Improving medicines regulation can lead to better population health, but how this process works in low- and middle-income countries remains underexplored. Tanzania's pharmaceutical sector is often cited as a successful example of a well-functioning regulatory system in a developing country, attributed to the work of the Tanzania Food and Drugs Authority (TFDA), now the Tanzania Medicines and Medical Devices Authority (TMDA). This raises the question: how was this regulatory capacity developed, and what lessons can other countries learn from Tanzania's experience? This paper analyzes changes in Tanzania's pharmaceutical regulation over three periods of significant sectoral reform. A desk review was conducted of Tanzania's policies, laws, regulations, guidelines, procedures, and institutional reports. The study reveals that Tanzania's regulatory capacity improved significantly through targeted reforms that addressed challenges in key regulatory areas. The three key periods examined are: 1) The separation of medicines regulation from food safety (1978-2003), 2) The expansion of regulatory domains and the establishment of a semi-autonomous regulatory agency (2003-2011), and 3) The expanded role of the Pharmacy Council to include premises regulation (2011-2020). The development of a well-functioning regulatory system in Tanzania resulted from advancements in four key areas: 1) The evolution of a legal regulatory framework, 2) Strong stakeholder engagement, 3) Continuous capacity building, and 4) Effective organizational leadership. Tanzania's regulatory system has evolved from being relatively ineffective to leading regional harmonization efforts in East Africa. This progress was not linear, requiring sustained effort, collaboration, and support from key development partners such as the Global Fund, WHO, and UNDP. Future efforts to enhance regulatory effectiveness should focus on creating adaptive systems that respond to changing needs, rather than solely prescriptive functions.

Objective The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) partnered with the Ethiopian Pharmaceutical Supply Agency (EPSA) in 2018–2019 to reform procurement and supply chain management (PSCM) procedures within the Ethiopian healthcare system. This assessment sought to determine the impact of the reforms and document the lessons learnt.Design Mixed-methods study incorporating qualitative and quantitative analysis. Purposive and snowballing sampling techniques were applied for the qualitative methods, and the data collected was transcribed in full and subjected to thematic content analysis. Descriptive analysis was applied to quantitative data.Setting The study was based in Ethiopia and focused on the EPSA operations nationally between 2017 and 2021.Participants Twenty-five Ethiopian healthcare decision-makers and health workers.Intervention Global Fund training programme for health workers and infrastructural improvementsOutcomes Operational and financial measures for healthcare PSCM.Results The availability of antiretrovirals, tuberculosis and malaria medicines, and other related commodities, remained consistently high. Line fill rate and forecast accuracy were average. Between 2018 and 2021, procurement lead times for HIV and malaria-related orders reduced by 43.0% relative to other commodities that reported an increase. Many interview respondents recognised the important role of the Global Fund support in improving the performance of EPSA and provided specific attributions to the observed successes. However, they were also clear that more needs to be done in specific critical areas such as financing, strategic reorganisation, data and information management systems.Conclusion The Global Fund-supported initiatives led to improvements in the EPSA performance, despite several persistent challenges. To sustain and secure the gains achieved so far through Global Fund support and make progress, it is important that various stakeholders, including the government and the donor community, work together to support EPSA in delivering on its core mandate within the Ethiopian health system.

Tanzania is among the first countries to adopt District Health Information System version 2 (DHIS2) as the national health management information system (HMIS). In this article, we share experiences on achievements and challenges encountered in the process of customizing and rolling out the DHIS2 in Tanzania. This instrumental case study was conducted using a qualitative approach involving desk reviews, key informant interviews, and field observations. Tanzania successfully adopted the DHIS2 as evidenced by innovation of new apps; improving availability of quality data and enhancing data analysis. These achievements were attributed to inbuilt system strengths that provided the necessary flexibility for customization; the use of local experts to customize and maintain the system; cascaded training; and formation of a consortium to coordinate and support the rollout process. Prior existence of a robust paper‐based HMIS and lessons from other countries' experience favored smooth transition. However, several challenges hindered the DHIS2 implementation including donor dependency and ineffective cascade training that left many users untrained. Countries envisaging to adopt the DHIS2 need to consider the use of cost‐effective training approaches to accommodate all users including the use of champions to conduct on‐the‐job training, support, and mentoring.

