Tanzania is located in East Africa and is home to Africa’s highest peak, Mt. Kilimanjaro. Tanzania is comprised of the mainland, as well as the semi-autonomous island of Zanzibar. The agrarian-based country benefits from a network of national parks and wildlife that attracts an annual migration of tourists, making tourism a major contributor to the economy. Although the country is making progress on many development fronts, Tanzania has a Human Development Index that ranks it within the sub-Saharan average, but well towards the bottom of all nations. In 2011 Tanzania was ranked 152 out of 187 nations by the United Nations Development Programme’s annual assessment of human development indicators.
Overall health care system in Tanzania faces many challenges. A critical shortage of health care workers inhibits access to facilities and services. 108 in 1,000 children are estimated to die before the age of five. Child mortality in Tanzania has, however, fallen very quickly over the past 15 years, from 176 per 1,000 live births in 1980. AIDS and malaria are constant drains on health care services. Tanzania faces a mature, generalized HIV epidemic with approximately 1.4 million people living with HIV/AIDS.
With a staff of 21, MSH works at the national and regional levels to increase access to pharmaceuticals, and to professionalize drug-dispensing outlets. The country office has a diverse array of technical expertise and works with several technical government health agencies and civil society groups. MSH Tanzania also works to support local partners in developing their leadership and organizational and financial management capacity to provide a sustainable response to the HIV epidemic and other health challenges.
Additionally MSH partners to scale up best practices in successful tuberculosis diagnosis and treatment. The staff has technical expertise in TB Interventions, in both public and private health sector, through the Tuberculosis Indefinite Quantity Contract (TB IQC) project and Systems for Improved Access to Pharmaceuticals and Services Program (SIAPS) (SIAPS). The project team developed a variety of tools to improve TB case detection, including an awareness poster, a tool for diagnosing adults, a pediatric score chart for diagnosing children, and standard operating procedures for TB case detection. These tools were used in 12 health facilities during the pilot phase to improve TB case detection through increasing community awareness and improving providers’ capacity to accurately and efficiently diagnose TB. MSH’s role in TB IQC includes DOTS expansion, program management, and monitoring and evaluation. Their other projects are funded through multiple donors, including USAID, the Center for Disease Control, and the Gates Foundation.
Experience in this Country
- Tanzania Institutional Capacity Building Program 2010–2015
- Capacity Project: Tanzania 2009–2013
- Tanzania: Angaza Zaidi 2008–2013
- International Network for Rational Use of Drugs Initiative on Adherence to Antiretrovirals (INRUD-IAA) 2006–2011
- Capacity Project 2004–2014
- Strengthening Pharmaceutical Systems (SPS) Program 2007–2012
- East African Drug Seller Initiative (EADSI) 2007–2010
- Leadership, Management and Sustainability (LMS) Program 2005–2015
- Extending Service Delivery (ESD) for Reproductive Health and Family Planning 2005–2011
- Rational Pharmaceutical Management Plus Program 2000–2008
Tanzania Institutional Capacity Building Program2010–2015
The Tanzania-Institutional Capacity Building (TZ-ICB) Program, funded by the U.S. Health and Human Services and the Centers for Disease Control and Prevention (CDC), will support the first two goals of PEPFAR's strategy for the next five years in Tanzania: (1) to transition from an emergency HIV response to sustainable country programs; (2) to strengthen government capacity to lead the response to this epidemic and other health demands.
Between 2005 and 2010 in Tanzania, there was a rapid expansion in the amount of funding available to support the national HIV & AIDS response which led to greater public knowledge about HIV prevention; increases in voluntary counseling and testing; increasing numbers of patients enrolled in treatment; and the development of national strategic policies that address the epidemic. Although these successes have improved health outcomes, much still needs to be done to sustain and expand these advancements. The TZ-ICB Program will help to build the institutional capacity of local organizations to support high-impact, sustainable programs that respond to the epidemic.
