by Ben Taylor

Coping with USAID cuts?
Tanzania is grappling with significant challenges following the abrupt cuts to USAID funding in early 2025, particularly impacting the 1.6 million Tanzanians reliant on antiretroviral (ARV) medications for HIV management. The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), which provided USD $450 million annually, was a cornerstone of Tanzania’s HIV response, funding ARVs, testing, community outreach, and healthcare workers. The funding freeze has disrupted this lifeline, threatening lives and reversing decades of progress.

Widespread fear of ARV shortages has led to hoarding and some patients dropping out of care, exacerbating risks of treatment failure and resistance.

On January 20, 2025, an executive order from the Trump administration imposed a 90-day pause on all US foreign assistance, including PEPFAR, for a review of programmatic efficiencies. This was followed by a stop-work order on January 24, halting existing grants and contracts, effectively freezing PEPFAR operations. USAID, the primary implementer of PEPFAR, faced severe cuts, with over 80% of its programs cancelled by February 2025.

Ten days later, US Secretary of State Marco Rubio granted a limited humanitarian waiver allowing PEPFAR to resume “life-saving HIV services,” specifically HIV treatment and care, prevention of mother­to-child transmission (PMTCT), pre-exposure prophylaxis (PrEP) for pregnant and breastfeeding women, and HIV testing.

Despite the waiver, many PEPFAR contracts, particularly those managed by USAID, remain terminated or scaled back. Programmes in Tanzania providing HIV treatment to hundreds of thousands, including children, were shuttered. Payments for some intact contracts, such as those for HIV drug supply, are not flowing, keeping services effectively frozen. The Trump administration’s move to dissolve USAID and integrate its functions into the State Department as well as reductions at the Centres for Disease Control and Prevention (CDC), which handles 37% of PEPFAR funding, add additional strain.

In Tanzania, the USAID cuts have strained ARV supply chains, with reports of patients being told that free ARVs are no longer available, forcing them to purchase costly. Current ARV stocks are expected to last until the end of 2025, but the 2026 forecast is uncertain, risking stockouts. The loss of funding has led to clinic closures, job losses for healthcare workers and disruptions in testing services, reducing access to care. Community-based services, including counselling and home delivery, have been hit hard, increasing risks of treatment interruptions, drug resistance, and HIV transmission.

The Tanzanian government, through the Ministry of Health and the Tanzania Commission for AIDS (TACAIDS), has pledged to reallocate budget funds to maintain ARV supplies, with the Medical Stores Department (MSD) assuring availability to quell public fears. A web­based Care and Treatment Centre (CTC) database, integrated with DHIS-2, is being launched to mitigate the loss of USAID-funded data clerks, enabling healthcare workers to manage records directly.

Meanwhile, the Global Fund to Fight AIDS, Tuberculosis and Malaria is exploring reinvesting savings from its HIV grant to secure ARV commodities, while UNAIDS and WHO are engaging TACAIDS to assess impacts and explore fundraising. Civil society is advocating for expanded Global Fund implementation to bridge gaps.

The annual cost of ARVs for 1.6 million people in Tanzania is estimated at TSh 5.7 trillion (~£1.6bn), far exceeding the Ministry of Health’s 2024/25 budget of TSh 1.3 trillion, making it impossible to fully cover without external aid. Experts warn of 30,000 additional HIV-related deaths in two years if the crisis persists, along with risks of increased infections due to interrupted prevention programmes.

Tanzania is exploring alternative donors and private-sector partnerships, though these are unlikely to match PEPFAR’s scale. The government’s commitment to absorb healthcare workers and enhance digital systems shows proactive steps, but the scale of the crisis demands urgent international support to prevent a public health catastrophe.

Beyond HIV/AIDS, USAID’s support for maternal, newborn, and child health, including antenatal care and vaccinations, has been cut, with crucial elements of ante-natal care programmes unbudgeted in national plans. This risks increased maternal and neonatal mortality, especially in rural areas.