BACKGROUND Tanzania introduced DHIS2 in 2013 to support the already existing HMIS which was largely paper-based aiming at improving data quality and use. To achieve these objectives, building human resources was imperative in the face of new technologies. OBJECTIVE This study sought to determine the perceived usefulness of DHIS2 among district health managers and their competency in using it and the generated data. METHODS This is a descriptive cross-sectional study employing a quantitative approach using a self-administered online questionnaire. The study included all core and co-opted members of the district health management team from all the districts in the country. Frequency and bivariate analyses were conducted and the differences between categories were measured using chi-square. P-values less than 0.05 were considered significant. RESULTS Overall, district health managers were satisfied with DHIS2 (80%) because of work-load reduction (82%) and easy to learn (83%), and enhances data use (86%). Although only half of the managers had user accounts (53%) and were trained on DHIS2 (48%) majority of them claimed to have an average of advanced skills in data validation (70%); produce visualization (61%); and use DHIS2 data (>60%). The biggest challenges facing health managers included using a paper-based system as a primary data source (73%) and internet slowness (60%). Whereas core members were more confident in using DHIS2 compared other members; programme coordinators were found to receive more training on data analysis and use; and more confident in using DHIS2 data compared to other CHMT members. CONCLUSIONS This study has shown that district health managers have appreciable competencies in using DHIS2 and its data. However, their level of skills is incommensurate with duration since commencement. This study recommends improvement of access to and use of DHIS2 data.

BACKGROUND:The Tanzania government sought support from The Global Fund to Fight AIDs, Tuberculosis and Malaria to reform its Medical Stores Department, with the aim of improving performance. The study sought to assess the impact of the reforms and document the lessons learnt.METHODS:Quantitative and qualitative research methods were applied to assess the impact of the reforms. The quantitative part entailed a review of operational and financial data covering the period before and after the implementation of the reforms. Interrupted time series analysis was used to determine the change in average availability of essential health commodities at health zones. Qualitative data were collected through 41 key informant interviews. Participants were identified through stakeholder mapping, purposive and snowballing sampling techniques and responses were analysed through thematic content analysis.RESULTS:Availability of essential health commodities increased significantly by 12.6% (95% CI 9.6% to 15.6%) after the reforms and continued to increase on a monthly basis by 0.2% (95%CI 0.0% to 0.3%) relative to the preintervention trend. Sales increased by 56.6% while the cost of goods sold increased by 88.6% between 2014/2015 and 2017/2018. Surplus income increased by 56.4% between 2014/2015 and 2017/2018 with reductions in rent and fuel expenditure. There was consensus among study participants that the reforms were instrumental in improving performance of the Medical Stores Department.CONCLUSION:Positive results were realised through the reforms. However, despite the progress, there were risks such as the increasing government receivable that could jeopardise the sustainability of the gains. Therefore, multistakeholder efforts are necessary to make progress and expand public health.

Background The Tanzania government sought support from The Global Fund to Fight AIDs, Tuberculosis and Malaria (Global Fund) to reform its Medical Stores Department (MSD), with the aim of improving performance. Our study aimed to assess the impact of the reforms and document the lessons learned. Methods We applied quantitative and qualitative research methods to assess the impact of the reforms. The quantitative part entailed a review of operational and financial data covering the period before and after the implementation of the reforms. We applied interrupted time series analysis to determine the change in average availability of essential health commodities at health zones. Qualitative data was collected through 41 key informant interviews. Participants were identified through stakeholder mapping, purposive and snowballing sampling techniques, and responses were analyzed through thematic content analysis. Results Availability of essential health commodities increased significantly by 12.6% (95%CI, 9.6-15.6), after the reforms and continued to increase on a monthly basis by 0.2% (95%CI, 0.0-0.3) relative to the preintervention trend. Sales increased by 56.6% while the cost of goods sold increased by 88.6% between 2014/15 and 2017/18. Surplus income increased by 56.4% between 2014/15 and 2017/18, with reductions in rent and fuel expenditure. There was consensus among participants that the reforms, were instrumental in improving performance of MSD. Conclusion Many positive results were realized through the reforms at MSD. However, despite the progress, there were risks such as the increasing government receivable that could jeopardize the gains. Multi-stakeholder efforts are necessary, to sustain the progress and expand public health.