MSH defines institutional capacity building as the strengthening of institutional vision, mission, strategy, structures, systems and processes, as well as management and leadership capacity, to enhance institutional, team and individual performance.The TZ-ICB project’s technical approach to capacity building is to assist local institutions to analyze and fill the gaps in existing HIV programs and activities, as well as identify and respond to new programmatic opportunities. TZ-ICB's capacity building efforts will focus on: project management and execution; organizational systems and structures; leadership and management; and, grants management and reporting.
Capacity Project: Tanzania2009–2013
Without strengthened human resources for health care, it will be impossible to sustain gains made in child survival, family planning and other areas while responding to critical demands such as the HIV & AIDS pandemic.
An innovative global initiative funded by the United States Agency for International Development (USAID), the Capacity Project strengthens human resources to implement quality health programming in developing countries.
In partnership with IntraHealth, MSH provides technical assistance to strengthen organizational management of local health partners as well as at the district health levels in the Iringa, Mtwara, and Lindi regions, covering a total of 20 districts.
The Capacity Project: Tanzania's focus is:
- To build the capacity of the national and local government authorities to predict;
- To plan for and recruit the health and social welfare force;
- To build the capacity of local Tanzania Human Resource Capacity Project (THRP) partners in leadership and management to support their roles in the THRP and beyond.
Tanzania: Angaza Zaidi2008–2013
The AMREF/MSH Angaza Zaidi Project in Tanzania is a five-year cooperative agreement to carry out innovative counseling and testing services in 20 Regions of Tanzania with USAID/Tanzania PEPFAR support.
Angaza Zaidi, meaning "shed more light," builds on the previous Angaza project to rapidly expand access to voluntary counseling and testing (VCT) services among underserved and at-risk populations in all 21 regions of mainland Tanzania through continued support to 52 existing sites in years one and two, the establishment of eight new static sites, mobile counseling and testing outreach services, and referral of HIV-positive people for treatment and care.
AMREF's partnership with MSH will address the scale and strategic information demands of PEPFAR support in Angaza Zaidi. MSH is responsible for developing and applying evidence-based approaches for the use of information to monitor project performance and outcomes and for capacity-building of subgrantees funded by AMREF.
In year one, MSH provided hands-on capacity-building for 58 staff from subgrantees and district CT sites and continues to provide onsite support to area support office staff and subgrantees.
MSH and AMREF are partnering on an operations research study to test the feasibility, acceptability, and capacity-building potential of low-cost netbooks to improve data reporting, data use, information seeking, and linkages with local district health units.
International Network for Rational Use of Drugs Initiative on Adherence to Antiretrovirals (INRUD-IAA)2006–2011
The International Network for Rational Use of Drugs (INRUD) was established in 1989 to design, test, and disseminate effective strategies to improve the way drugs are prescribed, dispensed, and used, with a particular emphasis on resource poor countries.
Launched in September 2006, the INRUD-IAA initiative is funded by the Swedish International Development Cooperation Agency. The objectives of the five-year initiative are to—
- Develop and validate a set of indicators that can be used to monitor adherence to ART
- Investigate adherence rates and determinants for these rates for ART programs and individuals in two target countries
- Pilot interventions to improve adherence in individual patients and in programs in two countries
- Establish the process needed for national AIDS control programs to scale-up successful interventions as part of national policy in the two countries
- Work with the other three countries in the region to develop national adherence policies and implement interventions to improve adherence
Capacity Kenya is a USAID-funded project led by IntraHealth International and implemented with partners African Medical and Research Foundation (AMREF), Deloitte and Touche, MSH and Training Resources Group (TRG). The five-year project began in April 2009. MSH works with partners and in alignment with the government of Kenya’s health strategy to support the development of a comprehensive approach to addressing the health workforce shortages across the country.