The termination of USAID-backed malaria prevention (e.g., insecticide-treated bed nets) and TB programs threatens a resurgence of these diseases. The loss of logistics for TB sample transport and vaccine storage security has paralysed diagnostic and treatment efforts.

It has been reported that around 5,000 healthcare workers, many in HIV and malaria programmes, have lost their jobs, particularly in rural clinics.

Over 60 NGOs, particularly those supporting agriculture and health, face collapse due to USAID’s funding halt. Health-focused NGOs like ICAP have shut down, leaving thousands of medical professionals jobless and disrupting community-based services like counselling and ARV home delivery. Amref Health Africa, a major NGO, lost 20% of its budget. Smaller NGOs, reliant on USAID for HIV and TB programs, face immediate financial crises, with many unable to secure alternative funding quickly.

The Africa CDC (a public health agency of the African Union) has stepped in with $2 million for Tanzania’s Marburg outbreak response, but its $1 billion annual budget target is insufficient to fill USAID’s void across health programs.

“The disruptions to HIV programs could undo 20 years of progress,” WHO Director-General Tedros Adhanom Ghebreyesus said at a press conference. He added that this could lead to over 10 million additional HIV cases across Africa and three million HIV-related deaths. He said that the US government has “a responsibility to ensure that if it withdraws direct funding for countries, it’s done in an orderly and humane way that allows them to find alternative sources of funding.”

The US’s plans to exit the WHO have also forced the UN agency, which typically receives about a fifth of its overall annual funding from the US, to freeze hiring and initiate budget cuts.

It is no exaggeration to say that Tanzania’s health sector is in crisis due to USAID cuts, with HIV/AIDS programmes, maternal health, and TB/malaria efforts facing severe disruptions. NGOs are collapsing, healthcare workers are unemployed, and patients are struggling to access ARVs and services. The government’s mitigation efforts and support from the Global Fund and Africa CDC are insufficient to bridge the funding gap. Without rapid intervention, Tanzania risks a public health catastrophe, with millions facing life-threatening consequences.

Tanzania declares end to Marburg Virus outbreak
The government on March 13, 2025 formally declared the end of the outbreak of the Marburg Virus after 42 days of monitoring with no new cases reported.

The outbreak of Marburg virus was declared on January 20 this year by President Samia Suluhu Hassan after two cases were confirmed in Biharamulo District, in the Kagera Region, which borders Uganda to the north, Rwanda to the west and Burundi to the southwest. Both patients lost their lives while on treatment.

The last confirmed MVD case was reported on January 28, 2025. This second case (which occurred after the previous issue (No.140) of Tanzanian Affairs went to press), came after both President Samia and the World Health Organisation celebrated Tanzania’s swift actions to contain the outbreak and limit the number of infections to a single case.
This is the second outbreak of Marburg virus, with the first having occurred in 2023.

“Since the declaration of the outbreak the government in collaboration with stakeholders and partners jointly took stringent measures to contain and control the outbreak,” said Minister for Health, Jenista Mhagama.
She urged the public to remain vigilant and continue observing all recommended measures and adopt positive behaviours including hand washing using running water, soap or hand sanitizer and timely report all rumours and unusual events in the community using toll-free hotline number 199 or nearby health facility.

“We should also be aware that the country remains at risk of other highly infectious diseases, including Ebola which has been reported in neighbouring countries and Mpox which has recently been declared in our country and continues to be reported worldwide,” Ms Mhagama said.

In a similar statement the World Health Organisation said it worked closely with Tanzanian health authorities to rapidly scale up key measures such as disease surveillance and trained more than 1000 frontline health workers in contact tracing, clinical care and public health risk communication to contain the second outbreak of MVD in Tanzania. “The Organisation also delivered over five tonnes of essential medical supplies and equipment,” WHO said in a statement.

Auditors criticise dependence on poorly-regulated traditional medicine
Criticism of traditional medicine came from an unusual source in April, with the presentation to Parliament of the annual Controller and Auditor General (CAG) report.

