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Consumer Rights and the Limits to Trust in an African Market for Essential Medicines: Regulatory Implications in Rural Tanzania

Author(s): P. G. M. Mujinja*1, M. Mackintosh2
Affiliation(s): 1Public Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania, 2Faculty of Social Sciences, The Open University, Milton Keynes, United Kingdom
Keywords: Consumer rights, consumer information, medicines, trust, Tanzania, dispensing, regulation
Background:

If access to medicines is obtained by a population largely through market exchange, then consumer rights become a key aspect of the right to health. In Tanzania, out-of-pocket payment is dominant; consumers thus rely on a market transaction for both access to treatment and for essential information concerning the proper use of medicines. In many cases, this is a drug seller in a small private shop.

Methods:

The results reported here are drawn from a survey of medicines dispensing and purchase in four rural districts of Tanzania, which formed part of a larger study of the supply chain of medicines to rural consumers. The rural survey included staff and customers at all types of non-governmental medicine outlets including NGO/FBO facilities and private shops and facilities; interviewees included prescribers, dispensers, shop and facility owners and managers, shop sellers and customers interviewed on exit. The wider study included stakeholder and policy interviews, also used here. The rural districts varied by income and pattern of facility ownership. All the selected medicine outlets’ were asked to provide price data for a selected list of 32 essential medicines from the National Essential Drug List. This paper draws particularly on the qualitative interviewing concerning dispensing practice and consumer information.

Results/Conclusions:

The results of this study show that there is very poor provision of information by sellers and dispensers to consumers of medicines. Consumers are shown to have poor knowledge of the types of information they require, and dispensers and sellers poor knowledge of the information that they should provide. Sellers and dispensers frequently offer diagnostic advice without training and dispense without prescription: interview questions concerning diagnostic knowledge showed a lack of basic knowledge of symptoms and treatments for common illnesses. The dangerous practice of dispensing part-doses was found to be widespread, and indeed normal. Consumers thus were putting misplaced trust in dispensers in a context of poor dispensing practice. NGO and faith-based facilities displayed somewhat better dispensing practice on average than the private shops and dispensaries, but still failed to protect consumers. Furthermore, both consumers and sellers had little knowledge of consumers’ rights to information and protection, and the less educated the consumer, the less they were likely to have asked for medicine information of any kind. Regulation of transactions was poor and failed to protect the consumer, and there was virtually no knowledge of means of redress. The paper notes the efforts made so far in Tanzania to improve rural dispensing practice. In discussing the findings, the paper argues however for a shift of emphasis in research on medicines markets from exploration of sources of trust to a much stronger focus on methods of strengthening the implementation of consumer rights. It proposes a clearer incorporation of consumer rights in medicines markets into efforts progressively to implement the right to health; and argues that a strengthening of civil society and NGO activity in promoting consumers’ rights – moving the source of consumers’ information away from sole reliance on the drug purchase transaction itself – is essential to promote better consumer protection and the appropriate use of medicines.

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