Strengthening Pharmaceutical Systems (SPS) Program2007–2012
Strengthening Pharmaceutical Systems is a follow-on to the Rational Pharmaceutical Management (RPM) Plus Program. MSH is pleased to announce that the US Agency for International Development has awarded us the Strengthening Pharmaceutical Systems (SPS) Leader with Associates Cooperative Agreement. SPS will focus on four key results:
- Improve governance in the pharmaceutical sector
- Strengthen pharmaceutical management systems to support public health services
- Contain the emergence and spread of antimicrobial resistance
- Expand access to and improved use of essential medicines
- BroadReach Healthcare
- Ecumenical Pharmaceutical Network
- The Lewin Group
- LMI Government Consulting
- University of Washington Department of Global Health
- WHO Collaborating Center in Pharmaceutical Policy: Harvard University/Boston University
- African Medical and Research Foundation
- American Society of Health-System Pharmacists
- Euro Health Group
- Infectious Disease Institute at Makerere University
- Joint Commission International
- London School of Hygiene and Tropical Medicine
The SPS Program's objectives related to HIV/AIDS activities in Tanzania are to:
- Link accredited drug dispensing outlets (ADDOs) to community-based HIV/AIDS palliative care services.
- Strengthen commodity management systems to support antiretroviral therapy (ART) programs.
The SPS Program objectives in malaria include:
- Increasing access to artemisinin-based combination therapy (ACT) by helping implement the rollout of subsidized ACT distribution through the ADDO program.
- Working with the TFDA to establish pharmacovigilance systems, including monitoring adverse drug reactions related to ACTs.
In response to antimicrobial resistance in previously used malaria medicines, Tanzania is implementing ACTs as its first-line treatment with support from different funders, including the President's Malaria Initiative and the Global Fund to Fight AIDS, Tuberculosis and Malaria. In March 2006, the President's Malaria Initiative asked the RPM Plus Program to support malaria-related activities in Tanzania.
Now, SPS continues to advocate for appropriate policies, regulations, and quality assurance and pharmacovigilance systems that help improve medicine access and reduce malaria morbidity and mortality. In addition, SPS is leveraging resources with MSH's East African Drug Sellers Initiative to implement the ADDO program rollout nationwide, which will increase access to effective ACTs, especially in Tanzania's rural areas.
East African Drug Seller Initiative (EADSI)2007–2010
The East African Drug Seller Initiative (EADSI) will create a sustainable model to replicate and scale up private-sector drug seller initiatives based on Tanzania's accredited drug dispensing outlet (ADDO) project. The resulting model will be evaluated in one pilot region compared to a control region and experiences and a finalized model will be made available to help other countries facing similar challenges in increasing access to essential medicines. The initiative addresses the problem of people in developing countries seeking advice and medicines from retail drug sellers who are largely untrained and unregulated. As a result, customers are less likely to receive quality pharmaceutical care and products or to be counseled on proper medicines and their correct doses.
The initiative’s goals include:
- Developing a regional strategy to support the implementation of a stainable private-sector drug seller initiatives.
- Strengthening the Tanzania ADDO model to facilitate scaling up and sustainability.
- Developing a plan to replicate the ADDO model to scale in a second East African country (Uganda) and demonstrating the adapted model in one district (Kibale).
- Creating and disseminating an ADDO “tool kit” to facilitate adoption and adaptation of the approach by other countries.
The EADSI project in Uganda recently celebrated the launch of Accredited Dispensing Outlets in the western district of Kibaale.
In collaboration with the Tanzania Food and Drugs Authority (TFDA), CPM worked to finalize recommendations on how to strengthen the accredited drug dispensing outlet (ADDO) model. The recommendations were the result of an options analysis and a stakeholders' consensus meeting held in Dodoma in July 2008. Many recommendations were carried out over the year, including decentralizing ADDO implementation from the central level to the district level.
In addition, sustainability, scalability, and transferability of the revised model are being evaluated in previously ADDO-implemented regions (Ruvuma and Mtwara) and in Uganda.
Leadership, Management and Sustainability (LMS) Program2005–2015
The Leadership, Management and Sustainability (LMS) Program develops managers and leaders who achieve results in the areas of reproductive health, HIV & AIDS, infectious disease, and maternal and child health. LMS works with health organizations in the public and private sectors to create sustainable programs and systems through improved leadership and management. By strengthening management systems and increasing system-wide leadership, LMS improves the performance of health care organizations at all levels, develops human resources, and builds the capacity to anticipate and respond effectively to changing external environments.
