AFYA-TEK: A people-centered digitised healthcare systems: Using technology as a platform to strengthen the continuum of care in Kibaha, Tanzania

GOAL: This project aims to link private drug shops, primary health facilities, and community health workers in a fully digitized, people-centered healthcare system; the first of its kind in the world. This ecosystem will save lives by improving coordination between actors in the healthcare system while building on Fondation Botnar‘s investments in cutting-edge technology, such as artificial intelligence (AI), to deliver people-centered care and improve the well-being of children, adolescents, and families in Tanzania. Lessons learned from this project will have the potential to be replicated and scaled throughout the country and beyond.

CHALLENGES: Poor quality of care within the Tanzanian primary health system contributes to more than 600,000 preventable under-five deaths, 1.2 million unintended pregnancies (including 26% of adolescent girls age 15-19), and 9,000 preventable maternal deaths each year. In order to save lives and improve well-being, it is criticial to bring preventive and curative care closer to communities and explore private-sector solutions to reduce the workload of health facility staff and strengthen the overall health system. Community health workers and private drug shop dispensers are two resources that already support individuals at the community level. However, they lack formal linkages to facilities and one-another and often have limited health training. There is an urgent need to establish linkages among health facilities, community health workers and drug shops to (1) improve provider decision-making in care provision and patient referrals and (2) ensure high quality, respectful, and people-centered care throughout health system touch points.

SOLUTIONS: To address these challenges, we will deploy a fully integrated digital system among three health system actors (community health workers, drug shop dispensers, and primary care facilities) and create linkages among them to track patients from initial diagnosis, through treatment and follow-up. Human Centered Design and emerging technology such as artificial intelligence, biometrics, and predicative analytics will be used to identify patient needs, refer them to the appropriate source of care, and then track results and follow-up. Real-time data and analytics will enable decision makers to monitor that care is consistent with international standards.

IMPACT: We expect this project will directly support more than 110,000 children and adolescents leading to a 10% decrease in mortality and resulting in more than 11,000 lives saved; a 30% decrease in adolescent pregnancies in Kibaha during the implementation phase; and an overall savings of more than $2.5 million per year from year 4 onwards if the program continues. As we will design a low-cost, scalable model, we anticipate that the system could be quickly scaled throughout Tanzania and globally to strengthen health systems and accelerate gains in child and adolescent health and well-being.

REASON TO FUND: This project will build on the Foundation’s existing partnerships with D-tree International, Ada Health and 2018 Botnar Challenge winner Dr. Elsa to deploy a fully digitized system that has the potential to disrupt and significantly improve the way that child and adolescent healthcare is delivered, both in Tanzania and in other low and middle income countries globally. GAVI will provide match funding, which will allow the project to have greater impact and scale at no additional cost to the Foundation. Since the work is groundbreaking, this project will position the Foundation as the leader in applying emerging technologies in healthcare in low and middle income countries, while also building a strong foundation of evidence in partnership with local Tanzanian researchers for future scale-up of these technologies in low-resource settings.


Data collection on Accredited Drug Dispensing Outlets (ADDO) and unaccredited Duka la Dawa Baridi and households in Singida and Mara regisons respectively. Data collected on Medicines access, availability, quality of service provided by drug outlets, affordability, medicines’ price, product availability, program sustainability and health seeking behaviors. (October, 2010).


Consultancy with Ecumenical Pharmaceutical Networks (EPN) to develop a syllabus for training non- pharmaceutical staff working in Church hospital pharmacies. The Syllabus on Essentials of Pharmacy Practice will be used by church hospitals in Sub-Sahara Africa with EPN support (November 2010).


Contracted by MSH through MediaNet (T) to develop Accredited Drug Outlets Owner/Dispensers Association Tools. Several Tools were developed in areas of Association Formation, Management Planning, Template Constitution, Mobilization and Financing (August-October 2011).


Contracted by MSH and the Pharmacy Council to carry out Assessment of ADDO program regulatory system (June – September 2012)

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Contracted by MSH and the National Medicines and Health Products Regulatory Authority of Liberia (LMHRA) to develop Inspector’s training manual and Inspection strategy for Accredited Medical Shops (AMS) (August –October 2012)


Contracted by MSH and the Pharmacy Council to carry out Cross Sectional Survey - Medicines Access and Use in Districts Served by Accredited Drug Dispensing Outlets in Tanzania (January 2013)

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Contracted by MSH to provide support to the Muhimbili University School of Pharmacy in updating the curriculum for training in pharmaceutical management and to participate in course delivery methodology training (March – May 2013)


Contracted by MSH to conduct a holistic assessment of health care seeking behaviour, medicines availability, medicines use, and stakeholder perceptions in communities served by ADDOs in Tanzania (April –October 2013).


Contracted by MSH to explore the motivation of the ADDO owners and dispensers to see to what extent the accreditation has influenced their behaviour. In particular to explore their perception and knowledge regarding medicine use, AMR and treatment guidelines (October – December 2013)


Contracted by MSH to provide support to the Muhimbili University School of Pharmacy in delivering its 2014 Pharmaceutical Management Training course with focus on rational medicine use (June-July 2014)

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Contracted by MSH to provide supportive supervision to ADDOs and CHMT members on the use of and reporting on Amoxicillin DT and Zinc/ORS co-pack in ADDOs in 12 districts of Mbeya, Njombe, and Iringa regions in Tanzania (October – December 2015)

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Contracted by MSH to collaborate with Directorate General Drug Administration (DGDA) of Bangladesh, Pharmacy Board of Bangladesh and other stakeholders to strengthen the regulatory oversight and monitoring systems for retail drug shops in Bangladesh through the development or revision of standards, regulations, and regulatory processes, inspection & monitoring strategy, inspection guide and related capacity building (February 2016 – January 2017)


Contracted by MSH to provide local support on coordination of a project implemented between MSH and MOH/PMTCT Unit on introduction on appointment system on health facilities integrating Option B plus HIV services in Mbeya region ( 2014-2015)

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Contracted by Management Sciences for Health to collaborate with the University of Notre Dame and TFDA to conduct an operational research on the use of Paper Analytic Device (PAD) by TFDA inspectors as a tool for detecting fake medicines in retail outlets.


Contracted by MSH to implement a pilot on introduction of a Point of Sale (POS) applications a business support tool for Accredited Drug Dispensing Outlets.


Contracted by MSH to support development of a Resource Mobilization Strategy for scale up of Accredited Medicine Stores in Liberia ( March 2018)


Contracted by MSH to document progress on implementation of the Health Shops Program in Zambia (February 2018)


Contracted by MSH to collaborate with Pharmacy Council to support coordination of learning visits from African Countries to the ADDO program in Tanzania and to provide technical support on initiation of Accredited Drug Seller Initiatives activities after the learning visits.


Contracted by MSH to carry out a rapid assessment on private sector Pharmaceutical supply system as a basis for possibilities to establish a Group Purchase Organization in Tanzania.