotion is “the

process of enabling people to increase control over and to improve their health.” (Ottawa Charter,

First International Conference of Health Promotion, 1986)

2.2.1.2. Private Accredited Drug Dispensing Outlet (ADDO)

The private Accredited Drug Dispensing Outlets (ADDO) popularly known in Swahili as “Duka

la Dawa Muhimu” (DLDM), is the drug outlet registered by TFDA to store and sell medicine

that do not need prescription and some essential medicine that needs prescription. The ADDO

program solicits the support and expertise of stakeholders including health professionals from the

public and private sector as well as commercial associations. The program develops the

standards and requirements to regulate the ADDO and to build stewardship and governance

capacity within the public sector.

2.2.1.3 Policy

Policy is a set of interrelated decisions concerning the selection of goals and the means of

achieving them Berman, P.(2000). According to Berman, P.(2000). ‘policy’ is defined as the

product of political influence, determining and setting limits to what the state does. For further

clarification, when a government takes a decision or chooses a course of action in order to solve

a social problem and adopts a specific strategy for its planning and implementation, it is known

as public policy Berman, P.(2000).

2.2.1.4. Policy implementation

According to Ottoson and Green (1987) suggest that “Policy implementation” is an iterative

process in which ideas, expressed as policy, are transformed into behavior, expressed as social

7
action”. The social action transformed from the policy is typically aimed at social betterment and

most frequently manifests as programs, procedures, regulations, or practices for bringing social

betterment.

2.2.1.5. Accessibility of drugs In this study accessibility

means the quantity of drugs delivered and used by the public. Accessibility influences treatment

and therefore public health, distance and time used but also reliability and potentially cost

(Bartram, 2003). The Tanzania Food and Drugs Authority (TFDA) is responsible for the

regulation of medicines and conduct inspections of the public and private drugs dispensing

outlets in Tanzania.

2.2.2. The Primary Health Care

Primary Health Care means: Community involvement and the use of local and physical resources

to provide a range of curative and preventive services and health promotion measures that are

both accessible and affordable to the local population Cornejo E.M. (2007). While the national

health policy has given broad guidelines on the health services delivery system in Tanzania, the

PHC strategy has outlined how the policy is to be implemented. The Government adopted the

PHC as a rational and equitable way of improving the health and well being of the whole

population. This means that the PHC is relevant and applicable, whether the population is rural

or urban based. It is therefore incorrect to equate PHC to either rural populations or inferior

health care Cornejo E.M. (2007).

8
2.2.3. Health Sector in Developing Countries

Increasingly, decision-makers in developing countries are taking notice of the role of Private

Sector Providers (PSPs) in health care provision. This is because PSPs are important providers of

care and health care costs are a major drain on people’s resources, particularly the poor.

Managing PSPs is among the most complex stewardship tasks facing policy-makers; for this they

require better information and tools.

2.2.4. Health Sector in Tanzania

The leading sector in the Tanzanian health system is the public sector, with stakeholders in the

executive and legislative branches of government – PMO-RALG and Parliament – as well as

various line agencies and ministries. The primary actor in the public sector is the MOHSW, with

support from other government agencies such as the Ministry of Finance and Economic Affairs

(MOF) and the Ministry of Science, Technology, and Higher Education (MOSTHE).

2.4. Empirical Literature

Cornejo E.M. (2007). carried out a study on malaria treatment guidelines among drug dispensers

in private pharmacies in Tanzania. The study aimed to assess the knowledge of dispensers in

private pharmacies on new malaria treatment guidelines. Data collection was done using

structured questionnaire. The study revealed that none of the participants had been involved in

the preparation of the treatment guidelines, nor had they undertaken any training on their

implementation. Minzi and Haule’s study was on private medical provision. However, although

their focus was on assessing knowledge of the dispensers, which is also targeted by this study,

the fact that they did not specifically focus on challenges calls for a separate study to be carried

out in Ilala. Evidence on whether policy implementation was assessed is also limited from Minzi

9
and Haule’s study. Therefore, this calls for a separate study to be carried out in order to find out

not only challenges on knowledge of dispensers but also those affecting other key sectors of the

scheme. In 2006 Health Action International’s Coordinating Office for Latin America and the

