Health risk as pharmacies sell drugs without prescriptions

Pharmacies, originally intended to dispense medicines strictly on medical prescription, are increasingly turning into unofficial treatment points, where patients can obtain drugs without ever consulting a doctor.

According to the Pharmacy Council of Tanzania, medicines such as antimalarial drugs like Artemether–Lumefantrine (ALU) and antibiotics including Amoxicillin and Doxycycline are listed as prescription-only, meaning they should only be issued under a doctor’s written authorisation.

In reality, however, the situation on the ground tells a different story. Many Tanzanians now rely almost entirely on pharmacies for diagnosis and treatment, often bypassing hospitals altogether.

While the convenience is undeniable, experts caution that the risks are grave, with one of the most dangerous consequences being the rise of antimicrobial resistance (AMR), a condition where bacteria, viruses, and other pathogens evolve to resist the drugs designed to kill them.

A global and local concern

The issue is far from isolated. A global study published in The Lancet revealed that antimicrobial resistance was linked to 4.71 million deaths worldwide, with about 24 percent of those deaths directly attributed to drug resistance rather than underlying health conditions.

If unchecked, experts predict that AMR-related deaths could rise by 70 percent by 2050, with sub-Saharan Africa among the regions expected to be worst affected.

Closer to home, research conducted by Dr Pendo Ndaki of the Catholic University of Health and Allied Sciences (CUHAS) in Mwanza showed that 89 percent of pharmacy workers dispense antibiotics for urinary tract infections without prescriptions, while 87 percent admit to offering incomplete doses based solely on patients’ symptoms rather than diagnostic tests.

A casual test conducted in Sinza, Dar es Salaam, confirmed how common the practice has become in urban settings.

After walking into a local pharmacy and complaining of symptoms associated with gonorrhoea—without any prescription—a reporter was handed a syringe and medication and instructed to go to another pharmacy for administration.

The attendant admitted she was “afraid” to administer the injection herself.

In another pharmacy, a full course of malaria medication was sold within minutes after merely describing fever-like symptoms.

When the experiment was repeated at 30 pharmacies in the city, posing as patients with different ailments such as ulcers and urinary tract infections—20 of them provided medicines without asking for a prescription or medical history.

Some attendants claimed they had received informal medical training or experience during hospital field placements, which they now rely on to advise patients.

“After college, I did fieldwork at a hospital and learned how to assist patients. That’s what I use today,” said one pharmacy worker who requested anonymity.

Another attendant admitted that the behaviour is partly customer-driven. “The patient often insists that their doctor told them to buy the medicine, and because I also need to make a sale, I give them what they want,” she said.

However, some attendants were more cautious. Those unsure of a customer’s background or seriousness demanded prescriptions, while others relied on appearances and confidence levels to decide whom to serve.

Government responds

According to the Government Chief Pharmacist, Daudi Msasi, misuse of medicines, especially antibiotics, remains one of the leading causes of antimicrobial resistance both locally and globally.

Citing studies, he noted that more than half of Tanzanian patients use medicines without professional guidance, often purchasing them directly from pharmacies or reusing leftover drugs at home.

Mr Msasi said the government is implementing the National Action Plan on Antimicrobial Resistance, which promotes rational medicine use, disease prevention, improved laboratory diagnostics, and public awareness.

“The government, through the Tanzania Medicines and Medical Devices Authority (TMDA) and the Pharmacy Council, has strengthened regulatory oversight of pharmacies to curb the sale of medicines without a doctor’s prescription,” he told The Citizen.

Among the ongoing interventions, he mentioned the nationwide awareness campaign ‘Holela Holela Itakukosti’—loosely translated as ‘Reckless Use Will Cost You’, which has so far reached about 24.7 million people.

The initiative has been recognised by the Africa Centres for Disease Control and Prevention (Africa CDC) as one of the continent’s most impactful public health campaigns.

Although no specific region has been identified as having the highest rate of malpractice, Dar es Salaam remains the country’s largest pharmacy hub, hosting 1,345 registered outlets, or 47 percent of all pharmacies nationwide.

Authorities attribute this to the city’s large population and growing demand for quick health services. To enhance enforcement, the Pharmacy Council recently established an Eastern Zone Office in Dar es Salaam and equipped it with additional staff and vehicles to improve inspection coverage.

During the 2024/2025 financial year, a total of 1,768 pharmacies were inspected out of the 3,302 registered nationwide, according to official figures.

For many Tanzanians, pharmacies have become the first—and sometimes only—point of medical care. Residents interviewed by The Citizen said they often resort to pharmacies because of long queues, limited staff, and high consultation costs in hospitals.

“I only go to the hospital when it’s very serious. For fever or flu, I just buy painkillers or antibiotics from a nearby pharmacy and it’s gone,” said Gladness Aloyce, an entrepreneur based in Sinza.

Another resident, Deogratius John, said the efficiency of pharmacies makes them more appealing than hospitals. “I once went to hospital but the queue was too long.

I went to a pharmacy instead, got tested for malaria, and received medication immediately. Since then, I’ve been advising others to do the same,” he said.

For Sabrina Jumanne, who suffers from severe menstrual pain, pharmacy-based painkillers have become her main source of relief. “They work for me. I’ve never felt the need to go to the hospital,” she said.

“Using these medicines has really become part of our lives,” she added. “I get faster service instead of wasting hours at the hospital.”

Shakira Ahmadi, another resident, agreed. “Unless it’s a serious illness, I don’t see the point of going to the hospital. For things like headaches or stomach pain, I just go to the pharmacy and buy medicine as long as the attendant is helpful,” she said.

The legal framework

The Pharmacy (Prescription Handling and Control) Regulations, 2020 prohibit any person from selling or dispensing prescription-only medicines without a valid prescription issued by a licensed medical practitioner.

Anyone found violating the regulations faces a fine ranging between Sh500,000 and Sh5 million, or imprisonment of up to 12 months, or both. Moreover, each prescription is valid for only seven days from the date of issue.

Despite the clear legal provisions, enforcement remains difficult due to weak monitoring mechanisms and limited manpower. Some pharmacies also operate in residential areas, making inspection more challenging.

Experts call for stronger enforcement

Public health experts are calling for tighter control and broader awareness campaigns to address the growing culture of self-medication.

Health advocate Erick Mahatara said the trend is driven by a mix of patient behaviour, poor regulation, and economic hardship. “High consultation fees, misinformation, and easy access to drugs at pharmacies push people to self-medicate,” he said.

He added that stiff competition and the desire for profit compel many pharmacy operators to bend the rules. “Many fear losing customers if they don’t provide treatment, especially when rival pharmacies nearby are doing so,” he noted.

Mr Mahatara further pointed out that inadequate training among some pharmacy attendants exacerbates the crisis. “A number of those dispensing drugs are not qualified pharmacists. They may have minimal or no formal training, yet they provide medical advice,” he said.

Experts say a long-term solution lies in addressing both the demand and supply sides of the problem. They recommend increasing access to affordable healthcare, expanding public hospitals, and ensuring that pharmacies are manned by certified professionals.

Others urge the government to invest more in community health education, particularly in explaining the dangers of antimicrobial resistance and the importance of following prescriptions.

As the government continues its crackdown and awareness drives, the challenge remains balancing enforcement with accessibility—ensuring that while essential medicines remain within reach for ordinary citizens, the safety of public health is not compromised.

Unless urgent measures are taken, experts warn that Tanzania risks joining the global list of countries facing a silent but deadly epidemic—an age where ordinary infections become untreatable because the drugs meant to cure them no longer work.