Across low- and middle-income countries, governments are making bold commitments to strengthen primary health care as the foundation for universal health coverage (UHC). At the same time, foreign aid cutbacks and tightening fiscal space are increasing pressure on governments to do more with fewer resources. Translating national ambition into practical, actionable plans remains a persistent challenge.

Through the Advancing Realistic Health System Design and Planning (HSDP) for PHC program, R4D is working alongside governments to help redesign health systems so that financing, workforce, and service delivery decisions are aligned with real-world constraints such as population needs, institutional capacity, and political context.

This work builds on prior research and analysis conducted by R4D with support from the Gates Foundation to understand what enables realistic health care reform. Through a cross-country analysis of exemplar health systems, R4D examined how countries achieved transformational change. The findings showed that countries that successfully strengthen PHC over time tend to sequence reforms deliberately, align short-term operational plans with a longer-term system vision, and use strategic policy levers to maximize impact within available resources.

Phase 2 builds on these findings to deepen learning and support implementation in select countries currently undertaking major PHC reforms. This work is already underway in Ghana, and Tanzania has now been selected as an additional country partner. Through a structured learning approach, the previously identified enabling factors for realistic health system design and planning will be validated and further refined. The initiative will also generate practical tools, analytical frameworks, and global public goods to support policymakers in other countries to apply these lessons in their own contexts.

Additionally, R4D will provide strategic advisory and coaching support to Ghana and Tanzania, working alongside government leaders as they embed more realistic, evidence-informed approaches to system design and planning within ongoing PHC reform efforts — translating commitments into feasible implementation.

“Making rational, results-oriented investment decisions across health system building blocks, especially at the primary health care level, is critical for realizing improvements in population health services and health outcomes,” said Gemini Mtei, R4D Tanzania country director. “Building on more than a decade of collaboration, we’re excited to partner with the Government of Tanzania at this pivotal moment for strengthening delivery of primary health care services in the context of Universal Health Insurance reform implementation. Our work will help turn national commitments into plans that are ambitious and truly achievable, leading to real improvements in access to quality health services, improving health outcomes, and making progress towards Universal Health Coverage.”

The post Tanzania selected in expansion of primary health care reform initiative appeared first on Results for Development.

Before joining R4D, Dr. Balsara served as director of health, population and nutrition at USAID/Ghana, where she oversaw a $90 million annual portfolio and designed the Mission’s five-year, $450 million public health strategy. Previously, she held senior leadership roles with USAID in Nigeria, Indonesia and Tanzania, and worked at the Bill & Melinda Gates Foundation, where she managed flagship global health financing partnerships in collaboration with the World Bank, the Global Financing Facility, the Islamic Development Bank and the Lives and Livelihoods Fund.

Dr. Balsara’s work sits at the intersection of health financing, supply chains and service delivery design, with deep expertise in primary health care, prevention and health promotion, and community health. She is recognized for building coalitions across governments, donors and the private sector to expand sustainable access to essential medicines and health products and to strengthen health systems.

She holds a Ph.D. in international health and health systems and speaks English, Hindi and Bahasa Indonesia.

The post Zohra Balsara appeared first on Results for Development.

Access to essential medicines and other health products is fundamental to achieving Universal Health Coverage (UHC) and improving population health. But recent shifts in global financing — including the reduction of donor support — have exposed the fragility of many domestic systems, resulting in stockpiling, shortages, and inequitable access to life-saving commodities.

Results for Development’s (R4D) recent analytic work revealed that these challenges stem not only from insufficient funding, but from deep systemic disconnects. Without addressing these underlying system weaknesses, simply allocating more funds or trying to ringfence funds with budget lines will not ensure that essential medicines reach those who need them.

Ensuring sustainable, equitable access to essential health commodities requires governments to act across multiple, interconnected domains. They must:

• Set priorities for which services and products to fund
• Forecast needs based on population health and demand
• Shape markets to ensure high quality products are available at affordable prices
• Allocate resources effectively within budgets
• Align payment and pricing systems so that financial flows support reliable supply
• Ensure funds flow smoothly through financing arrangements to reach product suppliers and health care providers
• Procure and distribute products efficiently to the point of care

When any one of these links breaks down, it can cause cascading effects across the system — resulting in stockouts, inefficiencies, and high out-of-pocket costs.

R4D’s Integrated Approach: Bridging Health Financing, Market Shaping and Supply Chain

R4D has long been a leader in both health financing and market shaping, two fields that have often evolved separately. Recognizing the need for a new, integrated perspective, R4D has brought these areas together to understand how their interactions and linkages to supply chains can make or break access to essential commodities.

This intersectional approach was at the heart of R4D’s multi-country rapid assessment, conducted in Ethiopia, Ghana, Nigeria and Tanzania with support from the Gates Foundation. The assessments mapped the critical connections between health financing, market shaping, and supply chain functions and policies — and highlighted where critical misalignments lead to inefficiencies and gaps that undermine access, but also where there are promising practices that can be built on and shared.

Four country-specific briefs, one overview brief and a full report, can be found below:

• Overview Brief — Building Integrated Systems for Financing Essential Medicines and Other Health Products: From Silos to Systems (4 Pages)
• Full Report — A mapping of domestic systems for financing essential medicines and other health products (33 Pages)
• Ethiopia Brief — Opportunities to align supply chain, market shaping and health financing functions and policies (16 Pages)
• Ghana Brief — Opportunities to align supply chain, market shaping and health financing functions and policies (15 Pages)
• Nigeria Brief — Opportunities to align supply chain, market shaping and health financing functions and policies (17 Pages)
• Tanzania Brief — Opportunities to align supply chain, market shaping and health financing functions and policies (16 Pages)

The post Building Integrated Systems for Financing Essential Medicines and Other Health Products — From Silos to Systems appeared first on Results for Development.