Dar es Salaam, Tanzania — Results for Development (R4D) marked a significant sustainability milestone in its program to increase access to childhood pneumonia treatment in Tanzania by providing the final consignment of amoxicillin dispersible tablets (amox DT) to the Ministry of Health. Amox DT is the World Health Organization’s preferred treatment for non-severe pneumonia in children under 5, and R4D has been working with officials in Tanzania to increase access to this lifesaving medicine since 2015.
The R4D-led program fully transitioned the procurement of amox DT to the government of Tanzania. Traditionally, the government of Tanzania has relied on external parties to procure amox DT, but when past programs have ended, the government has faced grave concerns about how to ensure an uninterrupted supply. With funding from Good Ventures, at the recommendation of GiveWell, R4D stepped in to address the funding cliff, but planned for a gradual transition to local funds and authority from the very beginning. After years of careful planning and partnership, R4D handed over the last box of amox DT.
R4D has also helped to strengthen capacity in other key areas, including forecasting, financing, supply, and regulatory aspects of the amox DT market. To date, through this partnership, a total of 13.6 million courses were made available for the treatment of childhood pneumonia; 1.6 million of these courses of treatment were fully funded by government-mobilized resources. By early 2022, amox DT is now in-stock in 90% of the facilities in Tanzania (compared to 48% in 2016).
To understand the impact of its market shaping interventions, R4D estimated, that in the absence of the program, amox DT treatment availability would be at 29%, 31%, 33%, and 35% in 2019, 2020, 2021, and 2022, respectively. This estimate takes into consideration factors such as underestimation of demand, incomplete disbursement of funds and supply planning challenges that were all representative of the amox DT landscape in Tanzania when R4D started its program. While these estimates look at data from 2017, R4D has also been tracking the current performance of a comparator commodity — the zinc/oral rehydration solution (ORS) co-pack which is used to treat diarrhea in children under 5. The two commodities share many similarities: the zinc/ORS co-pack is used for the same population as amox DT and entered the market in Tanzania around the same time as amox DT. It also faced similar market challenges, including limited registered suppliers and financing.
However, one of the key differences between the two commodities is that no market shaping support was provided to increase access to the co-pack. The availability of the zinc/ORS co-pack in public health facilities has not significantly changed, which may be connected to the lack of market shaping support; in fact, availability decreased from 64% in 2020 to 50% in 2022. While Zinc/ORS co-pack is not a perfect comparator medicine it can give us clues about the direction amox DT availability might have gone in (i.e., increased, decreased, stagnated) without R4D’s market shaping support.
“We’ve seen that there has been a significant reduction in mortality among children under 5 over the past 20 years,” said Nelsha Haji, a senior program officer in R4D’s Tanzania office. “One of the challenges we face is directly making the link of causation between our work and the government’s larger national priority of reducing child mortality. However, with the evidence we do have through R4D’s health facility survey results on amox DT availability and stockout numbers, as well as numbers on zinc/ORS co-pack for comparison, we do believe our work has contributed to this positive trend in reducing under 5 mortality — particularly over the past five years, when R4D ramped up its market shaping support for the government.”
Another key aspect of this program has been a focus on accurate diagnoses of pneumonia. As part of a clinical study conducted in 2017, R4D used 8 lung ultrasound machines to assess accuracy of pneumonia diagnosis across a sample of health facilities, learning that provider diagnosis accuracy was as low as 18%. Since then, R4D has been piloting various interventions to improve provider diagnosis and prescription behavior. To further support the government of Tanzania on improving provider diagnosis, the R4D Tanzania recently donated the machines used in the original study to 8 different district hospitals and health centers across the country.
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About Results for Development
Results for Development (R4D) is a leading non-profit global development partner. We collaborate with change agents — government officials, civil society leaders and social innovators — supporting them as they navigate complex change processes to achieve large-scale, equitable outcomes in health, education and nutrition. We work with country leaders to diagnose challenges, co-create, innovate and implement solutions built on evidence and diverse stakeholder input, and engage in learning to adapt, iterate and improve. We also strengthen global, regional and country ecosystems to support country leaders with expertise, evidence, and innovations. R4D helps country leaders solve their immediate challenges today, while also strengthening systems and institutions to address tomorrow’s challenges. And we share what we learn so others around the world can achieve results for development too. www.R4D.org