The audit report exposed significant public health risks due to unregulated traditional and alternative medicine practices. From 2020 to 2024, at least 16 deaths were linked to unsafe traditional remedies, with seven fatalities in 2023 alone in Simiyu and Lindi regions. The report highlights systemic weaknesses in oversight by the Ministry of Health and the President’s Office – Regional Administration and Local Government (PO-RALG). The Tanzania Traditional and Alternative Health Practice Council (TAHPC) lacks a system to track incidents, leaving many cases unreported and hindering effective response.

The audit revealed that only 12 of 21 practitioners visited in four Local Government Authorities (Dodoma, Arusha, Temeke, and Bariadi) were registered, with Temeke having 71% unregistered practitioners. Inadequate registration data, missing details like street or ward information, and an outdated Health Practitioners Registration System (HPRS) exacerbate enforcement challenges. Overburdened coordinators struggle to monitor remote areas, and the sector’s 2022/23–2027/28 strategic plan remains unapproved, stalling progress.

“The continued operation of unregistered practitioners and use of unsafe remedies not only poses serious health risks but also undermines public confidence in the traditional medicine sector,” the report cautions.

by Ben Taylor

Tanzania announces single Marburg virus case
In January, 2025, President Samia Suluhu Hassan announced that a single case of the Marburg Virus Disease (MVD) had been detected in Biharamulo District, Kagera Region. She went on to assure the public that the country has successfully controlled the spread of the disease.

This announcement comes six days after the World Health Organization (WHO) reported that eight individuals had died from suspected Marburg virus infections in the region. Speaking alongside the WHO Director-General, Dr Tedros Adhanom Ghebreyesus, in Dar es Salaam on January 20th, President Hassan reiterated that the nation had managed to contain the outbreak early on, with all suspected cases tested negative for the virus.

The President elaborated on the government’s swift response. She explained that a team was formed and sent on January 11 to investigate the cases and to ensure that the public was informed. Samples were tested at the Kabaile Laboratory in Kagera before being sent for further analysis at the National Laboratory in Dar es Salaam. “One person was found to be infected with the virus, while others tested negative,” President Hassan reported.

This marks the second time the country has experienced a Marburg virus outbreak, following the detection of cases in March 2023 in Bukoba District. “As of January 20, 2025, 25 samples have been tested, and only one person has been found infected, making this the second outbreak. However, the country is currently safe, and no further infections have been detected,” she added.

The President further stated that investigations into the source of the outbreak are ongoing.

In support of the efforts to contain the virus, Dr Tedros praised the country’s swift action, commending President Hassan’s leadership for controlling the outbreak. He confirmed that WHO is providing a financial aid package of $3 million (approximately TSh7.5 billion) to support the response. “We believe that, as Tanzania successfully controlled the outbreak two years ago, the country will manage to control this disease as well. WHO is providing $3 million to support control efforts and strengthen disease monitoring systems,” Dr Tedros said.

Dr Tedros also reiterated that Tanzania is now free of further infections and remains open to international activities, including tourism and business.

The Marburg virus, which causes severe haemorrhagic fever, is highly contagious and often fatal. Symptoms include high fever, back pain, vomiting blood, and internal and external bleeding. WHO has warned that the proximity of Kagera Region to neighbouring countries elevates the risk of cross-border transmission.

Health experts have emphasized the importance of community awareness, robust surveillance, and international cooperation to prevent further spread.

by Ben Taylor

Vigilance around Mpox
On August 17th, 2024, the Ministry of Health provided an update on the threat of Mpox outbreak. This followed a recent global upsurge of cases, including in Kenya, Uganda, Rwanda and Burundi, as well as in the Democratic Republic of the Congo (DRC) where the disease has long been established. One confirmed case was identified very close to the Tanzanian border, in Taveta, Kenya.

Due to this threat the public was advised to take recommended precautions to protect themselves and prevent the disease from entering the country.

The Minister of Health, Jenista Mhagama, offered reassurance that “until now, no patient has been proven to have Mpox infection in the country,” and that “the Ministry of Health continues to take measures to prevent Mpox from entering the country.”

This includes strengthening port health services through screening of all travellers entering the country through ports, land borders and airports, to identify travellers with signs and symptoms of Mpox and take appropriate action.

