As countries navigate the rapid decline of donor support, R4D is partnering with the Government of Tanzania to strengthen domestic financing and delivery of essential, lifesaving health commodities for women and children across the country.
The Challenge
Access to quality reproductive, maternal, newborn, child and adolescent health (RMNCAH) products and services for women and girls in Tanzania remains a significant challenge. This is driven by a combination of demographic pressures, reduced donor funding, non-optimal priority setting strategies and limited domestic financial resources.
Inadequate availability of essential RMNCH commodities, including family planning (FP) supplies. A 2019 analysis revealed that 18 out of 20 prioritized RMNCH products fell below the national availability target of 80%. More recent data indicates that, on average, only about 20% of health facilities maintain adequate stocks (i.e. above specified minimum months of stock) of RMNCAH commodities.
Fragmented and inefficient allocation of health budgets hinder the system’s ability to meet the needs of women and girls. Tanzania has historically depended heavily on donor funding — up to 60% of total public health spending. In 2025, only 6.5% of family planning commodity volumes are to be financed using domestic sources, with the remaining 93.5% reliant on external donors.
Limited government capacity to effectively lead market management and universal health coverage (UHC) initiatives. Key gaps include:
- Strategic stewardship of resources,
- Routine data analysis to identify gaps and opportunities to inform priority setting strategies,
- Translating evidence into policy and action, and
- Continuous learning and adaptation to improve program performance.
These capacities are critical for identifying underperformance, optimizing resources, and ultimately improving access and health outcomes for women and girls.
The Opportunity
Results for Development (R4D) is supporting leaders in Tanzania to integrate market shaping and health financing strategies to strengthen health systems for women and girls through the Improving Market Access and Financing for Health (IMAF-H) project, with funding from UK International Development. The partnership is improving markets for RMNCAH products and enhancing planning, budgeting and resource allocation processes at both national and subnational levels. Furthermore, the move towards implementing universal health insurance in Tanzania provides an opportunity for targeted financing advocacy for RMNCAH products and provides a window to support targeted capacity strengthening to ensure long-term, sustainable impact.
R4D’s Work
IMAF-H will support the Government of Tanzania’s efforts to strengthen RMNCAH systems by:
- Conducting a comprehensive market diagnostic and public financial management (PFM) assessment to identify the underlying root causes of persistent RMNCAH challenges, such as limited commodity availability and inadequate financing.
- Co-designing market management and domestic resource mobilization strategies, informed by the assessment findings. These strategies will integrate relevant market shaping and health financing solutions to improve the availability, accessibility, and sustainability of RMNCAH products and services.
- Identifying high-impact areas for health system and institutional capacity strengthening based on insights from the assessment, particularly in:
- Commodity monitoring and market stewardship,
- Subnational planning and budgeting of domestic resources, and
- Implementation of health financing mechanisms (e.g., universal health insurance) that promote sustainable domestic financing for RMNCAH.
IMAF-H leverages R4D’s unique expertise in integrating market shaping and health financing approaches to sustainably address domestic commodity financing needs. As leaders in Tanzania face major shifts in donor support for health and development, this work is vital to ensuring that women and girls continue to access life-saving health products.
