THRIVE: System-level analysis of early detection and referral systems for children with, or at risk of, disability in mainland Tanzania

The study had the following objectives:

• To conduct a systematic analysis to map and assess existing models of early detection and referral pathways for children with or at risk of disabilities in mainland Tanzania – focusing on the primary and community health care system (key entry point for early years)
• To understand the strengths and weaknesses of the existing systems
• To generate evidence on how these systems could be strengthened in Tanzania and other similar settings

Early detection of disabilities in children is key to effective and inclusive early childhood development (ECD). Identification can lead to design of effective follow up and rehabilitation services so that further delays in the child’s development are prevented. Literature suggests there is a strong need to strengthen disability identification systems (conceptualisation, access and follow-up support systems) across countries and especially in especially in poorer contexts.

This study conducted a systematic analysis of existing models of early detection and referral pathways for children with or at risk of disabilities – focusing on the primary and community healthcare system.

The aim was to understand the policy context, available structures and systems, enabling and constraining factors, and assess system effectiveness, and the lessons provided by the Tanzania case study on strengthening service delivery for early detection and referral of children with disabilities more widely.

The study found that although policy oversight had improved, coordination remained challenging because many government agencies and non-governmental organisations were involved in delivering services. While internationally recognised definitions of disability were used, different interpretations sometimes created confusion about which children were eligible for services and support.

At the community level, awareness of disability had increased, but social and relationship barriers continued to affect children with disabilities and their families. In addition, while there was a disability information management system in place, it was only being used in some regions and was not yet accessible in all regions.

Shortages of healthcare workers meant that some children with disabilities were not identified in public healthcare settings. Efforts were being made to expand the number of community health workers who could help address this gap, but financial constraints limited progress.

Funding for childhood disability services was also insufficient and relied heavily on both government support and external donors, contributing to gaps in early detection and referral services for children at risk.

Although government policy provides free treatment for children under five in public health facilities, out-of-pocket costs still prevented some families from accessing services. Basic disability screening tools were also scarce, particularly in rural areas, and budgets often did not prioritise essential disability-related supplies.

Finally, disability data recording was inconsistent. Some government agencies and NGOs operated separate disability tracking systems with limited coordination, leading to duplication of effort and missed opportunities to improve services.

This study highlighted strengths and challenges of early detection and referral for children with disabilities in a resource-limited setting and while not generalisable to the whole of Tanzania, they may provide insights that are useful for other regions of the country.

• Qualitative methods
• Participatory methods

• Read the journal article
• Read the study report