Clinical Advisor Consultant -Collaborative Care Model for Diabetes and Hypertension

1. Background

Diabetes and hypertension are a growing share of the disease burden in Tanzania Mainland. Many people living with these conditions are not diagnosed, and many of those who are diagnosed do not stay in care long enough to reach and keep control of their blood pressure or blood glucose. Care is concentrated at hospital-level NCD clinics, while dispensaries, health centres, and community health workers (CHWs) have a limited but growing role in screening, follow-up, and adherence support.

One third of adults aged 30–79 are estimated to have hypertension, but only 34% of these people have been diagnosed, 15% are receiving treatment, and 7% have controlled blood pressure. Nearly one in ten adults lives with diabetes, but only 40% know they have it. Patients are often lost between encounters: referrals are not completed, follow-up falls away, and medicines are not consistently collected or available. People then return to hospitals with complications that could have been prevented or identified earlier, including stroke, kidney failure, and diabetic foot ulcers. A previous program in Tanzania screened more than 75,000 people, yet fewer than half of those referred reached diagnosis and care. Among people with diabetes who did reach care, follow-up fell from 47% at six months to 27% at 12 months. This experience showed that screening alone does not create continuous care.

Tanzania’s National Integrated CHW Programme creates a formal cadre linked to primary facilities, offering an opportunity to bring diabetes and hypertension care closer to communities through defined, safe clinical roles and referral pathways.

D-tree is hiring a Clinical Advisor to guide the design of a collaborative care model for diabetes and hypertension. The advisor will leverage clinical evidence and local experience to define quality care across the patient journey (screening through long-term control), identify current pathway gaps, and establish priority health outcome indicators. Additionally, the advisor will validate research tools, lead field interviews with health workers, and partner with D-tree, MoH, and PMO-RALG clinicians to translate clinical insights into updated workflows and digital health tools.

2. Objective

To provide the clinical evidence base, field insight, and expert judgment D-tree needs to design a collaborative care intervention for diabetes and hypertension that is grounded in national guidelines and best practice, and that improves the quality of service delivery at community and primary health facility levels in Tanzania Mainland.

In addition to supporting intervention design and clinical quality, the advisor will define health outcome indicators that demonstrate impact on diabetes and hypertension outcomes, health system cost savings, and patient experience. The advisor will work in coordination with a health economist, to link clinical indicators to quantifiable cost implications, and with a D-tree design staff to make sure the care pathway is designed around the needs of people living with diabetes and hypertension and their families.

3. Scope of Work

The advisor will cover the following areas.

A. Review and Validation of Clinical Protocols

Review the existing national and D-tree protocols relevant to diabetes and hypertension, including the current Standard Treatment Guidelines and National Essential Medicines List (STG/NEMLIT), MoH NCD guidelines and training materials, the NCD content of the national CHW curriculum, and the clinical logic in D-tree-supported digital tools. Are they aligned with current WHO guidance (including the WHO PEN package and the HEARTS technical package) and best practice? Where are the gaps or inconsistencies between documents?

Who should CHWs screen or refer for screening (age, risk factors, symptoms), how often, and using which methods (blood pressure measurement, point-of-care glucose testing, risk questionnaires)? What is realistic given equipment and supplies at community level?

CHW Screening: Who, how often, and using which methods (BP, POC glucose, risk tools) should CHWs screen/refer, considering community supply realities?

Community Referral Triggers: What thresholds trigger community-to-facility referral for high BP/glucose, danger signs (stroke, crisis, foot complications), or uncontrolled patients?

Facility Referral Triggers: What clinical criteria require referral from primary facilities (dispensaries/health centers) to district/higher hospitals?

CHW Post-Diagnosis Care: What post-diagnosis tasks (monitoring, counseling, refills, tracing) should CHWs handle, and what are their clinical risks and benefits?

Primary Protocol & Task-Sharing: What does an evidence-based protocol look like under NEMLIT constraints, and where is task-sharing (e.g., stable patient maintenance) clinically safe and policy-supported?

B. Identify Where Collaborative Care Could Have the Greatest Impact

The advisor will review Tanzania-specific evidence to understand the landscape of complications, challenges, and care gaps, and identify where CHWs and facility providers could most meaningfully drive change through better service delivery and collaboration.

What are the leading causes of poor outcomes for people with diabetes and hypertension in Tanzania Mainland? Where along the care cascade (undiagnosed, diagnosed but not on treatment, on treatment but not controlled, lost to follow-up) are the largest drop-offs?

What are the most critical clinical challenges and bottlenecks in early detection, treatment initiation, referral, and long-term management (for example medicine and test-strip stock-outs, cost to patients, distance to NCD clinics, limited health worker training), and what does the evidence say about how they are best addressed in similar low-resource settings?

Where are the gaps in coordination between CHWs and facility providers most significant for these conditions? What does better collaboration look like in practice, and where could it most improve outcomes?

Which points in the care pathway offer the greatest opportunity for earlier identification, better management, or more effective follow-up, and what would CHWs and facility providers each need to do differently?

What evidence exists from Tanzania and comparable settings on the effectiveness of collaborative or community-based care models for diabetes and hypertension (for example CHW-led follow-up, decentralised refills, integration with HIV care platforms)?

C. Identify Critical Failure Points in the Care Pathway

Note: Findings from the D-tree design staff formative work with people living with diabetes and hypertension and their families should be reviewed alongside the clinical analysis below. A joint review of clinical failure points and patient-reported experience gaps will give a more complete picture of where the care pathway breaks down. D-tree will lead the synthesis of both perspectives into integrated design decisions.

What are the critical clinical decision points in the diabetes and hypertension care pathway where errors or delays most commonly occur in Tanzania Mainland?

At the facility level: what training gaps, supervision gaps, workflow issues, diagnostic or medicine shortages, or record-keeping practices contribute to these failures?

At the community level: what CHW protocol gaps, equipment limitations, or referral process issues contribute to failures in screening, identification, referral, and follow-up?

At the interface between community and facility: where does the handoff between CHWs and facility providers currently break down? What information should flow in each direction at referral and after a facility visit (for example diagnosis, treatment plan, next visit date, latest readings)? What does the evidence suggest about mechanisms such as shared records, two-way notifications, or closed-loop referral tracking, and how could these work alongside existing facility systems such