Caribbean (AIS-LAC) undertook a survey measuring medicine prices, availability, affordability

and component costs in Peru, using the World Health Organization and Health Action

International (WHO/HAI) price measurement methodology. The purpose of the study was to

measure the price people pay for medicines, and their availability, in various sectors and regions

of the country as well as the government procurement price, the affordability of standard

treatments for patients on low wages, and all the costs in the supply chain from the manufacturer

to the patient (taxes, mark-ups etc). The findings indicated that in private pharmacies prices were

very higher than expected. However, the study carried out in Peru took place in a context that is

different from that of Ilala in which policy implementation is involved. Besides, the study did not

focus on the challenges facing the private Accredited Drug Dispensing Outlets. This therefore

raises the need for this study.

10
 CHAPTER THREE

3.0 RESEARCH METHODOLOGY

This chapter describes the research approach, study area, the sample, techniques used for data

collection and their administration. This chapter is divided into the following: Research

methodology, Area of the study, Research approach, population of study, sample and sampling

techniques, data collection methods, and instrumentation, and data analysis procedures and the

limitation of the study at Ilala ward.

3.1 Source of data

The sources of data which was used in data collection are primary and secondary source. Primary

data collection was obtained from the respondents, while secondary was obtained from the

written documents that can was available from the office like journals, books and different

newspapers.

3.2 Sampling plan

The sample used was 50 people at Ilala ward in Ilala district individual selected was participate

fully to contribute their knowledge about impact of cholera disease at Ilala ward. The sample size

was 25 males’ and 25 females’ respondent in the Ward, the sample was collected through

probability

3.3 Data collection instruments

The researcher was use instrument like questionnaire, tape recorder and checklist in collecting

primary data by using focus group discussion, observation as well as interviews in order to

measure the validity information concern with the study.

11
Questionnaire

This is the set of written questions divided to the respondents for the purpose of collecting data.

This research was distributing 50 questionnaires to all respondent that are selected from the study

area.

Checklist

This is the list of key issues that direct a researcher when collecting data. Under this study the

checklist was contain the key sub-topic of the research topic that the researcher needs to get

when collecting data through interview.

3.4 Data processing and data analysis

The data was processed and analyzed manually also by using computer program like SPSS and

EXCEL in order to create the relationship among the research question was provide the answer

to the specific objectives of the research.

3.5 Limitations of the study

There are some hurdles which attempted to hinder this study to be conducted effectively, these

were:-

Resources

Financial Resources, Financial resources were the major obstacle to make the study to be easily

implemented. The researcher was self – sponsored, and thus depended upon his meager salary.

Time Resource, The time required to accomplish the research work was too short and this made

the researcher to focus on only one district in order to meet the time allocated.

12
Illiteracy, Some of the respondents may have proper information about the study but they hide it

because they do not understand the importance of the exercise.

CHAPTER FOUR

4.0 FINDINGS AND DISCUSSION

This chapter presents the finding based on data collected. The discussion and analysis have been

represented under the three specific objectives which are the challenges facing small hotels in

improving their well being at Ilala ward, the effects of cholera at Ilala ward and measure to be

taken in order to control impacts of cholera to children at Ilala ward.

4.1 Population characteristics of respondents

4.1.1 Sex

The study was gender sensitive. It involved both male and female where by female were 30

equal to 60% and male where 20 equal to 40% as indicated in Table 1.

Table 1: Sex of respodents

Sex Respondents Percentage (%)

Male 20 40
Femalees 30 60
Total 50 100
Source: Field work, 2019.

Main age group of respondents is 18 -30 which is 32% followed by 31 -43 which is 14% as

indicated in table 2.

13
Table 2: Age group of respodents

Age Respondents Percentage(%)

18 -30 16 32

31 -43 7 14

44 -59 13 26

57 -69 14 28

Total 50 100

Source: Field work, 2019.

4.1.3 Occupation

The study involved respondents who engaged are farmers and employees whereby farmers have
50%, followed by employees 30% and business man with percentage of equal 20% for all, as
indicated in table 3.

