Tanzania

The R4D Tanzania Market Shaping practice is comprised of pharmacists, as well as public health, business, and policy experts with deep experience in addressing inefficiencies across global and country-level markets to dramatically expand access to essential health and nutrition commodities. This is achieved by aligning priorities and incentives of market actors (policymakers, procurers, financiers, and manufacturers) at   the global and country levels to develop and execute solutions to ensure that lifesaving health and nutrition products are available at the right quantity, time, cost and quality.

R4D leverages the four sets of market-shaping expertise to systematically identify and address holistic market and delivery barriers. These are:

1. Market Analysis: application of a broad range of analytic techniques to understand barriers and challenges to increasing access to a given commodity or service;
2. Market shaping strategy development: development of targeted strategies or recommendations to inform donor decisions to shape markets efficiently and holistically;
3. Implementation: a deep engagement with key actors within a market to catalytically address identified market barriers, shape a sustainable market, and strengthen overall systems;
4. Monitoring, Evaluation & Learning (ME&L): application of a range of monitoring, evaluation, research, and learning methods to generate timely evidence around the effectiveness and impact of market shaping interventions.

Health

Increasing Access to Childhood Pneumonia Treatment

In Tanzania, pneumonia is among the top five causes of mortality in children under five accounting for 18% of total under-five mortality. Lowering pneumonia-related mortality is key to Tanzania’s goal of reducing overall child mortality by 80% by 2030.

WHO recommends amoxicillin dispersible tablets as the drug of choice for the treatment of uncomplicated pneumonia. To that end, in 2015 R4D and the GoT developed a holistic market shaping strategy that sought to increase access and rational use of amox DT by tackling barriers to demand, supply, financing, policy, and regulatory aspects of the Amox DT market.

Through this work, Tanzania observed a 2.6-fold increase in amoxicillin DT availability at public health facilities between 2016 and 2022 and a 76% decline in amoxicillin DT stockout among public health facilities during the same period. Through advocacy to Amox DT manufacturers, the number of suppliers for Amox DT in the country increased from 1 to 8.

To increase access in the private sector, R4D and RCHS worked to increase awareness of Amox DT across the supply chain including coordinating meetings between RCHS and private sector actors. R4D and RCHS further worked on updating policies to ensure Accredited Dispensing Outlets (ADDOs) can stock Amox DT. They also further piloted the sensitization approach by ADDOs which revealed that awareness of Amox DT as first line treatment of childhood pneumonia and knowledge of accurate dosing can be strengthened and sustained through sensitization workshops.

Increasing Access to Lifesaving Maternal, Newborn and Child Health Medicines

Every year more than 5.5 million children die before their fifth birthday and more than 300,000 mothers die due to pregnancy or childbirth-related causes. In Sub-Saharan Africa (SSA), where the majority of global under-five and maternal mortality occurs, access to life-saving medicines for mothers, newborns, and children under the age of five has remained low even though interventions to prevent more than half of these deaths exist.

Sustainable Development Goals set a target to end preventable maternal, newborn, and child (MNCH) deaths by the 2030s (SDG 3.1 and 3.2). To accomplish this, increased access to lifesaving MNCH medicines is essential.

Many MNCH medicines have not benefited from coordinated market-shaping interventions that are critical to rationalize products, reducing costs, ensuring high quality, increasing efficiencies, and improving commodity availability.

In Tanzania, R4D worked in collaboration with the ministry of health, implementing partners, donors, and other stakeholders to systematically analyze the financing, procurement, pricing, quantification, and regulatory data and identify market barriers in areas of (i) product selection, (ii) procurement, and suppliers (iii) financing (iv) quality and (v) pricing. R4D then collaborated with market actors to develop solutions that are aimed at addressing market challenges and increasing access to MNCH medicines

Nutrition

Increasing Access to Products for the Treatment of Acute Malnutrition and Wasting

Undernutrition for both women and children is a major driver of infant and child morbidity and mortality. Estimates show that approximately 240 million women in lower and middle-income countries are underweight. Maternal underweight is a key factor to adverse pregnancy outcomes such as small for gestational age (SGA) and low birth weight (LBW). In 2019, child wasting also affected 47 million children under 5, contributing to millions of preventable deaths.

In Tanzania, the UNICEF study of 2018 showed that the national average for the prevalence of underweight among non-pregnant women was 7.3% with three regions reporting a more than 10% prevalence. The same study showed that stunting among children stood at 31.8%, and severe acute malnutrition among 0-59 months old children was 0.4%.

Ready-to-use therapeutic foods (RUTF) are a highly effective and cost-effective treatment with decades of proven success in curing child acute malnutrition. While the products in the market are generally of high quality, well designed, and well accepted by children, the key actors in the RUTF market have not been able to make RUTFs available to those who could benefit from this life-saving treatment.

In Tanzania, R4D thoroughly diagnosed the regulatory, demand, supply, and financing barriers inhibiting access to RUTFs and identified priority bottlenecks. Identified bottlenecks were then used to scope out priority opportunities and recommended solutions to address the identified barriers. Solutions included prioritizing RUTFs within the existing health budgets and mobilizing additional resources by leveraging donor funding. R4D also identified key factors to facilitate the local production of RUTFs and provided recommendations on the approach to local production of RUTFs in Tanzania.

