Consultancy Opportunity at D-tree International: Clinical Advisor – Diabetes and Hypertension Collaborative Care Model, Dar es Salaam, October 2026

Position: Clinical Advisor Consultant – Collaborative Care Model for Diabetes and Hypertension
Organisation: D-tree International
Department: Program Excellence
Location: Dar es Salaam, Victoria Area, Tanzania Mainland (Hybrid)
Employment Type: Consultancy Contract
Minimum Experience: Experienced
Assignment Duration: 4–8 weeks
Expected Start Date: 1 November 2026
Estimated Level of Effort: 15 working days, including 5 days of fieldwork
Application Deadline: 28 October 2026
Budget: Applicants must submit a proposed budget in Tanzanian shillings (TZS).

About D-tree International

D-tree International is a global health organisation that works to expand access to high-quality primary healthcare by enabling better decisions at every stage of a person’s health journey.

The organisation partners with governments in Zanzibar, Mainland Tanzania, and Malawi to strengthen health systems, support frontline health workers, and improve healthcare delivery and outcomes. D-tree uses digital health solutions to improve the quality, accessibility, and continuity of care.

1. Background

Diabetes and hypertension account for a growing share of the disease burden in Mainland Tanzania. Many people living with these conditions remain undiagnosed, while others who receive a diagnosis do not remain in care long enough to achieve and maintain control of their blood pressure or blood glucose levels.

Care is largely concentrated in hospital-level non-communicable disease (NCD) clinics, although dispensaries, health centres, and community health workers (CHWs) have an expanding role in screening, follow-up, and treatment adherence support.

According to the background information provided in the consultancy announcement, approximately one-third of adults aged 30–79 have hypertension. However, only 34% have been diagnosed, 15% receive treatment, and 7% have controlled blood pressure. Nearly one in ten adults lives with diabetes, but only 40% know their diagnosis.

Patients frequently experience gaps between healthcare visits because referrals are not completed, follow-up is interrupted, and medicines may not be consistently available or collected. Consequently, patients may return to hospitals with preventable or earlier-detectable complications, including stroke, kidney failure, and diabetic foot ulcers.

A previous programme in Tanzania screened more than 75,000 people, yet fewer than half of those referred reached diagnosis and care. Among patients with diabetes who reached care, follow-up declined from 47% at six months to 27% at 12 months. These findings demonstrate that screening alone is insufficient to ensure continuity of care.

Tanzania’s National Integrated Community Health Worker Programme provides an opportunity to bring diabetes and hypertension services closer to communities through clearly defined clinical responsibilities and referral pathways.

D-tree International is seeking a Clinical Advisor to guide the design of a collaborative care model for diabetes and hypertension. The consultant will use clinical evidence and local experience to define quality care throughout the patient journey, identify gaps in existing care pathways, and establish priority health outcome indicators.

The advisor will also validate research tools, lead field interviews with health workers, and work with D-tree, the Ministry of Health (MoH), and the President’s Office – Regional Administration and Local Government (PMO-RALG) to translate clinical insights into improved workflows and digital health tools.

2. Objective of the Consultancy

The objective is to provide the clinical evidence, field insights, and expert judgement needed to design a collaborative care intervention for diabetes and hypertension grounded in national guidelines and best practices.

The intervention aims to improve service delivery at community and primary healthcare facility levels in Mainland Tanzania.

The consultant will also define health outcome indicators that demonstrate the intervention’s impact on:

• Diabetes and hypertension outcomes.
• Healthcare system cost savings.
• Patient experience and continuity of care.

The advisor will collaborate with a health economist to link clinical indicators to measurable cost implications and work with D-tree’s design team to ensure that the care pathway reflects the needs of people living with diabetes and hypertension and their families.

3. Scope of Work

A. Review and Validation of Clinical Protocols

The consultant will review existing national and D-tree protocols relevant to diabetes and hypertension, including:

• Current Standard Treatment Guidelines and National Essential Medicines List (STG/NEMLIT).
• Ministry of Health NCD guidelines and training materials.
• NCD content in the national community health worker curriculum.
• Clinical decision-making logic in D-tree-supported digital tools.

The review will assess alignment with current World Health Organization (WHO) guidance, including the WHO Package of Essential Noncommunicable Disease Interventions (PEN) and HEARTS technical package, and identify gaps or inconsistencies between documents.

Specific responsibilities include:

• Determining which individuals CHWs should screen or refer for screening, based on age, risk factors, and symptoms, and recommending screening frequency and methods.
• Assessing appropriate screening methods, including blood pressure measurement, point-of-care (POC) glucose testing, and risk assessment tools, considering equipment and supply limitations at community level.
• Defining community-to-facility referral triggers for elevated blood pressure or glucose, danger signs such as stroke or hypertensive crisis, foot complications, and uncontrolled conditions.
• Identifying clinical criteria requiring referrals from dispensaries and health centres to district or higher-level hospitals.
• Recommending appropriate post-diagnosis tasks for CHWs, including monitoring, counselling, medicine refill support, and patient tracing, while considering clinical risks and benefits.
• Developing recommendations for evidence-based protocols that account for NEMLIT constraints and identify where task-sharing, such as routine maintenance of stable patients, is clinically safe and supported by policy.