Table 3: Occupation

Occupation Respondents Percentage (%)

Farmers 25 50
Employees 15 30
Business man 10 20
Total 50 100
Source: Field work, 2019.

4.1.4 Education level

Majority where having secondary level of education which is 40%, followed with primary

education which have 30%, and lastly are those who has college which have 30%, as indicated in

table below table 4.

Table 4: Education level

Education level Respondents Percentage (%)

Primary 15 30

14
 Secondary 20 40
College 15 30
Total 50 100
Source: Field work, 2019.

4.1.5 Marital status

The study participated with respondents with different marital status, where by majority of

respondents are married which is accounted with 60%, followed by divorced which have 30%,

and lastly single which are 10% as indicated in table 5.

Table 5: Marital status

Marital status Respondents Percentage (%)

Single 5 10
Married 30 60
Divorced 15 30
Total 50 100
Source: Field work, 2019.

15
4.1 Challenges Facing the Private Accredited Drug Dispensing Outlets in the provision of

Services in Ilala Ward.

Unavailability of Professionals. The results have also been reported by Cornejo E.M. (2007).

that unavailability of professionals is a challenge facing the private Accredited Drug Dispensing

Outlets in the provision of services hence maintaining availability of trained personnel to fill

openings in ADDOs.

Poor Storage Facilities With regard to poor storage facilities, The result observed by

Ottoson, J. M. and Green, L. W. (1987). through their study that poor medicine storage

conditions is a challenge facing the private Accredited Drug Dispensing Outlets in the provision

of health services.

Shortage of Required Drug Dispensing Regarding to shortage of required Drug dispensing,

result observed by Improving Child Health through the ADDO Program: Baseline Survey from 5

Districts in Tanzania, 2006, that shortage of required and unreliable drug dispensing is a

challenge facing the private Accredited Drug Dispensing Outlets in the provision of health

services.

Low Purchasing Power With regard to low purchasing power, result observed by Baseline

Ottoson, J. M. and Green, L. W. (1987). that shortage of required and unreliable drug dispensing

is a challenge facing the private Accredited Drug Dispensing Outlets in the provision of health

services.

Difficulty Policies Regarding to difficulty policies, results were also reported by Ottoson, J. M.

and Green, L. W. (1987). through their study, that difficult policies is a challenge facing the

private Accredited Drug Dispensing Outlets in the provision of health services.

16
Inadequate Preservation As far as inadequate drug preservation is concerned, reported by

Strategies for Enhancing Access to Medicines Programme Ottoson, J. M. and Green, L. W.

(1987), that inadequate preservation is a challenge facing the private Accredited Drug

Dispensing Outlets in the provision of health services.

Poor Government Support In accordance with poor government support, in Bangladesh

according to Ottoson, J. M. and Green, L. W. (1987), poor government support is a challenge to

ADDOs. In order for the poor to benefit from poverty alleviation effects of health

interventions,the performance of unorganized ADDOs need to be supported by the government.

High Training Costs With regard to high training costs, observed by Repoa Report (2013).

of which exisiting evidence indicated that high training cost led to the majority of service

providers lack the necessary training from the government and capacity to provide basic curative

services rationally.

Selling Expired Drug About selling expired drugs, reported by Alliance for Health Policy and

Systems Research Flagship Report (2014), that selling expired drugs and unauthorized products

is a challenge facing the private Accredited Drug Dispensing Outlets in the provision of health

services.

High Drug Price Referring to high drug price, reported by Jafary et al. (2014) through their

study, that high drug price is a challenge facing the private Accredited Drug Dispensing Outlets

in the provision of health services.

17
4.2 Causes of challenges facing the private Accredited Drug Dispensing Outlets in the
provision of services in Ilala ward

Poor Medical Infrastructures, reported by the Tanzania Assessment of Community Services

for Repoa Report (2013).Through their study, that availability of medical infrastructures

(weighing scales, vaccine cards and timing device) for assessing service users in health services

delivery is very low in private Accredited Drug Dispensing Outlets hence a cause for the

challenges.

Inadequate Medical Skills. result was observed by Strategies for Enhancing Access to Repoa

Report (2013). assessment report on Populations access to essential medicines, that Dispensers

lacked basic skills and qualifications.

