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Uwazi Monitoring  June 2012 Brief No. 4
Buying medicines in Dar es Salaam
Do pharmacies follow regulati  ons?
Introducti  on
Can medicines make us sick? Are they dispensed properly? Is the system of 
protecti  ng people from misuse of medicine working? To answer these questi  ons, 
Youth Initi  ati  ves Tanzania (YITA), in associati  on with Twaweza, investi  gated 
whether pharmacies observe regulati  ons regarding sales to consumers. The 
exercise was carried out in November 2011 through a survey of pharmacies by 
‘mystery clients’ in Dar es Salaam.
This brief explains what happened during the mystery visits. It shows that, 
contrary to regulati  ons, the majority of pharmacies sell prescripti  on medicines 
without a prescripti  on from a doctor. This raises questi  ons about how the 
pharmacy business is monitored in Tanzania, and whether people’s health is 
adequately protected.  
By selling drugs and other medical supplies, pharmacies provide a crucial health 
service. Pharmacies sell two types of medicines: prescripti  on drugs, which can 
only be bought when the pati  ent/buyer has an authorized doctor’s prescripti  on, 
and over the counter drugs which can be bought at any ti  me and do not require 
a prescripti  on. The fi  rst type can cause serious harm when used improperly, and 
that is why they require a prescripti  on. Buying and using prescripti  on medicines 
This note was produced by YITA in associati  on 
with Twaweza, housed by Hivos Tanzania.
YITA, P.O. Box 90540, Dar es Salaam, Tanzania
Telephone: +255 22 240 1426
Email: info@yita.org Web: www.yita.org2
without a doctor’s authority can harm or even poison the individual (e.g. when 
patients use the wrong medicines or in the wrong dosage) as well as harm other 
individuals’ health (e.g. by creating resistance to medicines that are not properly 
used). 
To prevent abuse of medicines, the 
Tanzania Food and Drugs Authority 
(TFDA, www.tfda.or.tz), a regulatory 
body under the Ministry of Health 
and Social Welfare, has been charged 
with the responsibility for controlling 
the quality, safety and effectiveness of 
food and drugs. TFDA sets regulations 
to protect people’s health, which 
pharmacies are required to follow. All pharmacies must be registered under 
TFDA to operate in the country, and none are to sell any prescription medicines 
without prescriptions issued by authorized medical practitioners (doctors). 
Methodology
The survey was carried out in November 2011 by field workers who made 126 
‘mystery visits’ to 64 pharmacies in the three districts of Dar es Salaam: Ilala, 
Kinondoni and Temeke. In Ilala, pharmacies in the Central Business District and 
Kariakoo were monitored. In Kinondoni, the mystery clients (field workers) went 
to pharmacies located at Kinondoni, Magomeni, Manzese, Masaki, Msasani, 
Mwananyamala, Mwenge, Namanga, Savei/Mlimani City area and Sinza. In 
Temeke, they visited pharmacies at Chang’ombe, Kigamboni and Temeke. In each 
area several pharmacies were visited, with a higher number of pharmacies visited 
in more densely populated areas. 
The three field workers were young women, each with a bachelor’s degree or 
diploma. They visited pharmacies which were randomly selected from the list 
of the Tanzania Medical Directory (http://tanzaniamedicaldirectory.com/html/
list.html ). Initially, 64 pharmacies of the 264 (24 percent) listed pharmacies 
were selected. However, when the field workers realized on their first day 
of monitoring that many pharmacies from the list could not be found, they 
replaced the selected pharmacies with pharmacies in the same area; many of the 
replacements were not in the list of the Tanzania Medical Directory. Annex 1 lists 
the number of pharmacies that were monitored in each area and the number of 
visits made per area.
‘No dispenser shall dispense any ADDO (Accred-
ited Drug Dispensing Outlet) prescription medi-
cines except on and in accordance with a pre-
scription issued by a medical practitioner, dentist 
or veterinarian or any authorized prescriber.’
The Tanzanian Food, Drugs and Cosmetics (Phar-
maceutical Business Standards) Regulations, 
2006: Article 31;33
not sold 7%
sold on
request
93%
The ‘mystery visits’ to pharmacies were done in two different ways. The first (88 
visits) entailed the field worker walking into a pharmacy and asking directly for 
a certain type of medicine for which one would need a prescription according 
to the regulations. The second approach (38 visits) involved the field worker 
discussing her sickness and symptoms or that of a family member with the 
pharmacy attendants, and asking for advice about what medication to take. Field 
workers were asked to persist – as people would do in ordinary circumstances – 
even if the pharmacies refused in the first instance. 
Interactions between pharmacy attendants and field workers were carefully 
recorded, and receipts and medicines procured were systematically 
photographed and documented. In the images below the names of pharmacies 
on receipts are covered to avoid singling out any particular business.
Three facts about whether prescription medicines are sold properly
Fact 1: In 93 percent of 88 visits, prescription medicines were sold without a 
prescription
In 88 visits to pharmacies, field workers walked into a pharmacy and asked 
directly for a certain type of prescription medicine without offering a prescription. 
In 82 of those visits (93 percent), the pharmacies sold the medicines requested 
by the client without asking for a prescription. 
Figure 1: Prescription medicines sold without a prescription when requested (%) 
Source: YITA Pharmacy Survey, 2011.4
