With the prediction that it will graduate from its low-income status in the coming decade, Tanzania has identified a sustainable health delivery system and the goal of UHC as key national development priorities, and is steadily scaling up its national insurance schemes. However, weak systems and capacities – as well as a lack of coordination and tools to identify and address country needs – have attenuated the introduction, delivery and scale-up of health technologies, which in turn has limited the effective implementation of efforts to effectively control malaria, TB and NTDs.
The country has a progressive approach to self-reliance in national health research, however, with several national institutions taking the lead and presenting opportunities to strengthen implementation research capacity towards improved access and delivery. The ADP has worked closely with the National Institute for Medical Research (NIMR) and respective national disease control programmes to strengthen national capacity in identifying challenges and design, and undertaking research to address critical bottlenecks in the introduction and delivery of health technologies in varying settings and contexts.
In collaboration with NIMR, the ADP also helped to strengthen the capacities of a cohort of national researchers for leading and conducting implementation research. The ADP previously worked with national disease control programmes to conduct an analysis of national implementation research capacity and identify the persistent gaps and implementation bottlenecks. Based on the resulting list of priority research areas, the ADP delivered training on systematic development of research proposals to 32 senior research staff from universities, research institutes and the MOH. The active participation in, and ownership of, this process by the NIMR, as well as the involvement of a large number of senior research and programme staff across the country, will facilitate sustainability in conducting implementation research.
The NIMR has subsequently secured US$160,000 in new funding for implementation research on malaria, TB and NTDs: For projects exploring strategies for motivating community drug distributors to improve mass drug administration coverage in endemic communities; and another focusing on optimization of rapid molecular diagnostics (Xpert MTB/Rif and Genotype MTBDR plus) for early MDR-TB diagnosis and treatment.
During the past year, the ADP has also supported the Ministry of Health, Community Development, Gender, Elderly and Children (MOH-CDGEC) and the Pharmaceutical Services Unit in the institutionalization of the HTA approach and built the capacity of a core group of national experts. Lessons from the ADP’s ongoing work in Indonesia have guided the technical support and capacity- building activities in the country.
The MOH-CDGEC was subsequently able to use the HTA process to evaluate the National Essential Medicines List (NEML) in terms of cost-effective prioritization and resource allocation. The ADP engaged with key stakeholders and sectors, including senior government officers and policymakers, through multiple consultations and workshops, to raise awareness of the need for a systematic priority-setting process to inform policy development around the selection and introduction of new health technologies. This process is critical for the ultimate economic sustainability of UHC, as the NEML defines the benefits package under the national health insurance schemes, which cover almost 10 million beneficiaries at the cost US$92 million annually.
The ADP also supported the NTD Control Programme in the country-wide campaigns for mass drug administration (MDA), by strengthening supply chain management to deliver preventive chemotherapy. The ADP developed the relevant tools, guidelines and training curricula for use in building capacities of front-line health workers, community drug distributors and district pharmacists across the country. These capacities relate to improving institutional structures and linkages, and cost-efficient and -effective practices in quantification, administration, storage and disposal of medicines. In 2014, even with 100% geographical coverage of 169 districts, the MDA campaigns were able to reach only 50% of the 49 million people at risk of NTDs. The annual spending of approximately US$183 million for NTD-related medicines alone also raises the issue of sustainability. The cohort of personnel trained by the ADP will train a further 3000 health personnel in 20 regions before the next MDA campaign in September 2016.
Adverse drug reactions are under- reported and under-addressed in Tanzania, largely as a result of low awareness and capacity among health professionals and consumers. Following on from earlier ADP initiatives that built health system capacity for monitoring and responding to safety issues of newly introduced health technologies, the ADP has continued working with the Tanzania Food and Drug Authority (TFDA) on expanding the reach of capacity-building activities on safety monitoring and pharmacovigilance at the central, regional and facility levels. So far, the ADP has supported the training of almost 300 health care providers from public and private health facilities across 20 districts. This large cohort of experts is now able to plan, implement and manage a robust, integrated and effective drug safety monitoring system. The ADP is also supporting the development and implementation of a new system that enables consumers to directly report adverse drug reactions, leading to increased reporting and the timely detection of adverse reactions.
The ADP has also facilitated cross- institutional learning and exchange by supporting the placement of TFDA staff members in New Zealand’s Medicines and Medical Devices Safety Authority and Malaysia’s National Pharmaceutical Control Bureau.
|Human Development Index Ranking||151|
|Population total (millions)||50.8|
|Gross national income per capita (USD)||2,411|
|Population living below $1.25 a day (%)||43.5|
|Public health expenditure (% of GDP)||7.3|
|Life expectancy at birth (years)||65|
|Under-5 mortality rate (per 1000 live births)||51.8|
|TB prevalence (per 100,000)c||528|
|TB incidence (per 100,000)||327|
|Deaths due to TB (per 100,000)||112|
|TB case detection (%)||36|
|MDR-TB in new/re-treatment cases (%)||/ 3.1|
|Estimated cases of malaria (per 100,000)||11,220|
|Total deaths due to malaria (per 100,000)||34.7|
|Children aged <5 years with fever who received
treatment with any antimalarial (%) (2013)
|SAC population requiring PC for STH / coverage||12,842,759 / 31%|
|Population requiring PC for LF / coverage||26,530,192 / 77.3%|
|Population requiring PC for SCH / coverage||10,765,946 / 27.3%|
|SAC population requiring PC for SCH / coverage||6,357,534 / 37.8%|
|Population requiring PC for onchocerciasis||3,542,959|
All data from 2014 unless where stated. SAC: school-aged children, PC: preventive chemotherapy; STH: soil-transmitted helminths; LF: lymphatic filariasis; SCH: schistosomiasis.