Table 1.
Human health providers in the Tanzanian health system.
| Level | Human Health Role | Description | Training | Recognition | Ability to Dispense/Sell Antibiotics |
|---|---|---|---|---|---|
| Health institutions: Degree holders and mixed post-secondary qualifications/training/knowledge | Medical Doctor (MD)/Officer | Most MDs are in the district hospitals, with a few in Health Centres. In district and remote rural communities, they treat patients with mild or chronic illnesses and refer those with serious conditions to higher-tier hospitals [34]. | Degree in medicine | Medical Council of Tanganyika | Yes |
| Clinical staff (Assistant Medical Officers, Clinical Officers, Assistant Clinical Officers) | Deliver the majority of care at district level and in rural primary health facilities (dispensaries and health centers [34]). | Four to six years of secondary education followed by three to four years of professional training at certificate and diploma levels. | Medical Council of Tanganyika | Yes | |
| Nurse (Nursing Officers, Assistant Nursing Officers, Nurse Mid-wives, Public Health Nurse) | Tanzania Nursing and Midwifery Council | Yes | |||
| Retail/Market-based providers | Type I drug providers | Sell prescription-only medications (POM), including antibiotics, pharmacy only (PO), and general sale list (GSL), medicines [16]. Must be run by registered pharmacist. | Degree in pharmacy | Pharmacy Council Tanzania, Tanzania Medicines and Medical Devices Authority (TMDA) |
Can sell antibiotics with prescription |
| Type II drug providers e.g., Accredited Drug Dispensing Outlet (ADDO*) | Can only sell medicines on the GSL (e.g., common painkillers, cold and flu remedies), and some antibiotics with prescription, e.g., amoxicillin capsule/suspension, benzyl-penicillin powder for injections, chloramphenicol eye drops, trimethoprim/sulfamethoxazole suspension, doxycycline capsules/tablets. | Staff required to have 4 years minimum training e.g., pharmaceutical technician or nurse at diploma or certificate level. | Pharmacy Council Tanzania, Tanzania Medicines and Medical Devices Authority (TMDA) |
Can sell some antibiotics with prescription | |
| General stores/community shop | Sell general supplies plus some over the counter drugs. Do not require registered pharmacist. | No professional certified training | Community-based and government | Cannot legally sell antibiotics | |
| Community health providers | Community Health Workers | Health promotion and basic curative and preventative services. Can advise sick people to go to a healthcare facility [35]. | Secondary education and short health training course | Community-based and government | Cannot legally sell antibiotics |
| Traditional Healers | Treatment often consists of a combination of ritual and herbal medication, offering extra, specific treatment for protection of body and mind that cannot be treated in hospital. | Through family and peers | Community-based and some are registered with the Traditional and Alternative, Medicine Council. | Cannot legally sell antibiotics |
* The Tanzanian Accredited Drug Dispensing Outlet, or ADDO, was established by the Pharmacy Council in 2009 to improve access to essential medicines, including antibiotics, by implementing trainings and inspections. According to Tanzanian regulations, antibiotics can only be dispensed with a prescription from a doctor at an ADDO dispensary. However, studies have shown that unregistered ADDO pharmacies and other shops continue to sell antibiotics without a prescription, with some research concluding that this dispenser behaviour is motivated by the need to make a profit and meet customer demand [35,36].