The national NCD response of the United Republic of Tanzania – best practice and nation-wide scale up

Over the past decade, the United Republic of Tanzania (population of 67 million, including the semi-autonomous region of Zanzibar with 1.2 million), has taken a lead in sub-Saharan Africa in terms of developing and implementing policies and action plans to address the burden of diabetes and other non-communicable diseases (NCDs). Unlike many low-income countries where national NCD strategies often face implementation challenges due to limited resources, Tanzania has achieved progress at scale.

From 2013-2017, Tanzania implemented a quite advanced first stage NCD programme supported through a grant from the World Diabetes Foundation (WDF). This first phase was guided by the country's first-ever national NCD plan, developed by Tanzanian health authorities. During the implementation, and through preceding pilot projects, a comprehensive package of NCD training guidelines, including case management tools, protocols, and health promotion materials, was developed, co-owned, and endorsed by Tanzanian health authorities and academic institutions. Zanzibar, with its semi-autonomous status and separate Ministry of Health (MoH), also initiated its NCD response plan during this first phase with support from WDF.

The initial USD 3.0 million grant provided by WDF in support of the national diabetes and NCD programme significantly strengthened the health system. Over 2,500 healthcare professionals, including doctors and nurses were trained, while all four national referral hospitals and 140 secondary-level hospitals across Tanzania established basic and advanced diabetes and NCD care services. As a result, hundreds of thousands of people living with NCDs gained access to enhanced care and to a more effective referral system between tertiary and secondary levels.

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Building on this progress, along with various policy advancements and guidance from the World Health Organization and the evolving global frameworks on the prevention and control of NCDs, the Tanzanian government revised and expanded its approach to NCDs. This culminated with the development of the comprehensive National NCD Prevention and Control Strategy, launched in 2019. At this stage, WDF awarded a grant of USD 6 million to support the roll out of the strategy, with focus on strengthening the primary healthcare level alongside promoting various other components of the new Tanzanian government NCD strategy.

Hence, since 2019 WDF has supported the MoH and the local government authorities, and key national stakeholders including Tanzania Diabetes Association, Tanzania NCD Alliance, universities and public health agencies, to implement major components of the NCD strategy. The key workstreams and outcomes are summarised as follows:

Political-administrative institutionalisation   

The institutionalisation of Tanzania's NCD programme has achieved several milestones. For the first time, NCDs are formally included in the parliamentary health committee system alongside HIV and other major health priorities. During the parliamentary committee sessions national stakeholders actively engage on matters related to NCD prevention and control, including with focus on integrated primary health care and universal health coverage. Linked to this, multisectoral coordination on NCDs is now anchored in a formal framework with the Office of the Prime Minister appointing a focal person to oversee these efforts. As a result, NCDs are now also more integrated into the national health budget planning cycles.

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Health system institutionalisation at regional and district level   

The health system institutionalisation at the regional and district levels involved nationwide sensitisation and mobilisation of Regional and District Health Management Teams (RHMTs and DHMTs). This ensured that management structures and clinical staff were adequately prepared for the comprehensive primary health care capacity building on NCDs. The process also strengthened NCD prevention and control into RHMT and DHMT organisational structures by establishing ‘NCD coordinators’ at both levels, nationwide. This has enhanced NCD data collection and monitoring and thereby supporting patient-centred and integrated health system reform.

Training of health care staff and capacity building of primary health care facilities 

A comprehensive process was undertaken to develop a primary health care and NCD integration curriculum, including pilot training in selected regions before finalisation and endorsement by national authorities and medical training institutions. Over 3,000 primary healthcare staff across various categories were trained through regional cohort modalities with thorough pre- and post-training evaluations. At the same time, more than 700 primary care facilities located across all Tanzanian districts were equipped with essential NCD diagnostic tools such as glucometers, digital sphygmomanometers, scales, peak flow meters, cervical examination trays, and stethoscopes. The rollout of improved registry systems, including EMR modules tracking diabetes, hypertension, and other NCD indicators, further strengthened primary care operations. Integrated approaches featuring ‘common triaging’ with multiple screenings at entry - including diabetes, hypertension, TB, HIV, and lung disease - are now advancing with plans for broader replication underway.

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Community mobilisation, awareness raising, and roll-out of services   

Following the capacity building at primary health care level, a nationwide community engagement and mobilisation effort was launched, leveraging civil society networks and community groups to raise awareness of NCDs, their risk factors, and the availability of screening and basic care services locally. In addition, an annual ‘NCD week’ has been established with government support and with a ‘host city’ approach rotating across the regions of Tanzania from one year to the next. Moreover, local and national media have been engaged and various campaigns rolled out. Altogether, a gradual increase in number of cases with diabetes, hypertension and other conditions is seen at primary care level.

Implementation research and other research   

The WDF grant has also supported the development of Tanzania's first-ever ‘National NCD Research Strategy’ led by national universities and academic institutions. Several PhDs and Master Students have been enrolled and are now conducting research on various NCD related topics and with the first scientific papers released. An annual ‘NCD Research Conference’ has also been established (in connection with the above mentioned annual ‘NCD week’) whereby hundreds of researchers and many other stakeholder groups convene. Additionally, various streams of implementation research, focusing in particularly on the integrated care models are now advancing including through international collaboration.

To gain deeper insights into the Tanzania NCD programme and hear first-hand perspectives from partners and patients, BBC StoryWorks produced a short film in 2021 entitled ‘Door-to-door diabetes support’. This film was created as part of the "Facing Forward" campaign and can be accessed here: Door-to-Door Diabetes Support.