The Ministry said it would also strengthen surveillance in the community for early and timely identification of any person with signs or symptoms of Mpox, in order to manage suspect and prevent the spread of infection in community.

Further, the Ministy said it will enhance the preparedness and readiness in health care facilities and provide health education through multi channels communication approach.

The Minister also issued guidance on steps people should take to prevent infection. These included seeking medical attention in case of rashes and swelling, avoiding skin-to-skin contact with patients, cleaning hands regularly and avoiding earing carcasses of animals that may be infected.

Understanding the virus
The World Health Organisation (WHO) on August 14th declared that the upsurge of Mpox in the DRC and a growing number of countries in Africa constitutes a public health emergency of international concern (PHEIC). As of August 17th, there had been 545 alerts of Mpox cases in Burundi, one confirmed case in Kenya, four in Rwanda and two in Uganda.

Confusion around how Mpox spreads and what risks it presents has been exacerbated by the range of viral variants in circulation. In East Africa, a strain known as clade 1b appears to be responsible for the majority of new infections, and has been detected elsewhere in the world in recent travellers.

In western DRC, a separate strain, known as clade 1a, has been in circulation at a relatively low level for over 50 years.

A third variant, known as clade II that had previously been circulating only in west Africa – Nigeria and elsewhere – was responsible since 2022 for a global epidemic. This spread largely among gay men and has thus far caused over 100,000 infections, including in the UK. With vaccination campaigns, this outbreak has been largely brought under control.

While clade II is thought to largely to be sexually transmitted, clade Ib is thought to be transmitted both via sexual contact and likely in other ways. Clade 1a is thought to be transmitted between humans only rarely, with most cases resulting instead from animal-human contact, such as consumption of bush meat.

A key factor in the rise of Mpox cases is thought to be the decline in population immunity after smallpox was eradicated in 1980 and smallpox vaccination—which also protects against monkeypox—was ended. (World Health Organisation, The Citizen, Science.org)

Dr Faustine Ndugulile elected to WHO role

Dr Ndugulile (centre) with Dr Moeti (left) who has completed her term. Photo WHO/Daniel Elombat

Tanzania politician and medical doctor, Dr Faustine Ndugulile, has been elected as the new World Health Organisation (WHO) Regional Director for Africa.

Elected to the position on August 28 during the 74th session of the WHO Regional Committee for Africa in Brazzaville, Congo, Dr Ndugulile, the former Deputy Minister for Health and Kigamboni Member of Parliament, will succeed Dr Matshidiso Moeti.

While acknowledging the progress Africa has made in the health sector, Dr Ndugulile emphasised in a statement to Parliament that substantial challenges remain before the Sustainable Development Goals (SDGs) deadline.

His campaign focused on four key areas: ensuring access to health services for all Africans, preparing the continent for pandemics such as Covid-19 and Mpox, fostering unique cooperation among African institutions—including parliaments—and strengthening the WHO’s presence in Africa to maximise resource benefits.

“I am currently preparing for my new role. I have been given six months to organise myself, understand the organisation’s operations and develop my vision. This preparation will ensure that I can start effectively when I begin my tenure in March,” Dr Ndugulile said.

by Ben Taylor

Universal health insurance imminent
Preparations for the introduction of a universal and compulsory health insurance scheme are at an advanced stage, according to the Deputy Minister of Health and Social Welfare, Dr Godwin Mollel.

The law to govern the new insurance arrangements was enacted by parliament late in 2023 and signed by the President on November 10, 2023. However, it is up to the Minister to formally announce the date on which the implementation of the law will commence.

The Act aims to provide health insurance for all Tanzanian citizens, with special provisions for the financing of health care for the poor. It provides for reforms in regulation, governance, health service delivery and financing of health services to address the fragmentation of financing arrangements of existing health systems by combining the formal public health insurance and the Improved Community Health Funds (ICHF).

Under the new law, an equity fund will be established to subsidise premiums for low-income citizens and finance treatment for chronic diseases. This fund will be resourced through levies imposed on items such as carbonated drinks, alcoholic beverages and electronic transactions.