Fact 2: In 92 percent of 38 visits, prescription medicines were sold after a client 
described symptoms
In 38 visits the field workers asked the pharmacies for advice after discussing 
the sickness and/or symptoms of their ailment. In 35 out of 38 (92 percent) of 
the visits, instead of advising the client to consult a doctor first, the pharmacy 
attendant recommended certain prescription medicines and sold the same to 
them. 
Figure 2: Prescription medicines sold when 
clients seek advice without consultation of 
a doctor (%)
Box 1: Example of an interaction where a 
client describes an ailment and asks for 
advice
Source: YITA Pharmacy Survey, 2011. Source: YITA Pharmacy Survey, 2011.
In total, in 117 out of the 126 visits (93 percent), prescription medicines 
were sold without asking for a doctor’s prescription. Only in nine instances (7 
percent) were clients refused to be sold prescription medicines without the 
requisite prescription. Figure 3 below shows examples of medicines procured 
improperly and the receipts provided. 
‘I told the pharmacist that I have a urinary 
tract infection and I asked her which type 
of medicine she thinks I can use to treat 
the disease. She went to her computer and 
typed something. After typing she turned 
to me and said, “It’s 7,500 Shillings.” Then I 
asked her, “What is the name of that medi-
cine?” She turned the computer screen to 
me so that I could read. I read it and I asked 
her if she will give me the receipt if I would 
buy it. She said yes.’
not sold 8%
sold on
request
92%5
Fact 3: In 12 of 15 areas visited, 100 percent of pharmacies sold medicines 
improperly
While overall it was very easy to get prescription medicines improperly in almost 
all cases, it was more difficult to do so in a few areas. In 12 of the 15 surveyed 
areas, the field workers were able to obtain prescription medicines without 
presenting a prescription in 100 percent of the visits (Figure 5). Only in three 
areas (Masaki, Central Business District, Savei/Mlimani) were they refused 
prescription medicine without a doctor’s prescription, and then only in some of 
the visits. 
Figure 5: Prescription medicines sold without prescription by area
Figure 3: Examples of prescription medicines and receipts sold without 
prescription
Source: YITA Pharmacy Survey, 2011.
Source: YITA Pharmacy Survey, 2011.6
Conclusion
This brief has presented findings of a monitoring exercise that sought to establish 
the extent to which pharmacies in Dar es Salaam adhere to the regulations 
regarding dispensing of prescription medicines laid down by the TFDA. 
The survey, carried out by YITA in association with Twaweza in November 2011, 
found widespread disregard of the regulations. During nearly all visits (93 
percent), pharmacies in Dar Es Salaam sold prescription  medicines to clients 
improperly. A number of reports by mystery clients even show that pharmacy 
attendants can be easily manipulated by clients who do not have a prescription 
from a doctor.
In both sets of approaches used – whether a client asked for medicines by name 
or asked for advice about how to treat a particular ailment – the results were 
the same. It is clear that TFDA regulations are violated frequently across Dar es 
Salaam and that the system for regulation is not working. 
The consequences of this practice are that citizens’ health is placed at significant 
risk. These include: 
•	 Patients may administer incorrect dosages which can lead to drug resis-
tance and other complications, including poisoning; 
•	 Patients may end up taking wrong medicines which places their health in 
danger; and 
•	 Patients may develop dependence on certain medicines.
This monitoring exercise did not examine the reasons for the broad prevalence 
of this problem, but one can speculate. Could it be that the pharmacy attendants 
are not properly trained and aware? Or are they aware but the profit motive of 
the pharmacy owners, combined with a weak regulatory system, makes them 
ignore their knowledge and sell medicines improperly anyway? Or is the primary 
driver for this practice the strong expectation from citizens to get medicines 
quickly and easily, without the cost, hassle and at times ill-treatment at the hands 
of medical personnel?  
We do not know the definitive answers to these questions. But if we care about 
the health and well-being of people, grappling with these questions and finding 
pragmatic solutions should be a key concern for the TFDA, the Ministry of Health 
and citizens alike. 7
Annex 1: Pharmacies visited and medicines supply behaviour
Area No. of 
pharmacies 
monitored
No. of 
mystery 
visits
Medicines 
sold without 
prescription
Medicines not 
sold without 
prescription
Medicines 
sold without 
prescription 
(%)
Kariakoo 11 22 22 0 100%
Magomeni 4 8 8 0 100%
Manzese 3 6 6 0 100%
Masaki 3 4 2 2 50%
Msasani 4 8 8 0 100%
Namanga 2 4 4 0 100%
Central Business 
District
9 18 14 4 78%
Kigamboni 2 4 4 0 100%
Mwananyamala 4 8 8 0 100%
Kinondoni 5 10 10 0 100%
Sinza 5 9 9 0 100%
Mwenge 4 8 8 0 100%
Savei/Mlimani City 2 4 1 3 25%
Temeke 4 8 8 0 100%
Chang’ombe 2 5 5 0 100%
Total 64 126 117 9 93%
Source: YITA Pharmacy Survey, 2011. 
NB: In Savei/Mlimani City only one pharmacy in each area was monitored. Two 
mystery visits in each pharmacy were conducted.8
Annex 2: Number of visits and medicines supplied
Total visits 126
Sold on request 82
Not sold on request 6
Sold seeking advice 35
Not sold seeking advice 3
Source: YITA Pharmacy Survey, 2011. 

Buying Medicine in Dar es salaam;Do Pharmacies Follow Regulations?

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Buying Medicine in Dar es salaam;Do Pharmacies Follow Regulations?

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