Inadequate Capital, result was observed through the study conducted by Ottoson, J. M. and

Green, L. W. (1987), that inadequate capital is a factor causing the challenges to private

Accredited Drug Dispensing Outets. Even when the poor are able to find money for basic care,

and even when essential drugs are available, their inability to purchase these medicines makes

treatment actually impossible. Drugs are often found to be more affordable at government

facilities but they run out quickly; they are more available at private and mission facilities but

people generally cannot afford to buy them.

Poor Drug Planning, results were reported by Ottoson, J. M. and Green, L. W. (1987), that

inadequate capital is a cause of challenges facing private Accredited Drug Dispensing Outlets in

the provision of services. Constant supply of drugs and medical supplies is very important to

improved health care. The study reported that at lower level health facilities in Mbeya Rural

18
District that did not charge official fees, most complaints focused on lack of drugs and supplies

(an issue of quality), and not on the informal fees people were required to pay.

Unethical Staff, results were also reported by Ottoson, J. M. and Green, L. W. (1987), through

their study, that unethical staff is a challenge facing the private Accredited Drug Dispensing

Outlets in the provision of health services. Some of the ADDOs sell medicines stolen from

public health facilities and froealthrelated projects.

Poor Drug Dispensing Outlets Policy, result was observed by Ottoson, J. M. and Green, L. W.

(1987), that none of the ADDO service providers had been involved in the preparation of the

treatment guidelines, nor had they undertaken any training on their implementation.

Inadequate Employed Qualified Staff, results were also reported by Accrediting retail drug

shops to strengthen Tanzania’s public health system, that inadequate qualified staff is a challenge

facing the private Accredited Drug Dispensing Outlets in the provision of health services.

Poor Management, results were also reported by Ottoson, J. M. and Green, L. W. (1987),

through their study, that poor management is a cause of challenges facing the private Accredited

Drug Dispensing Outlets in the provision of health services. Medicines are sold without

following proper guidelines for good dispensing practices.

4.3 Measures to overcoming the challenges in provision of health services by private

Accredited Drug Dispensing Outlets in Ilala Ward.

Employment of Medical Professionals, With regard to employment of medical professionals,

table 4.7 reveals that thirty five (40.23%) respondents agreed and fifty two (59.77%) respondents

strongly agreed. In other words 100 percent respondents agreed that employment of medical

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professionals is a measure of improving the performance of the private Accredited Drug

Dispensing Outlets in the provision of services in Ilala District. None of respondents were

neutral and none disagreed that employment of medical professionals is a measure of improving

the performance of the private Accredited Drug Dispensing Outlets.

Training to ADDO owners and service providers , Baruch, Y. (2004). reported that ADDO

owners and dispensers training curriculum should be reviewed so as to become more

comprehensive hence solving challenges facing ADDOs. Tools such as Drug dispensing register,

a list of ADDO recommended medicines and ADR forms should be available and easily

accessible by ADDO owners.

Adhere to the Government Medical Policy, Baruch, Y. (2004),reported that National

Medicines Policy should be adhered for it provides a framework to ensure the supply of good

quality affordable and appropriate medicines in the private sector as well as the public sector

while preventing the import and distribution of dangerous and sub-standard products.

Effective and Efficiency Drug, Baruch, Y. (2004),reported that selection of medicines for

procurement by ADDO owners should be based on the national essential medicines list, but the

quantity to order depends on how much is being used. The use of standard treatment guidelines

based on the standard list is the best way to ensure access to appropriate treatment.

Improving Drug Storage, Baruch, Y. (2004)., the premises of ADDOs should be maintained

adequately for proper storage of medicines. This in turn improves the quality of medicines

available in these shops.

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Dispensing Enough and Required Drugs, Baruch, Y. (2004). through their study, that the

range of medicines authorized to be sold in the ADDOs does not meet the health demand of the

customers.