The Act stipulates the removal of exemptions previously granted in health care, compelling every Tanzanian to enrol in a health insurance scheme. Employers are now required to register their employees for health insurance within 30 days of employment commencement. Those who are in informal employment, are self-employed or unemployed are required to join a recognised community health fund.

In a sign perhaps of the difficulties associated with such a major shift in health policy, a dispute arose in late February between the largest government provider of health insurance, the National Health Insurance Fund (NHIF) and several major hospitals. NHIF issued a new schedule of prices that it would be willing to pay for specified services, prompting hospitals in the Association of Private Health Facilities Tanzania (APHFTA) and the Christian Social Service Commission (CSSC) to suspend provision of services to NHIF members.

APHFTA said the new rates were around 20-30% lower than before and presented the hospitals with an impossible situation. A source at the group told The Citizen newspaper that profit margins were previously around 10%, and with the new prices, facilities could face up to a 30% loss on some treatments.

Within days, however, the situation had been largely resolved, and provision of services to NHIF members resumed in most hospitals in early March.

by Ben Taylor

Universal Health Insurance Bill enacted
On November 1, 2023, the Tanzanian Parliament enacted the Universal Health Insurance Bill, a highly significant piece of legislation that aims to ensure access to healthcare services for all citizens through a compre­hensive health insurance system.

The new law makes it mandatory for every citizen of mainland Tanzania to have health insurance. To achieve this, citizens may either join a recognised private health insurance scheme or the National Health Insurance Fund (NHIF) as a public scheme.

The Tanzania Insurance Regulatory Authority (TIRA) will oversee and manage the health insurance system. TIRA’s responsibilities include registering and regulating health insurance schemes, ensuring compli­ance with a standardised benefit package, and providing guidelines to optimise the efficiency of health insurance schemes nationwide.

The law mandates a standardised benefits package. Members also have the option to acquire additional benefits beyond the standard package. The Minister is granted the authority to modify the standard benefits package based on various evaluations and the sustainability of funds.

Similarly, the legislation empowers the Minister to enhance the public health insurance scheme based on findings from studies and evalua­tions.

Finally, a specific provision caters to financing healthcare for the poor­est households, constituting 27% of Tanzania’s population. Special funds, sourced from electronic transaction revenues, excise duty on select products, taxes on gaming, motor vehicle insurance, parliamen­tary allocations, returns from fund investments, and contributions from stakeholders, including development partners, will support health insurance for this demographic.

In tabling the bill before Parliament, health minister Ummy Mwalimu said the government will establish an equity fund which will be used to pay the insurance premium for poor Tanzanians and finance the cost of treating chronic diseases such as cancer, kidney and heart problems, and emergency services like accident treatment.

“We are going to revoke the exemption system which has not benefited people,” she added, referring to the system that has theoretically existed up to now whereby children under five, those aged over 60 and preg­nant women were entitled to receive free treatment. “The system is there on paper,” she explained, “but in most cases, exempted people do not get medicines and other services”.

The government made various changes to the Bill that had been pro­posed by the parliamentarians and other members of the public. The minister said the government repealed a section which restricted some public services for people who had not subscribed to the government’s health insurance schemes.

Previously, the Bill restricted access to services such as driving licence, motor vehicle insurance, tax identification number (TIN), Sim card registration, business licence, passport or visa, registration of students, and national ID. This section had drawn widespread public criticism.

Ms Mwalimu said the section was scrapped in response to public demand, but that the government had instead introduced a different “sanction” to make it necessary for people to join the insurance cover­age.

“We will invest in public awareness programmes and convincing peo­ple to join,” she said. “And there will be a penalty of 10% of the annual contribution for a person who do not join any insurance scheme after three years since the law starts,” she added.

“This is a basic step towards ensuring Tanzanians live in good health by accessing the health services timely,” said Stanslaus Nyongo, the chair of the Parliamentary Health and HIV/Aids Committee.