Since 2006, LMS has worked with 96 organizations in-country, providing leadership and management technical assistance and strengthening their capacity to improve and expand HIV/AIDS services at all levels.
LMS has supported four open rounds of grant making, resulting in 113 awards to civil society organizations. A total of 166 sub-grants have been awarded to 136 local Tanzanian NGOs participating in the fight against HIV/AIDS, totaling approximately $22.1 million.
LMS has strengthened Global Fund structures, procedures, and oversight on the mainland and Zanzibar. Each Country Coordinating Mechanism (CCM) has Operations and Procedures Manuals, Bylaws, new Secretariats, and technical oversight committees that use Executive Dashboards pioneered by LMS.
LMS also spearheaded the effort to renew CCM constituent membership through transparent processes and provide orientation to new CCM members.
LMS provided organizational development and capacity building technical support to the Tanzania Commission for AIDS; the Zanzibar AIDS Commission; three departments or programs of the MOHSW, and; five leading civil society organizations playing key roles in the national response to HIV and AIDS.
Areas supported included strategic and operational planning; monitoring and evaluation; human resource management; leadership and governance; financial management; ICT; resource mobilization; inventory and asset management; and team building. Capacity building support has been largely delivered by local Tanzanian consultants recruited and trained by LMS. These local capacity builders have participated in a series of Training of Trainers workshops delivered by LMS on topics of management, leadership and governance.
Extending Service Delivery (ESD) for Reproductive Health and Family Planning2005–2011
This project builds upon extensive work in reproductive health and family planning (RH/FP) services carried out under Advance Africa (MSH) and the CATALYST (Pathfinder International) projects. The USAID Office of Population and Reproductive Health will support a core agenda focused on increased utilization of quality RH/FP services at the community level among underserved and at-risk groups, especially youth, families in the poorest economic quintiles, postpartum and postabortion clients, and people at-risk for or infected with HIV.
For ESD, MSH has staff based in Guinea, Kenya, and Burundi. In 2010, MSH has worked in or supported Angola, Burundi, Ethiopia, Guatemala, Guinea, Jordan, Kenya, Nigeria, and Yemen.
- Healthy Timing and Spacing of Pregnancy Training Tool (English)
- Healthy Timing and Spacing of Pregnancy Training Tool (French)
- Healthy Mothers, Healthy Babies, Healthy Families
- View the ESD legacy documents, a series of technical briefs showcasing ESD's approaches and models for delivering family planning and reproductive health services in 18 countries.
Rational Pharmaceutical Management Plus Program2000–2008
MSH provided technical guidance and assists in strategy development and program implementation both in improving the availability of safe, effective health commodities of assured quality and cost—pharmaceuticals, laboratory diagnostics, vaccines, supplies, and basic medical equipment—and in promoting the appropriate use of these commodities in the public and private sectors at the community level, with special focus on managing pharmaceuticals essential for maternal, newborn, and child health.
MSH has a long-standing working relationship with the Tanzania Ministry of Health and in particular the Tanzanian Food and Drugs Authority (TFDA). Much of the work in Tanzania that RPM Plus is involved in today developed from initiatives started under the Strategies for Enhancing Access to Medicines (SEAM) Program (2000–2005). Current work includes expanding the Accredited Drug Dispensing Outlet (ADDO) initiative in Morogoro region, strengthening TFDA's quality assurance and pharmacovigilance programs, and providing support to the President's Malaria Initiative (PMI). In collaboration with the Basic Support for Institutionalizing Child Survival (BASICS) Project, the RPM Plus team is also working with the Ministry of Health to train ADDOs to properly recognize and treat pneumonia, malaria, and chronic diarrhea in children. BASICS and RPM Plus have also developed behavior change communications aimed at educating the public on when to seek health services and the importance of using government-accredited sellers for medicine purchases.