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:
- Market Analysis: application of a broad range of analytic techniques to understand barriers and challenges to increasing access to a given commodity or service;
- Market shaping strategy development: development of targeted strategies or recommendations to inform donor decisions to shape markets efficiently and holistically;
- Implementation: a deep engagement with key actors within a market to catalytically address identified market barriers, shape a sustainable market, and strengthen overall systems;
- 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.
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
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.