R4D Tanzania

R4D Tanzania works with government partners to strengthen how health resources are mobilized, allocated, managed and used to improve health outcomes. This includes supporting more effective planning and budgeting, strengthening links between investments and results, and identifying opportunities to improve efficiency and sustainability across the health system.

Through the Advancing Realistic Health System Design and Planning initiative, R4D is supporting the Government of Tanzania to examine how resources are allocated and used across the health system and identify opportunities to improve planning, budgeting, implementation and performance. The work combines analysis with extensive stakeholder engagement to help government leaders develop practical approaches for optimizing health investments and strengthening coordination and accountability at national and subnational levels.

R4D is also supporting efforts to strengthen financing for reproductive, maternal, newborn, child and adolescent health products and services. This work examines barriers related to public financial management, commodity financing and resource allocation and supports national and subnational leaders to develop strategies for more sustainable domestic financing and stronger implementation of health financing mechanisms.

R4D Tanzania works with policymakers, procurers, manufacturers, financiers and other market actors to identify and address barriers that limit access to essential health and nutrition products. Drawing on expertise in market analysis, strategy development, implementation and monitoring, evaluation and learning, R4D helps partners improve financing, forecasting, procurement, supply, regulation and other market conditions so that quality products are accessible when and where they are needed.

Since 2014, R4D has partnered with the Government of Tanzania to expand sustainable access to amoxicillin dispersible tablets (amox DT), the recommended first-line treatment for childhood pneumonia. R4D supported efforts to strengthen financing, forecasting, procurement, policies and supply conditions, helping Tanzania transition procurement of amox DT from full donor dependence to full domestic financing. The program was able to increase the number of registered manufacturers from one to eight, while availability of amox DT in public health facilities increased from 48% in 2017 to 93% by the project’s end in 2023 and has remained high since. Stockouts also declined substantially. R4D and government partners have also worked to expand access through private-sector drug outlets.

To strengthening pneumonia diagnosis and care for children in Tanzania, R4D generated evidence to better understand and address gaps in the diagnosis and management of childhood pneumonia. Working with the Government and partners, R4D assessed the accuracy of routine pneumonia diagnosis in public health facilities and found important gaps in providers’ ability to correctly identify children with pneumonia.

Building on the findings, R4D tested practical approaches to strengthen the quality of pneumonia care, including clinical mentorship, case-based learning, mobile messaging, and job aids to support health workers in applying pneumonia diagnosis and treatment guidelines. This work helped identify feasible, evidence-informed approaches for improving pneumonia case management within Tanzania’s primary health care system and contributed to broader efforts to reduce preventable childhood deaths from pneumonia.

R4D has applied similar market-shaping approaches to maternal, newborn and child health products. Working with government, donors, implementing partners and market actors, R4D has analyzed financing, procurement, pricing, supply, regulation and product use to identify barriers and inform strategies for improving the availability and sustainability of priority medicines and commodities.

R4D Tanzania works with government and other partners to identify and address financing and market barriers that limit access to products for preventing and treating malnutrition and wasting.

R4D assessed regulatory, financing, demand, procurement and supply barriers affecting access to ready-to-use therapeutic food (RUTF) and identified opportunities to strengthen domestic financing and facilitate local production. Building on this work, R4D expanded its analysis to additional maternal and child nutrition products, including microbiome-directed RUTF, balanced energy protein supplements and small-quantity lipid-based nutrient supplements. The aim is to provide decision-makers with practical options for improving market conditions and expanding sustainable access to priority nutrition products.

R4D in partnership with UNICEF provided technical support to the Government of Zanzibar to develop a costed roadmap to introduce and sustainably scale-up Multiple Micronutrient Supplementation (MMS). R4D provided technical input across the key components required for sustainable MMS introduction and scale-up, including conducting the situational analysis, facilitating stakeholder consultations, developing and refining MMS coverage and implementation targets, and defining priorities across governance, service delivery, supply chain, human resources, financing, and monitoring and evaluation.

R4D also applied its MMS costing tool and market-shaping expertise to estimate resource requirements, assess financing needs and opportunities, and align the roadmap with Zanzibar’s existing health system and government processes. The technical support resulted in a context-specific, costed implementation roadmap to guide MMS scale-up and strengthen government ownership of financing, procurement, supply, and service delivery.

R4D Tanzania works with government and other partners to strengthen primary health care systems so they better support children’s holistic development. Primary health care provides multiple opportunities to reach young children and their caregivers during the critical early years, but realizing its potential requires health systems to look beyond child survival to support children’s health, nutrition, safety and security, responsive caregiving and opportunities for early learning.

With support from the Conrad N. Hilton Foundation, R4D has supported the Government of Tanzania to identify opportunities to better integrate early childhood development into routine primary health care and translate those opportunities into action. The work in Tanzania was part of a broader initiative spanning Tanzania, Kenya and Mozambique that generated practical, evidence-based resources to support similar efforts beyond the three countries. Drawing on country experiences and global evidence, R4D developed a global toolkit to help national and subnational leaders identify opportunities to strengthen PHC to promote optimal child development and put them into practice.

R4D has also supported efforts in Tanzania to strengthen the use of evidence and learning in early childhood development. With support from the Better Way Foundation, R4D worked with three foundation grantees to strengthen their capacity to monitor, adapt and improve their programs. R4D also worked with the Better Way Foundation to develop a theory of change for its ECD strategy.

R4D Tanzania works with government and education partners to strengthen the systems, evidence and capacity needed to improve teaching and learning, with a particular focus on teacher professional development and effective engagement of families and communities.

R4D is supporting the Government of Tanzania to strengthen the national Teacher Continuous Professional Development system through technology-enabled, government-led approaches. This includes supporting the design, testing and implementation of the national program; strengthening the Learning Management System and access for teachers, including those in rural and off-grid schools; and generating evidence to inform the effectiveness and scalability of different approaches to professional development. R4D also serves as a thought partner to government, donors and implementing organizations working to strengthen coordination across Tanzania’s teacher professional development ecosystem. For example, through EdTech Hub — a research consortium led by R4D and partners — R4D co-convenes Utafiti Elimu Tanzania, an annual education research conference that brings together policymakers, government officials, national and international researchers, development partners, and education program implementers to discuss national education priorities, identify evidence gaps and inform policy and implementation.

R4D has also generated evidence on how schools can strengthen parent and community engagement in children’s learning. Through a rapid feedback study conducted with RTI International, R4D examined how community mobilization, parent-teacher partnerships and school committee capacity building affected engagement and learning, with findings used to inform program decisions.

R4D Tanzania uses research, evaluation and adaptive learning to help partners understand what is working, identify opportunities for improvement and use evidence to strengthen programs and systems. Across its health, nutrition and education portfolio, R4D combines targeted research with monitoring, experimentation and ongoing learning to support better decision-making.

For example, R4D has used health facility and private drug shop surveys to track access to childhood pneumonia treatment and conducted research to better understand the quality of pneumonia diagnosis and treatment. Working with government partners, R4D has tested approaches including mentorship, job aids and mobile tools to identify practical ways to improve health provider knowledge, skills and practices.