Zanzibar on track to eliminate cholera
Epidemics of the deadly disease have been absent on the Zanzibar isles for the last five years, even as cholera incidence has risen globally, and researchers say the current approach to controlling cholera looks set to eliminate the disease on the islands by 2027.

Scientists from the World Health Organization (WHO), the Ministries of Health for Tanzania and Zanzibar, and UNICEF, conducted the research, which was published this year in The Pan-African Medical Journal.

Zanzibar’s cholera plan rests on three pillars – an enabling environment, prevention and response – and encompasses a diverse set of actions, from training food workers on cholera prevention, to major investments in water and sanitation in hot-spot zones, to preventive vaccination, to stockpiling life-saving IV fluids and oral rehydration solutions where they might be needed, and more.

The model has proven “very effective”, write the researchers. Zanzibar’s high-level leadership commitment ought to be taken as “exemplary”, they add. “The improvement of water and sanitation infrastructures, coupled with a comprehensive plan to eliminate cholera, has set Zanzibar on the path towards a future free from this disease,” said Ghirmay Andemichael Redae, Liaison Officer for WHO Zanzibar.

The entire population of Zanzibar has been targeted for cholera elimi­nation through the approach, which included providing preventive cholera vaccination to 322,483 people in cholera hotspot areas of Unguja and Pemba Islands. However, the researchers noted that when COVID­19 vaccines were introduced concurrently, the coverage for cholera vaccination declined.

Cholera, a bacterial disease transmitted in contaminated food and water, spreads fast, sometimes killing patients in as little as a few hours after exposure.

Zanzibar residents remember the last major outbreak of cholera to hit the island. It began in September 2015, and rolled on for ten months, affecting 4,330 people, and killing 68. Zanzibar has experienced no fewer than 17 cholera outbreaks since the 1970s.

by Ben Taylor

Marburg virus outbreak over
The Minister of Health, Ummy Mwalimu, announced in June that Tanzania was officially free from the Marburg Virus Disease (MVD), after completing 42 days of monitoring per the World Health Organisation (WHO) guidelines.

In a post on Twitter, the minister reported that May 31, 2023 marked the end of the monitoring period since the last patient recovered. “I’m officially announcing that the Marburg Virus Disease in the Kagera region is officially over,” she said. “We have managed to end the disease with great success. Today is a happy day; it’s a day to celebrate.”

On March 21, 2023, Tanzania had officially declared the country’s first Marburg virus outbreak. It was the second country to report the disease after Equatorial Guinea, which continues to battle with the disease. Across March and April nine cases were reported in Tanzania, including eight laboratory-confirmed cases and one probable case. The last confirmed case was reported on April 11, and the sample collection of the second negative PCR test was on April 19. All cases were reported from Bukoba district, Kagera region. Among the confirmed cases, three have recovered, and six deaths have been reported, of which five were confirmed cases, and one was probable. Cases ranged from 1 to 59 years old. Six cases were close relatives, and two were healthcare workers who provided medical care to the patients.

WHO Director General, Tedros Adhanom Ghebreyesus, described the development as “good news” in a statement posted on Twitter. “My appreciation goes to health [and] care workers, the government of Tanzania, WHO colleagues, and all partners for their efforts to end the outbreak in just over two months,” he said. “The key lesson is that we need to continue investing in epidemic preparedness,” he added.

WHO confirmed an outbreak of the deadly Marburg virus disease in the central African country of Equatorial Guinea on February 13, 2023. In the past, the disease was reported in the Democratic Republic of Congo and Uganda.

According to WHO, the Marburg virus spreads between people via direct contact through broken skin or mucous membranes with infected people’s blood, secretions, organs, or other body fluids and surfaces and materials such as bedding and clothing contaminated with these fluids.

There are currently no approved treatments or vaccines against Marburg virus disease. Outbreak control relies on contact tracing, sample testing, patient contact monitoring, quarantines and attempts to limit or modify high-risk activities such as traditional funeral practices. (The Chanzo)

by Ben Taylor

Tanzania experiences first Marburg virus outbreak, now considered to be contained
On March 21, the Ministry of Health confirmed an outbreak of the Marburg virus in the district of Bukoba in the far north-west of the country, four days after reports of a “possibly contagious disease” emerged in the district. The Ministry stated that five people including a health worker had died as a result of the outbreak, after developing symptoms of fever, vomiting, bleeding, and kidney failure.

