Before joining R4D, Dr. Balsara served as director of health, population and nutrition at USAID/Ghana, where she oversaw a $90 million annual portfolio and designed the Mission’s five-year, $450 million public health strategy. Previously, she held senior leadership roles with USAID in Nigeria, Indonesia and Tanzania, and worked at the Bill & Melinda Gates Foundation, where she managed flagship global health financing partnerships in collaboration with the World Bank, the Global Financing Facility, the Islamic Development Bank and the Lives and Livelihoods Fund.

Dr. Balsara’s work sits at the intersection of health financing, supply chains and service delivery design, with deep expertise in primary health care, prevention and health promotion, and community health. She is recognized for building coalitions across governments, donors and the private sector to expand sustainable access to essential medicines and health products and to strengthen health systems.

She holds a Ph.D. in international health and health systems and speaks English, Hindi and Bahasa Indonesia.

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Access to essential medicines and other health products is fundamental to achieving Universal Health Coverage (UHC) and improving population health. But recent shifts in global financing — including the reduction of donor support — have exposed the fragility of many domestic systems, resulting in stockpiling, shortages, and inequitable access to life-saving commodities.

Results for Development’s (R4D) recent analytic work revealed that these challenges stem not only from insufficient funding, but from deep systemic disconnects. Without addressing these underlying system weaknesses, simply allocating more funds or trying to ringfence funds with budget lines will not ensure that essential medicines reach those who need them.

Ensuring sustainable, equitable access to essential health commodities requires governments to act across multiple, interconnected domains. They must:

• Set priorities for which services and products to fund
• Forecast needs based on population health and demand
• Shape markets to ensure high quality products are available at affordable prices
• Allocate resources effectively within budgets
• Align payment and pricing systems so that financial flows support reliable supply
• Ensure funds flow smoothly through financing arrangements to reach product suppliers and health care providers
• Procure and distribute products efficiently to the point of care

When any one of these links breaks down, it can cause cascading effects across the system — resulting in stockouts, inefficiencies, and high out-of-pocket costs.

R4D’s Integrated Approach: Bridging Health Financing, Market Shaping and Supply Chain

R4D has long been a leader in both health financing and market shaping, two fields that have often evolved separately. Recognizing the need for a new, integrated perspective, R4D has brought these areas together to understand how their interactions and linkages to supply chains can make or break access to essential commodities.

This intersectional approach was at the heart of R4D’s multi-country rapid assessment, conducted in Ethiopia, Ghana, Nigeria and Tanzania with support from the Gates Foundation. The assessments mapped the critical connections between health financing, market shaping, and supply chain functions and policies — and highlighted where critical misalignments lead to inefficiencies and gaps that undermine access, but also where there are promising practices that can be built on and shared.

Four country-specific briefs, one overview brief and a full report, can be found below:

• Overview Brief — Building Integrated Systems for Financing Essential Medicines and Other Health Products: From Silos to Systems (4 Pages)
• Full Report — A mapping of domestic systems for financing essential medicines and other health products (33 Pages)
• Ethiopia Brief — Opportunities to align supply chain, market shaping and health financing functions and policies (16 Pages)
• Ghana Brief — Opportunities to align supply chain, market shaping and health financing functions and policies (15 Pages)
• Nigeria Brief — Opportunities to align supply chain, market shaping and health financing functions and policies (17 Pages)
• Tanzania Brief — Opportunities to align supply chain, market shaping and health financing functions and policies (16 Pages)

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This report, produced under the USAID-funded FHM Engage project which was implemented by Results for Development (R4D) and partners, with technical analysis and modeling led by Metrics for Management (M4M), introduces a new approach to estimating family planning market size in Tanzania. By applying innovative small area estimation techniques and combining data from multiple sources, the report provides subnational insights into contraceptive use, demand and market value. It offers detailed maps, product-specific estimates, and projections of potential private sector growth, giving stakeholders — from social marketers to policymakers — practical tools for decision-making.

This resource provides actionable market intelligence to identify opportunities, target investments, and improve access to modern contraceptives. It also highlights a replicable methodology that can be applied in other countries and health sectors where granular market data is lacking.

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Monte is a senior fellow at Results for Development (R4D), where he supports market development and mixed health systems initiatives aimed at increasing access to products and services in public and private sectors. He contributes to quality of technical inputs, strategy development, partner and donor liaison, thought leadership and programmatic design efforts.

Prior to R4D, Monte was chief of party for USAID Transform WASH at Population Services International (PSI) Ethiopia, where he led market development efforts that resulted in sales by business partners of more than 70,000 sanitation products and services to household customers across the country. He also served as country representative for PSI in Pakistan and Kenya and deputy regional representative in Central America, as HIV and marketing technical advisor in Cambodia, and as country director for Equal Access International in Cambodia. His background spans multiple health areas including HIV, family planning and reproductive health, water and sanitation, maternal and child health, malaria, TB and cervical cancer. In other experience, Monte worked as a media producer for Spark Media in Washington, DC, as vice president of international programs at Alight (formerly the American Refugee Committee), and as a senior program officer for the National Democratic Institute where he managed democratic development programs in Nepal, Haiti and West Africa.

Monte holds two master’s degrees, one in international economics and development from the Johns Hopkins University’s School of Advanced International Studies (SAIS) and a second in communications (film & video) from American University, both in Washington, DC. He also earned a BA in journalism and French from the University of Wisconsin – Madison. He speaks English and is also proficient in French, Spanish and Nepali.

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