APPROACH AND METHODOLOGY
MSH's expansive model relies on public-private partnerships at the national, district, and community levels. Governments develop and enforce quality standards, while providing economic incentives and oversight of an expanded list of legal quality drugs and supplies that shops can dispense. Private sector partners contribute to accreditation costs (including training), product supply, shop renovations, and financing. The shop owners have a vested interest in the success of their businesses.
Tanzania, Uganda, and Liberia are each in different phases of planning, initiation, or scale up of accredited drug seller programs. Through our work in these three countries (plus 2 additional countries TBD), MSH expects not only to expand access to medicines in additional geographic areas, but to solidify the view that such initiatives are feasible, effective, and sustainable. The initiative's objectives are to:
1.) Enhance accredited drug seller initiatives' long-term sustainability and their contributions to community-based access to medicines and care in Tanzania and Uganda.
2.) Facilitate the spread of private-sector drug seller initiatives through regional mechanisms.
3.) Expand private-sector drug seller initiatives into Liberia and two additional TBD African countries.
Planned activities in these five countries will expand private sector access to essential medicines and provide further evidence of the adaptability and sustainability of the accredited drug seller concept and its transferability to different settings.
IMPLEMENTATION, TIMELINE, AND DELIVERABLES
By 2012, Tanzania's drug seller initiative will be fully scaled up nationwide, with a sustainable maintenance strategy developed and in place by 2013. By 2014, Uganda will find their accredited drug seller initiatives brought to nationwide scale up. In both countries, the programs will be deeply embedded in their respective health systems, with links to community health initiatives and a central public-private sector coordinating body in place.
By 2013, Liberia will have launched a nationwide rollout strategy for an accredited drug seller initiative, phasing in its two most populated counties and completing work for full rollout by 2014.
By 2014, a regional mechanism in sub-Saharan Africa will be in place to advocate for and provide technical support to countries in the region wishing to implement and scale up accredited drug seller initiatives.
By 2015, two additional African countries (TBD) will have conceptualized and implemented drug seller initiatives.
Most people in rural areas of Africa often first turn to their local drug shops for their medicines and health care advice needs. These shops may not be legally licensed, have staff that are often untrained, and sell medicines that may be of uncertain quality or that they are not allowed to dispense. Regulatory inspection is infrequent and shops receive no supportive supervision.
As mentioned in the section on lessons learned, the financial resources needed to scale up in countries and expand into new countries is significant, but well worth it. Support from countries is high, not only because they value improving access to quality medicine and care in their countries, but an accredited drug seller program opens new markets for business, improves economic opportunities for shop owners and sellers, and increases the capacity and credibility of national and district governance bodies. MSH will need an estatimated $1,000,000 to expand to a new country, or $100,000 to expand into new districts in Uganda and Liberia.