Promoting Access and Rational use of Antibiotics for Children: 5 things I learnt in Tanzania

In January I had the pleasure of joining the first of five country workshops for the Promoting Access and Rational use of Antibiotics for Children (PARAC) project, being led by UNICEF, which I have written about on here before.  

First up is Tanzania.  It is one of the leading countries in Sub-Saharan Africa in terms of developing and implementing a National Action Plan for drug-resistant infections, but still faces challenges around ensuring antibiotics are accessible to those who need them – and only those for whom the drugs are necessary. 

The three-day meeting identified the research priorities for the project and gathered fascinating insights from pharmacists, programme managers, policy makers and researchers spanning the Ministry of Health, the National Institute Medical Research, academic institutions, NGOs and the private sector.

It was a great opportunity to learn directly from Tanzanian health professionals about their experiences of both tackling drug-resistant infections and increasing appropriate access to antibiotics. Here are my five main takeaways.

1.    Rolling out regulations is harder than writing them

Tanzania has made some impressive progress in implementing its National Action Plan for drug-resistant infections over the last two years and is the top performing country being supported by the Fleming Fund. But the Government is facing challenges in implementing new regulations and guidelines across the country. There’s clearly a role for implementation research to ensure that these crucial new guidelines are rolled out in districts across Tanzania.

2.    Community pharmacists are key

The Accredited Drug Dispensing Outlets (ADDO) programme – which has formalised community pharmacists and improved links to other parts of the health system – has been a great success, and led to increased access to antibiotics and improved patient care. It is now being scaled up in Tanzania and replicated in other countries too.

3.    Access through the private sector

A large proportion of antibiotics administered to children are accessed through private sector providers, such as the ADDO community pharmacists, because of problems in the public healthcare system. These private providers are therefore critical to ensure access to antibiotics, but greater training and oversight is needed to ensure that only patients that need antibiotics receive them. This means the focus of some of the research in Tanzania will focus on this – known as responsible ‘stewardship’.

4.    Problems in the supply chain need fixing

One of the big challenges relating to antibiotic access in Tanzania is problems in the supply chain that result in the cheapest and most appropriate drugs being regularly unavailable. This means that more expensive antibiotics, that some cannot afford, are the only option. Therefore, one of the research projects in Tanzania is likely to focus on tackling problems in the supply chain to improve access.

5.    Collaboration is essential

It’s helpful to have decision makers, implementers and researchers in the same room, dissecting the problems together, and then developing solutions collaboratively. This allows policy makers and programme managers to learn how research is designed and conducted and ensures that the research focuses on real-world implementation problems. This should also increase the likelihood of the research impacting policy and practice.

I can’t wait to see the exciting research that the participants of the workshop will undertake, and the impact this could have on improving access to, and stewardship of, antibiotics for children in Tanzania. UNICEF have already held a workshop in South Africa to identify the research priorities there, so next up are Cambodia and Vietnam.