Afya-Tek, our flagship program in Tanzania, in collaboration with Apoteheker Health Access Initiative, connects community health workers, health facilities and drug shops to serve people’s health needs better, when and where they need it. Last year, through the Digital Innovation Seed Fund project and with funding from the Gates Foundation, we embarked on a journey to deepen our understanding of how people access medicines for family planning, pregnancy and beyond, as well as for their newborns and children.
We engaged community health workers, drug shops, clients and government staff to paint a better picture of the current situation and understand what key challenges exist to access the right medicine and what potential interventions could address these barriers. Access to and correct use of medicines is just one part of people’s health journeys, but it is a very important one – both for prevention and treatment.
About the study
The research team took two approaches: they collected data from the Afya-Tek digital system and complemented this with field-based activities, including surveys, focus group discussions and interviews. Data from the Afya-Tek program provided insights into service delivery, with additional questions to capture availability, accessibility, demand and affordability. The study was carried out in Kibaha, a region in Eastern Tanzania.
Here’s what we discovered and how we plan to address the barriers.
Demand: A Growing Need for Correct Use of Medicines
As Kibaha’s population grows, so does the demand for medicines. But with this growth comes a critical challenge: ensuring medications are used correctly to maximize health benefits and prevent risks like antibiotic resistance.
Our study identified commonly used medicines across different groups: for pregnant women, iron supplements and malaria prevention drugs; for postpartum women, oral contraceptives; and for children, antibiotics were frequently used.
We also uncovered concerning trends in medication use. Antibiotics were often overused, while essential treatments – like Oral Rehydration Salts with Zinc for diarrhea and combined iron and folic acid supplements for pregnant women – were underutilized.
To promote the correct use of medicines, we must strengthen education efforts both in health facilities and drug shops. We need to emphasize the importance of ORS and Zinc for children’s diarrhea, ensure pregnant women receive both iron and folic acid, and most importantly, reduce unnecessary antibiotic use. By addressing these challenges, we can improve health outcomes and safeguard the effectiveness of essential medicines for future generations.
Availability: A Mostly Reliable Supply Chain
The proximity of Kibaha to suppliers ensures a relatively steady supply of medicines. Afya-Tek data showed that 99 % of clients reported receiving the medicines they needed. Of those who didn’t get the medication they needed, 39 % were health facility clients and 30% were drug shop clients citing stock out as the reason they couldn’t access it.
The root of these challenges seems to lie in gaps in inventory management training. Without proper stock tracking and coordination, essential medicines can become unavailable when they are needed most.
Looking ahead, we must deepen our understanding of supply dynamics and expand research to rural areas, where supply chains may be weaker. There is also an opportunity to strengthen inventory management training at both health facilities and drug shops where levels of experience vary. Additionally, Afya-Tek presents an untapped opportunity to enhance the coordination of stock levels between these key points of care – ensuring medicines are available where and when they are needed.
Affordability: Addressing Cost Barriers
While health facilities provide most medications free of charge under an exemption policy, some facilities will still charge for medicines which leads to dissatisfaction among clients. Additionally, clients may not be aware of non-exempt drugs, such as antibiotics, and are surprised when charged for those medications. At drug shops, medications are not free, and the lack of price regulation means that costs can be a barrier for some clients.
Afya-Tek surveys revealed the extent of this issue: among those unable to obtain medicines, cost was a barrier for 56 % of health facility clients and 70 % of drug shop clients.
To address these financial barriers, we must ensure health facilities adhere to exemption policies and clearly communicate them to clients. At the same time, promoting education about exempt and non-exempt drugs at the health facility, as well as cost transparency at both health facilities and drug shops is essential. Encouraging enrollment in community health insurance can also play a key role in easing the financial burden of accessing care.
Accessibility: Convenience Matters
Proximity plays a major role in where clients choose to seek care. Data shows that 83 % of drug shop clients selected them as the point of care because they were close to home, compared to only 12 % of health facility clients. In Kibaha, most residents live within 2 kilometers of a drug shop, making them a highly accessible option.
To further improve healthcare access, we need to expand research into rural areas, where distance poses a much greater barrier. Mapping the distribution of drug shops and health facilities will help identify underserved areas, and introducing incentives for opening drug shops in remote regions could bridge critical gaps in access.
The Potential of Digital Solutions
The Afya-Tek program has demonstrated the power of digital tools in identifying and addressing medication barriers. By connecting key players in the healthcare system and generating real-time data, the program has helped inform better decision-making. One clear impact: since the program began, the percentage of children receiving both the Oral Rehydration Salts and Zinc for diarrhea has increased from 13 % to 30 %.
The insights from the study are valuable, but we also recognize there is still much we don’t know. More data is needed to fully understand healthcare access challenges in different settings, particularly in rural areas. Closing this gap presents an opportunity to design even more effective interventions tailored to specific community needs.
As Afya-Tek continues to expand, there is opportunity to deepen our understanding of healthcare access across Tanzania by scaling research efforts, identifying medication barriers in different settings, and implementing targeted interventions to address them. Additionally, Afya-Tek can be leveraged to generate insights into other health challenges, such as non-communicable diseases.
Sustained engagement with the government remains important, including integrating data into national dashboards and conducting trainings on research-driven policy and intervention strategies. This includes strengthening access to essential medicines and introducing drug shops in underserved areas.
By harnessing a digital solution like Afya-Tek and prioritizing data-driven insights, we can address these challenges head-on – bringing Tanzania closer to a healthcare system where essential medications are more accessible and affordable for all communities.