B. Identify Where Collaborative Care Could Have the Greatest Impact

The consultant will review Tanzania-specific evidence to understand complications, challenges, and gaps in care, and identify opportunities for CHWs and facility providers to improve service delivery and patient outcomes.

Responsibilities include:

• Identifying the leading causes of poor outcomes among people with diabetes and hypertension in Mainland Tanzania.
• Analysing gaps across the care cascade, including undiagnosed patients, diagnosed patients not receiving treatment, patients whose conditions remain uncontrolled, and patients lost to follow-up.
• Examining barriers to early detection, treatment initiation, referral, and long-term management, including medicine and test-strip stockouts, treatment costs, distance to NCD clinics, and inadequate health worker training.
• Reviewing evidence on effective approaches to addressing these barriers in comparable low-resource settings.
• Identifying weaknesses in coordination between CHWs and facility providers and recommending practical improvements.
• Determining where changes to community and facility practices could improve early identification, treatment, and follow-up.
• Reviewing evidence from Tanzania and comparable settings on collaborative and community-based care models, including CHW-led follow-up, decentralised medicine refills, and integration with HIV care platforms.

C. Identify Critical Failure Points in the Care Pathway

The consultant will identify clinical decision points where errors, delays, or breakdowns in care commonly occur.

Findings will be considered alongside formative research conducted by D-tree’s design staff with people living with diabetes and hypertension and their families. D-tree will lead the integration of clinical findings and patient-reported experiences into design decisions.

Key responsibilities include:

• Identifying critical clinical decision points where errors or delays occur along the diabetes and hypertension care pathway.
• Assessing facility-level barriers, including training and supervision gaps, workflow challenges, diagnostic and medicine shortages, and record-keeping practices.
• Examining community-level challenges involving CHW protocols, equipment limitations, screening, referral, and follow-up.
• Identifying failures in the handover between CHWs and facility providers.
• Recommending the information that should be shared at referral and after facility visits, including diagnoses, treatment plans, next appointment dates, and recent clinical readings.
• Reviewing evidence on shared records, two-way notifications, and closed-loop referral tracking, including how these mechanisms could work alongside existing facility systems such as GoT-HOMIS.
• Reviewing evidence from comparable settings on interventions such as training, supportive supervision, checklists, and digital decision-support tools.

D. Clinical Questionnaire Review and Input to Tool Design

D-tree will lead formative research to understand how diabetes and hypertension care currently operates at community and facility levels. The consultant will provide clinical oversight and technical input.

Responsibilities include:

• Reviewing interview guides, clinical questionnaires, and assessment tools developed by D-tree and the patient experience expert.
• Confirming that the clinical content is accurate, complete, consistent with national guidelines, and reflective of actual healthcare practices.
• Reviewing draft care pathways, CHW and facility workflows, decision-support logic, and referral rules.
• Advising on the minimum clinical data that CHWs and facility providers should record and share at each stage of the care pathway.
• Ensuring compliance with the approved study protocol, informed consent procedures, and required ethical and administrative clearances.
• Agreeing with D-tree on a clinical safety procedure for urgent concerns raised during fieldwork, such as very high blood pressure readings or signs of complications, including appropriate referral arrangements.

E. Clinical Input to Design and Digital Tool Content

The consultant will contribute to translating clinical findings into practical care pathways and digital health tools.

Responsibilities include:

• Participating in co-design workshops with D-tree, Ministry of Health, and PMO-RALG clinicians.
• Reviewing draft care pathways, CHW and facility workflows, clinical decision-support logic, referral rules, and counselling messages.
• Confirming that proposed workflows and digital content are clinically accurate, safe, and consistent with national guidelines.
• Advising on minimum clinical data requirements for recording and information-sharing between CHWs and facility providers.
• Supporting the presentation of the clinical rationale for the proposed model at a validation meeting with the Ministry of Health, PMO-RALG, and other stakeholders.

F. Define Measurable Health Outcome Indicators

The consultant will work closely with the health economist to define indicators that measure clinical impact and connect health outcomes with potential cost savings.

Clinical and care cascade indicators

• Blood pressure and glycaemic control, including relevant blood pressure and glucose/HbA1c targets.
• Screening, diagnosis, treatment initiation, and retention at six and 12 months.
• Referral completion and timeliness.
• Patient follow-up and tracing.
• Treatment adherence and continuity of medicine supplies.
• Severe complications and related hospital admissions.

Feasibility and causal pathways

• Assess which outcomes can realistically be influenced within the project timeframe.
• Identify the required inputs, including protocols, training, supplies, and digital tools.
• Develop causal pathways showing how the intervention is expected to improve outcomes and where weaknesses may undermine impact.

Economic linkage

• Work with the health economist to estimate the cost implications associated with each indicator.
• Identify priority outcomes with the greatest potential for savings for patients and the healthcare system.