Building on this work, R4D is working in the public sector taking an iterative, hypothesis-driven approach to analyze four market-enabling aspects of financing, demand/procurement, supply/production, and regulations to identify barriers and key areas of opportunity to increase access to maternal and child-wasting products namely microbiome-directed RUTF (MD-RUTF), Balanced Energy Protein supplements (BEP), Small quantity-lipid based nutrient supplement (SQ-LNS) and Ready to use therapeutic food (RUTF)

Results from the analysis will be used to develop practical market shaping options to address the identified market challenges and propose recommendations for the key decision makers in Tanzania on a prioritized set of strategic options to scale up access to these products.

Results for Development works with country governments; private sector providers of products and services; innovators and social entrepreneurs; as well as local, regional, and global partners and funders to strengthen mixed health systems and support countries on the road to universal health coverage (UHC). The aim is to improve health outcomes and enable resilient health systems.

Frontier Health Market Engage

In Tanzania, Results for Development is working with three other partners (Chemonics, Pathfinder, and Zenysis) to implement a USAID private sector health project to improve health markets to be responsive, equitable, resilient, and able to respond to consumer needs.

This work builds on existing structures and offers strong behavioral, technical, and managerial approaches to develop Tanzania-specific strategies and solutions to systematically change market environments and health markets. This project intends to increase private sector engagement in improving voluntary family planning, maternal and child health, malaria, HIV/AIDS, and other health outcomes. It also aims to contribute to greater equity in access to high-quality health services and products.

Results for Development uses evaluation and adaptive learning to improve the performance of health, nutrition, and education programs, contributing to stronger systems. R4D conducts targeted research to inform partner strategies, design and implement real-time monitoring systems, and work with partners to design, experiment with and evaluate ways to accelerate impact.

Health

Increasing Access to Pneumonia Treatments in High-Burden Countries

R4D Tanzania conducted a series of health facility and private drug shop surveys to monitor the availability and stocking levels of amox DT and comparator medicines to monitor progress toward improving access to pneumonia treatment for children under five.

To further support efforts in improving pneumonia treatment, in 2017, R4D conducted a pneumonia diagnosis and prescription study which used lung ultrasound examinations to measure the rate of over- and under-diagnosis of pneumonia as compared with a routine diagnosis according to IMCI guidelines. The study revealed that only 18% of children with confirmed pneumonia receive an accurate pneumonia diagnosis from health providers. To address this, R4D, RCHS and PORALG then tested interventions through an operational research study including mobile mentorship, job aids and mobile messages (as a form of mhealth), and found that these interventions have the potential to improve providers knowledge of IMCI. In 2022, R4D and RCHS resumed this operational research with a focus on identifying feasible interventions for improving not only provider’s knowledge but also skills and behavior in practice. Through this intervention, R4D and RCHS plan to do a small-scale pilot of IMCI for Pneumonia and triage process integration in which during the triage process, nurses seek to identify potential child pneumonia patients for clinician prioritization, validation of diagnosis, treatment, and follow-up.

Education

Increasing Parent and Community Engagement in Children’s Learning

R4D Tanzania is leading a rapid feedback study to inform a Tusome Pamoja program, an early reading program working to strengthen community engagement in children’s learning. As a leader of the Rapid Feedback Monitoring, Evaluation, Research, and Learning (Rapid Feedback MERL) consortium, R4D is working with RTI International in five regions to improve children’s reading, writing, and arithmetic through increasing effective parent and community engagement through community mobilization and action planning, creation of parent-teacher partnerships, and capacity building of school committees.

The study is examining how different program activities contribute to increased parental and community engagement, and how these are linked to changes in learning outcomes. The findings of this work will inform future Tusome Pamoja programmatic decisions.

Early Childhood Development

The early years in a child’s life, from prenatal stages through age 8, are the most important time for supporting holistic development and preparing the child for future success in life. Despite the presence of evidence that supports the importance of investing in early childhood development, governments are not investing enough in holistic early childhood programs and systems. In addition to a lack of adequate resources, the support and responsibility for early childhood development programs are typically fragmented across government ministries, as well as between the public and private sectors, making for a disjointed effort.

Understanding the Impact of Early Childhood Development Investments

Substantial evidence has shown that early childhood development (ECD) programs spanning education, child and social protection, and health and nutrition are needed by young children and their families to allow children to reach their development potential.

In Tanzania, R4D supported Better Way Foundation (BWF) and its grantees to assess grant-making activities and development of a plan to improve monitoring, evaluation, and learning capacity among BWF grantees. R4D supported the development of the theory of change for BWF strategy which supports early childhood development. R4D is also supporting training and strengthening the monitoring and evaluation systems for BWF and its grantees to improve early childhood development.

Teacher Continuous Professional Development

Teacher quality is the most important determinant of learning outcomes at the school level. Teachers are often either unqualified or unsupported by good quality professional development. Technology has the potential to address issues of scale, equity, and quality in TCPD.

In Tanzania, R4D is working with other partners to:

• support the government to develop, test, and implement a national-scale Teacher Professional Development (TPD) program, including costed guides for Local Government Area (LGA) implementation, the ongoing teacher needs assessments, and supporting government to roll out the plans in schools nationally.
• Conduct research to understand the impact of a technology-supported, school-based, decentralized TPD model on primary learning outcomes. The study employs a Design-Based Implementation Research (DBIR) approach and a cluster randomized control trial (RCT), with complementary qualitative research, in the second phase.
• Testing the role of a virtual learning environment in supporting teachers in Zanzibar.