MAXIMIZING POSITIVE SYNERGIES - World Health Organization

United Republic of Tanzania: Strengthening the
health system to address
the burden of HIV/AIDS
and TB
Abstract
Thyra de Jongh, Rifat Atun 28
The United Republic of Tanzania is facing a massive burden of HIV/AIDS and TB. Addressing these
issues is complicated by a weak health care infrastructure and a severe human resources crisis. In
response, the country has enjoyed considerable donor support, including several grants from the
Global Fund. Although these grants are primarily intended to fund disease-specific activities, it is
recognized that strengthening of the overall health system is a prerequisite to reap the full
benefits of the investment. This case study examined the effects of focused investment on
Tanzania’s health system as a whole. A mixed-methods design was used, based on the Systemic
Rapid Assessment toolkit (SYSRA). We conducted interviews with key stakeholders at all levels. We
found that, in addition to significant contributions in the areas of TB and HIV, the Global Fund has
strengthened the health system through training of health care workers and investment in general
health facilities. It has, however, also led to some duplication of activities, particularly in the area of
monitoring and reporting, diversion of resources, and potential distortion of resource allocation.
Although promising steps have been taken to further align national and donor activities, scope for
improvement remains.
Background
The United Republic of Tanzania was formed in 1964 by the union of the mainland territory then
known as Tanganyika with the island archipelago of Zanzibar. The largest country in East Africa,
Tanzania shares a border with Kenya, Uganda, Burundi, Zambia, Malawi, Mozambique, Rwanda,
and the Democratic Republic of Congo. As of 2007, Tanzania’s population was 40.4 million, with an
estimated 2.4% annual growth rate [1]. In 2006, Tanzania ranked 152 nd out of 179 countries on the
Human Development Index [2]. Though Tanzania is one of the continent’s most politically stable
countries, it remains one of the poorest countries in the world despite a real annual GDP growth of
about 6.3% since 2000 [1]. Significant macroeconomic and structural reforms introduced since the
mid-1990s have not succeeded in pulling the country out of poverty. Tanzania’s economy is largely
dependent on agriculture and tourism.
Since the first three cases were detected in 1983 in Kagera Region, HIV/AIDS has taken its place as
one of the leading causes of death in Tanzania [3]. In 2007, 1.4 million people were living with
HIV/AIDS [4].
28 Imperial College London/ Global Fund to Fight AIDS, TB and Malaria
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