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In 2013 increased investment in Tanzania has not yet translated into improvements in coverage, quality and sustainability of water and sanitation services. Around 45% of the population did not have access to an improved water source and over 80% did not have access to adequate sanitation. Availability of water and sanitation facilities in schools and health facilities was poor; this in turn undermined the quality and outcomes of education and health services.

An estimated 54% of rural water points were non-functional, reflecting poor quality and inappropriate approaches, a focus on hardware and neglect of the management, technical and financing issues that are critical to sustainability. In addition, approaches to sanitation and hygiene promotion had not resulted in increased uptake of sanitation or sustained changes in hygiene practices.

HDIF health outcomes

HDIF was able to support Tanzania to address these challenges through funding innovations targeting quality improvement. PharmAccess’ quality score has been adopted nationally and improved quality of health facilities by xxx. Digital decision support tools like Dimagi’s digital partograph, and D-Tree’s support tool for community health volunteer’s visits has improved maternal and early years care.


Examples of successful innovators:

  • PharmAccess (PAI) developed the SafeCare standards and stepwise quality improvement methodology, which has been scaled up nationally by the Tanzanian health Ministry. Seventy per cent of facilities enrolled in the program improved by more than 20 per cent in the SafeCare score on the subsequent assessment after the entry or baseline assessment.
  • With HDIF support, APHFTA launched a subsidiary social enterprise called Afya Microfinance Ltd (AMiF) which developed a micro-lending scheme to provide the lower end of the private health sector with access to affordable financing. In its first two years, AMiF issued and serviced 399 loans valued at TZS 1.7 billion (£561,000) to 300 private healthcare providers in 20 districts of 10 regions in Tanzania. This drastically reduced drug stock outs, providing improved first line care to some of Tanzania’s most vulnerable citizens and empowering healthcare providers, who are primarily female to grow their businesses.
  • APOPO Hero Rats increased case detection by 32 per cent, completing 30,692 patient evaluations in the period January–December 2017. APOPO and the team have ensured that 1,244 patients have been additionally detected and 1,005 initiated treatment – curing people and preventing potentially thousands of new cases.
  • Through VECNACARES program Portable Patient eRecords, over 9,000 patients have been registered on theCliniPAK Electronic Medical Records system in Zanzibar. The high volume of patientsindicates the uptake of the system by clinical staffand highlights the consistent uptime of a digitalsystem in a low-resource setting. The associated mobile application has sent health messages to over 1,700 patients – roughly 25 per cent of the Electronic Medical Records patients including four hundred and eighty antenatal mothers, who have received vital clinical information and 1,262 discharged patients have received postnatal care information.


Business of Quality in Health

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