The Ministry issued a travel advisory notice on March 22, which requires that all departing and domestic travellers from Kagera region will be required to complete an online traveller’s surveillance form, and that at all points of entry (airport, ground crossing or port), body temperature of all travellers will be checked. All persons with feverish conditions should be prevented from traveling in and out of the country until they complete the monitoring period and are given clearance to travel by the Port Health Authority.

The Ministry also initiated an urgent contact tracing process, identifying over 200 contacts of those infected. All persons in the contact tracing list are monitored regularly and prevented from leaving their places of isolation and travel.

As of April 25, six people have died out of nine confirmed cases, according to the World Health Organisation (WHO). Of 212 contacts, 206 had completed their monitoring period. Two of the cases involved healthcare workers, including one of those who died. Many of the contacts under monitoring were healthcare workers.

A few days later, the Ministry announced that they were confident that the outbreak had been contained. However, according to best practice procedures for managing such outbreaks, it will not officially be declared over until at least the end of May, 2023, six weeks after the final two patients were confirmed to be Marburg free. In the interim, authorities will maintain active surveillance.

The Health Minister, Ms Ummy Mwalimu, urged the general public to continue taking precautionary measures against the disease and other infectious diseases. She thanked the health experts, especially those on the front line in Kagera Region, including those who provided services to patients, and the contract tracing team.

This was the first ever outbreak of Marburg virus in Tanzania, though outbreaks have been recorded in the DRC, Uganda and Kenya, as well as other parts of the continent. The highly-infectious disease is similar to Ebola, with symptoms including fever, muscle pains, diarrhoea, vomiting and, in some cases, death through extreme blood loss. Hundreds of people have died from the virus in recent years, almost all in Africa. A 2005 outbreak in Angola killed more than 300 people.

According to the WHO, the Marburg virus kills around half of the people it infects. Marburg is considered much more dangerous than Ebola because, unlike with Ebola, there is “no vaccine or post-exposure treatment”, explained Cesar Munoz-Fontela, a specialist in tropical infectious diseases at the Bernhard Nocht Institute for Tropical Medicine in Hamburg. There is no vaccine because, until now, there has been “no market” for one. “Without the 2014 Ebola epidemic in West Africa, we wouldn’t have an Ebola vaccine,” he continued, referring to the Everbo jab created in 2015.

The virus can be carried by African green monkeys and pigs, as well as the Egyptian Rousette fruit bat. Among humans, it is spread mostly by people who have spent long periods in caves and mines populated by bats. Between humans, it spreads through bodily fluids and contact with contaminated bedding.

A major success story: reduction in child mortality
Tanzania’s marked reduction in child mortality over the past 2-3 decades is the kind of story that rarely makes headlines, but which should do so. A steady decline in the child mortality rate over this period means that currently 43 children die before reaching the age of five for every thousand children who are born. This is down by more than two thirds since 1999, when the figure was 147 per thousand.

Dr Felix Bundala, the assistant director for child health in the Ministry of Health ascribed the achievement to the successful adoption of Integrated Management of Childhood Illness (IMCI). IMCI is an integrated approach that aims at reducing preventable mortality, minimize illness and disability of children under five years of age, he explained. This includes focussing on increasing coverage of cost-effective interventions like immunizations.

According to Dr Bundala, between 2013 and 2018 over 7,000 providers from over 3,000 health facilities in 101 out of 185 councils had been trained in IMCI.

Dr Bundala listed pneumonia, malaria, diarrhoea as among the leading child killer diseases. Diarrhoea alone is responsible for nearly 20% of all under five deaths, but receives considerably less development assistance as compared to HIV, Malaria and Tuberculosis.

