Objectives: A public-private partnership in Tanzania launched the accredited drug dispensing outlet (ADDO)
program to improve access to quality medicines and pharmaceutical services in rural areas. ADDO dispensers play
a potentially important role in promoting the rational use of antimicrobials, which helps control antimicrobial
resistance (AMR). The study objectives were to 1) improve dispensing practices of antimicrobials, 2) build ADDO
dispensers’ awareness of the consequences of misusing antimicrobials, and 3) educate consumers on the correct
use of antimicrobials through the use of printed materials and counseling.
Methods: Our intervention targeted ADDO dispensers and community members in Kilosa district. We promoted
AMR awareness using posters hung in public places, health facilities, and ADDOs; sensitizing 84 health care
providers on AMR issues; and providing training and on-site support for 124 ADDO dispensers to increase their
AMR knowledge and dispensing skills. Baseline and endline assessments included direct observation of dispensers’
practices; interviews with ADDO dispensers (71 at baseline and 68 at endline) regarding dispensing experiences;
230 exit interviews with ADDO customers regarding use of antimicrobials during monitoring visits; and review of
ADDO records. Indicators were based on product availability, dispensing practices, customers’ knowledge of how to
take their medicines, and dispenser and public awareness of the AMR threat.
Results: Availability of tracer antimicrobials increased by 26% (p = 0.0088), and the proportion of ADDOs with
unauthorized items decreased from 53% to 13% (p = 0.0001). The percentage of ADDO dispensers following good
dispensing practices increased from an average of 67% in the first monitoring visit to an average of 91% during the
last visit (p = 0.0001). After the intervention, more dispensers could name more factors contributing to AMR and
negative consequences of inappropriate antimicrobial use, and over 95% of ADDO customers knew important
information about the medicines they were dispensed.
Conclusions: Providing educational materials and equipping ADDO dispensers with knowledge and tools helps
significantly improve community medicine use and possibly reduces AMR. The number of community members
who learned about AMR from ADDO dispensers indicates that they are an important source of information on
medicine use.