Duka La Dawa

A child gets sick. Often, Tanzanian parents take the child to a traditional healer first. If, after a few days, the child is not better, they will then take their kid to a duka la dawa (drug shop), which has medications, but no one licensed or trained to prescribe them. The medication may not be the correct treatment for the illness or it may not be the right dosage. So, a few days later, if the child still is not better, the parents now take the child to the health facility (a facility where they could have gotten the correct medication, at the correct dosage, for free). The child is now very, very ill; and has been sick for several days. Sometimes, the health facility can help, but often the child is now too far gone. The child dies, and of course, “the health facility killed my child.”

This compounds the problem and only makes families less likely to seek out the formal health sector. Meanwhile, duka la dawas prosper. In Karatu alone – a town with a population of just 71,000 – there are 14 drug shops. In August and September, to assess the extent of the problem, MIHV trained “secret shoppers” to visit the shops with their sick child. Our “shoppers” found that while correct medications were usually prescribed (two-thirds of the time), they did not provide proper dosage and consistently gave partial dosages. For example, if a parent comes in with a feverish child, the drug shop keeper may tell them the child needs to take an anti-malarial -- the first line malaria treatment in Tanzania, ALu, is 24 pills -- if the parents have only, say, half of the cost of the drugs, the shop keeper will take the money and give the parent 12 pills.

Involving these informal links in the chain of health services is crucial. In October, MIHV held the first of several drug shop keeper trainings, where they discussed the importance of not giving partial dosages (in the short term, people don’t get better; in the long term, partial dosing leads to drug resistance) and if a family can’t afford the full amount, then refer them to a health facility where they can get the drugs for free.

Recently, Jolene, MIHV’s Tanzania Country Director, started feeling sick. We have a pile of partial dosages left over from the “secret shopper” assessment, so Jolene took part of the medication she needed and then sent someone to a duka la dawa to buy her the rest of the dosage.

The drug shop keeper refused to sell the man a partial dose.