The overall objective of the National Health Policy is to improve the health and well being of all Tanzanians with a focus on those most at risk and to encourage the health system to be more responsive to the needs of the population, which stands at a total of 34,568,609 people (Mainland: 33,584,078 and Zanzibar: 984,531)(census 2002). The National Health Policy along with its underlying National Drug Policy (NDP) and the Health Sector Reform (HSR) clearly spell out the government responsibility for ensuring that Tanzanians have equitable access and utilization of health services offered by public, private and NGO institutions through the “public-private partnership” phenomenon.
Inspite of the progress made since independence and the recent favourable economic growth realized so far, the Tanzania’s social indicators, which include health, are still below the acceptable levels. The causes that have resulted in the current unfavourable situation include, amongst others:
• Shortfalls in the annual health sector budget allocations
• Increased demand for health care due to expanding population and changing disease patterns
• Increased costs of essential health care inputs e.g. personnel emoluments, drugs, equipment and medical supplies.
• Increased morbidity and mortality due to HIV/AIDS
In response to a number of problems encountered in the pharmaceutical sector, the government of Tanzania through its Ministry of Health has taken several steps in an attempt to improve the situation. In 1991 it endorsed the first National Drug Policy (NDP), which serves as the basis upon which future planning of pharmaceutical sector is carried out. A master plan for the pharmaceutical sector 1992 - 2000 was developed from the NDP clearly indicating the objectives, strategies, time frames and the budget required to achieve development in various key areas of the pharmaceutical sector. The government further established complementary/alternative-financing mechanisms/options to alleviate the problems namely:
• User Fees (Cost-sharing/Drug Capitalization)
• Community Health Fund
• The National Health Insurance Scheme
The main objective of these developments is to ensure that the most needed drugs and medical supplies of good quality are made available in health facilities at all times with special emphasis on rural health facilities.
Monitoring and assessing the pharmaceutical situation in Tanzania, like in any other country, is important so as to know whether or not the population has access to essential drugs that are of good quality, efficacious and are being used rationally.
Since the pharmaceutical sector is complex, a systematic method of gathering data is very important to assess if the above objectives are met. There are multiple, cross cutting factors that can influence the achievement of these objectives and a variety of strategies to achieve them that can be implemented and adopted by a particular country.
The International Network for Rational Use of Drugs (INRUD) in collaboration with the World Health Organization (WHO) has developed core indicators for monitoring national drug policies that can be used to systematically assess, evaluate and monitor the formulation and implementation of various strategies and components of the pharmaceutical system.
The indicator-based method of assessing the pharmaceutical situation can be useful for various groups and parties involved in the provision of pharmaceuticals. The method can clarify the responsibilities of various players in the pharmaceutical system and assess their contributions to attaining key objectives.
Indicators can provide policy-makers and managers with a clear picture of national and institutional problems so that they can reassess their strategies and priorities. Results can be used as a guide to prioritize and strengthen pharmaceutical system components and strategies to achieve maximum impact or to synchronize policies.
The core indicators have been grouped into three levels. Grouping monitoring indicators by level has the following advantages:
• Suits the different purpose of those interested in information on the country’s pharmaceutical situation:
• Rapid assessment of key pharmaceutical components.
• Monitoring outcome and achievement of key objectives of the pharmaceutical policy.
• In-depth assessment of specific system components.
• Provides practical methods for regularly monitoring NDPs and their components
• Encourages regular reporting and exchange of pharmaceutical information among facilities, districts, regions, government and non-government agencies within countries as well as international organization.
Rapid assessment, Level I indicators are intended to get information on the existing infrastructure and key processes in each component of the pharmaceutical sector.
Level II indicators provide systematic data to describe the degree of attainment of the NDP objectives access, quality and rational use. Access is measured in terms of availability and affordability of essential drugs especially to the poor and in the public sector. Measuring the actual quality of the drugs involve testing drug samples and can be expensive. Rational use is measured by examining patterns of drug use and the implementation of key strategies such as STGs and EDLs.
Level III indicators - such as those in the WHO manual on Indicators for Monitoring National Drug Policies can be used to assess in more detail the country’s NDP programme and the implementation of each component of the pharmaceutical system. Countries implementing national drug policies can use this as baseline assessment and follow up studies can be conducted depending on needs and capabilities for extensive assessment.
Following the fact that the government has invested substantially in ensuring that people have access to essential drugs and medical supplies of good quality and that the drugs are being used properly. This study has adopted the use of level II core indicators which measure access to drugs and medical supplies by the population, matters on quality of drugs and matters on rational use of drugs. The WHO recommends that activities to strengthen the pharmaceutical sectors are organised under the umbrella of a rehearsal drug policy (WHO, 1998).
