Tanzania is an amalgamation of Tanganyika (a former German colony that the British took over after World War I) and the islands of Zanzibar, formerly a British protectorate. Tanzania is about the size of Nigeria, but with less than a third of the population (about 41 million), and is largely rural and agricultural. In the early 1960s, Julius Nyerere, a proponent of African Socialism and a prominent figure in the decolonization movement, led Tanzania to independence and into a one-party system. Forced agricultural collectivization produced great economic hardship. Constitutional reforms finally led to the first multiparty elections in 1994. Even today, however, the ruling party remains overwhelmingly popular. In the past 20 years, economic reforms and foreign aid have produced some economic growth (5.8 percent in 2003) (CIA World Factbook 2009). The country has some natural resources, including both minerals and natural gas, and some famous tourist attractions, such as Mount Kilimanjaro and the Serengeti game reserves. But perhaps 85 percent of employment is still in agriculture, and poverty has been a continuing challenge. In 2003, per capita income was only US$630 in purchasing power parity terms (CIA World Factbook 2009). Because of the government’s limited economic capacity, the public health sector run by the Ministry of Health and Social Welfare (MOHSW) has long suffered from deteriorating buildings, a lack of equipment and supplies, and a lack of human resources. At the same time, the system confronts rising levels of HIV/AIDS and high rates of multidrug-resistant malaria. In rural areas, only 27 percent of pregnant women delivered at health facilities, compared to 77 percent in urban areas (United Republic of Tanzania 2006, 17).
The Drug Access Problem In 2001, Tanzania confronted major drug access problems. An estimated 60 percent of the country’s pharmacies were located in the capital city. In rural areas basic medicines were largely supplied by more than 4,000 licensed Cold Drug Shops (Duka La Dawa Baridi, in Swahili, or DLDBs; see figure F1). Unlike urban pharmacies, DLDBs were not supervised by a pharmacist and had a smaller list of approved drugs. In 2001, nearly 70 percent of DLDBs were staffed by nurse assistants or other auxiliaries who had no formal training in drug dispensing (CPM 2003, 30). Yet these shops were often the first point of contact with health services for rural patients. Indeed in 2008 only 620 licensed pharmacists were known to be working in the entire country (FIP 2009, 83). 256
Case Study F