Data sources and measurement

• Review available Tanzanian data sources and benchmarks, including DHIS2, GoT-HOMIS, health registers, and surveys.
• Assess the feasibility of using routine digital data versus supplementary data collection.
• Define clinical measures for continuity of care, completed care episodes, and sustained disease control.

4. Key Deliverables and Timelines

The consultant is expected to produce the following deliverables:

1. Inception Note – Week 1

Prepare an inception note covering all scope areas, including:

• A detailed work plan.
• A list of documents to be reviewed.
• The proposed approach to fieldwork and stakeholder engagement.

2. Clinical Protocol Review – Week 3

Produce a written review of existing diabetes and hypertension protocols, covering national guidance, CHW protocols, and clinical content in D-tree’s digital tools.

The report must include specific recommendations for improving protocols, screening criteria, referral procedures, and task-sharing arrangements.

3. Validated Research Tools – Week 3

Review and validate research interview and assessment tools, including:

• Clinical content and Kiswahili terminology.
• Clinical case scenarios.
• A pre-test report.
• An agreed clinical safety procedure for urgent clinical concerns identified during fieldwork.

4. Completed Fieldwork – Week 5

Complete the field interviews agreed with D-tree and submit:

• Daily debrief notes.
• A summary of clinical findings from formative research.

5. Care Pathway Report – Week 7

Prepare a report identifying critical failure points in the care pathway at facility level, community level, and the interface between the two.

The report must present evidence on effective interventions and practical recommendations for improving collaboration between CHWs and facility providers. It should specify:

• Responsibilities of each healthcare cadre.
• Required workflow changes.
• Information-sharing requirements at referral and follow-up.
• Opportunities for earlier identification, improved management, and more effective patient follow-up.

5. Ways of Working

The consultant will:

• Report to D-tree Tanzania Mainland’s Senior Technical Advisor.
• Work closely with D-tree’s design and digital teams.
• Coordinate regularly with the health economist.
• Review patient experience research materials and collaborate on integrated findings.
• Participate in joint working sessions organised by D-tree at key stages, including tool validation, synthesis, and indicator selection.

D-tree will facilitate introductions to the Ministry of Health, PMO-RALG, regional and council health management teams, and health facilities. The organisation will also arrange fieldwork logistics.

Progress check-ins will be held weekly or every two weeks, as agreed during the inception stage.

6. Qualifications and Experience

Applicants must meet the following requirements:

Education and Professional Registration

• Medical degree (MD or equivalent).
• Postgraduate qualification in Internal Medicine, Family Medicine, or Public Health.
• Registration with the Medical Council of Tanganyika (MCT).

Clinical Experience

• At least seven years of experience working in Tanzanian public health facilities.
• Direct clinical management experience with patients living with diabetes and hypertension.

Health Systems and Policy Knowledge

• Strong understanding of national treatment guidelines and NEMLIT.
• Knowledge of Tanzania’s primary healthcare structure.
• Familiarity with the National Integrated Community Health Worker Programme.

Research Experience

• Demonstrated experience in qualitative or mixed-methods research.
• Experience leading key informant interviews.

Additional Advantages

Experience in one or more of the following areas will be an advantage:

• Community-based non-communicable disease programmes.
• Implementation of WHO PEN or HEARTS.
• Digital health systems or clinical decision-support tools.
• Health outcome measurement.

7. Duration and Level of Effort

The consultancy is expected to run for four to eight weeks, starting on 1 November 2026.

The assignment is estimated at 15 working days, including five days of fieldwork. The allocation of working days across deliverables will be agreed with D-tree during the inception stage.

8. Confidentiality and Data Protection

Before the assignment begins, the selected consultant must sign D-tree’s Non-Disclosure Agreement (NDA).

All information accessed during the consultancy, including interview recordings, field notes, and patient information, must be handled in accordance with the approved study protocol, D-tree’s data protection policies, and Tanzania’s Personal Data Protection Act, 2022.

Documents and data shared by D-tree, the Ministry of Health, and PMO-RALG are confidential and must not be shared or used for any other purpose without D-tree’s written permission.

9. Budget Requirements

Applicants must submit a proposed consultancy budget in Tanzanian shillings (TZS) as part of their application.

The budget must include:

• The proposed daily consultancy rate.
• The number of working days.
• The total consultancy cost.
• Any other anticipated costs, where applicable.
• Applicable taxes, including VAT where relevant.

If a group is applying, the budget must identify each individual consultant and their respective daily rate.

D-tree will review and approve the proposed budget.

10. How to Apply

Interested and qualified candidates should submit their applications through D-tree International’s official recruitment portal.

Application Link: Apply for Clinical Advisor Consultant – D-tree International

Applicants must upload their documents as follows:

• CV: Upload in the CV section.
• Cover Letter and Proposed Budget: Upload both documents in the Cover Letter section.

Please note that by applying for this position, candidates consent to having their names checked against a terrorist watch list before entering into a consultancy engagement.

Application Deadline: 28 October 2026

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