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 CHAPTER FIVE

5.0 CONCLUSION AND RECOMMENDATIONS

5.1 Conclusion

This chapter has summarized the findings of the study objectives. The findings from the study

revealed that; Majority of respondents indicated private accredited dispensing outlets to be

constrained with the number of challenges, various measures were used to determine the degree

of performance of private Accredited Dispensing Outlets and generally poor degree of

performance was reported by the majority of respondents. The study exposed the challenges

facing Private ADDO; Unavailability of professionals, Poor storage facilities, shortage of

required drugs, Low purchasing power, difficult drug policy, poor Government support, selling

expired drugs and high training costs reported by respondents to be the major challenges facing

the Private Accredited Drug Dispensing Outlets. Causes of the ADDO challenges were pointed

by the respondents to be poor medical infrastructures, Traditional believes, Inadequate capital,

Inadequate medical skills, poor drug planning, Inadequate government support, Unethical staffs,

poor drug dispensing outlet policy, inadequate employed staff and poor Management. To

overcome the challenges facing ADDO, a number of measures were suggested by the

respondents, these include; adherence to the Government medical policies. Proper Dispensing of

required drugs, effective and efficiency drug planning, improving drug storage and dispensing

enough and required drug.

5.2 Recommendations

Despite that the study was carried out in the selected area, the researcher has some general

recommendations with respect to the improvement of private health service provision.

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First of all, policy makers from Ilala District in collaboration with Ministry of Health should

review the policy in improving public health management and private Accredited Drug

Dispensing Outlets. Government should provide short courses of three months to ADDO owners

and their service providers after two years on principles guiding the public health and the

negative impacts of poor provision of health services in the public.

Secondly, the available Private Accredited Drug Dispensing Outlets should be furnished with

good shelves, fixtures and frigerators for drug preservation and if possible new and modern

storage facilities should be provided by the government to the ADDO owners. Good ethical

conduct is needed to all public officials in performing public health activities so as adhered with

public health policy which calls for client confidentiality.

Thirdly, the issue of poor performance and management in the public health sector should be

tackled through strengthening the capacity to control ADDO as part of public health provision

through re-orientation programmes.

Fourthly, drug regulations and principles should not only exist on paper but must be operational.

Fifthly, Government should ensure that there is enabling environment for the ADDO owners,

service providers and public health employees to perform their health responsibilities; this will

be achieved by providing good health infrastructures and motivation to the best ADDO service

providers.

23
 REFERENCES
Adam and Kamuzora,F.(2008). Research Methods for Business and Social Studies.

Baruch, Y. (2004). Response Rate in Academic Studies: A Comparative Analysis. Journal of

Human Relations: 52 (4): 1573-9716

Berman, P.(2000). Organization of ambulatory care provision: a critical determinant of health

system performance in developing countries. Bulletin of the World Health Organization; 78(6):

791-802.

Cornejo E.M. (2007). Medicine Prices, Availability Afordability and Price Components in Peru.

Peru: Health Action International Latin America Coordination Office.

Elliott, J. (2005).Conceptual/operational frameworks. Workshop presented at the Association of

International Agricultural and Extension Education conference, San Antonio, TX.

Ottoson, J. M. and Green, L. W. (1987). Reconciling concept and context: Theory of

implementation. Health Education and Promotion

Repoa Report (2013). Extract from The Global Competitiveness Report 2013- 2014: Country
Highlights, p.18

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 APPENDICES

QUESTIONNAIRE

Name…………………………………………………………………

Sex…………………………………………………………………....

a) Male b) Female ( )

Age/…………………………………………………………………...

a) 18-30 b) 31-43 c) 44-56 d) 57-69 ( )

Occupation…………………………………………………………..

a) Farmer b) Teacher c) Entrepreneur ( )

Marital status………………………………………………………..

a) Single b) Married c) Widow ( )

Questions

1.Which sale-related challenges do you experience in your service provision?

…………………………………………………………………………………………

2. Please explain preservation-related challenges encountered by private Accredited Drug

Dispensing Outlets in Ilala ……………………………………………

3.Which technical-know-how related challenges affect your provision of medical

services?.................……………………………………………………………………

4. a) What measures have you taken as an individual to improve the provision of health services?
.....................................................................................................

b) To what extent have the strategies contributed to smooth provision of medical services?
…………………………………………………………………………………………

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