“It is only through IMCI where Pneumonia and Diarrhoea are captured. And therefore, it remains to be a priority intervention,” he pointed out.
He added that more work was needed to end preventable child deaths. In particular, he noted, there was a need for increased investment in primary health care interventions for children.

by Ben Taylor

Universal Health Insurance bill delayed
In November, Parliament postponed the tabling of the Universal Health Coverage Bill for and moved it the Standing Committee for Social Services and Community Development for further consultations. This followed concerns raised by members of parliament and stakeholders that the bill had several significant shortcomings.

The government initially brought the bill before the house in September. At this point, a spokesperson for the Ministry of Health stated that the bill will “answer the call to provide equitable and decent healthcare for all.” She added that “the process started in 2016, we’ve not only learned from challenges by the National health Insurance Fund (NHIF), but also from other countries that have established sustainable universal health insurance.”

Health minister Ummy Mwalimu said the government aimed, through the bill, to make health insurance both compulsory and affordable to all. To make it affordable, she explained that contributions to insurance schemes would be made four times a year rather than in one annual lump sum, that the elderly and most vulnerable would be identified using existing methods and would be enrolled in health insurance at no cost, and that the government would set a standard benefit package and reasonable contribution rates so that nobody would be excluded. “We will come up with standard benefit packages,” said the minister. The contribution to be unveiled later on, will be reasonable. The govern­ment’s goal is to cut the burden on citizens,” she insisted.

Ms Mwalimu also allayed fears over rumours that force would be applied to make Tanzanians comply with the UHI. “No one will be fined or jailed for not having health insurance,” she said.

Instead, according to the bill, it will be compulsory for citizens to have health insurance whenever other public services. This includes seek­ing a driving licence, motor vehicle insurance, admitting children for advanced secondary education or colleges, provision of a passport, Taxpayers Identification Number (TIN), business licence, visa, sim card registration and provision of a national identification card. “The lesson that we have drawn from Ghana, Rwanda and Ethiopia is that for citizens to join the Universal Health Insurance, we must attach it to social services,” explained the minister.

The minister said it would not be compulsory for Tanzanians to register with the National Health Insurance Fund (NHIF), but could decide to join private insurance companies if they preferred. Employees in the public and private sector will be enrolled in health insurance by their employers no more than 30 days after commencing their employment contract. For the basic benefits bundle, employers will be required to remit six percent of each employees’ salary, of which employers will contribute half or more with the remaining amount to be continued by the employee.

Those who are self-employed or work in the informal sector, includ­ing small-scale agriculture, will be required to register themselves for health insurance, either under the state-owned National Health Insurance Fund (NHIF) or a private provider.

The bill also affirms the Tanzania Insurance Regulatory Authority (TIRA) as the sole regulatory body mandated to regulate insurance activities in the country. According to the bill, “the authority will have three obligations: registration of health insurance schemes, monitoring the quality of services provided by contracted services providers and ensuring health insurances provide basic benefits bundles as provided by the act.”

The bill drew both praise and criticism from stakeholders. Executive Director of the Legal and Human Rights Centre (LHRC), Anna Henga, said they “commend the government for coming up with the bill which aims at ensuring that all citizens have access to health services, thus reducing the burden and costs of treatment incurred by people who have no health insurance.” However, she also pointed out that “there are sections of the bill which deny some people their rights.” She said the law targets poor people but it has not specified the criteria for a poor person, and noted that in denying people access to other services if they have not joined the health insurance, the law would deprive them of their rights.

At present, according to official data, around 15% of Tanzanian citizens are members of a health insurance scheme, dominated by the govern­ment-run NHIF and supplemented by a handful of private providers who largely serve those in formal employment. This leaves the vast majority of citizens lacking health insurance and vulnerable to serious financial shocks in case of illness or injury.

Earlier in 2022, a study by the National Institute for Medical Research (NIMR) found that 73% of Tanzanians expressed their willingness to pay for health insurance. “They say each Tanzanian is capable of contributing TSh 65,000 per year for the purpose and in return, they will access health services at all health facilities in the country including the Muhimbili National Hospital and Bugando Zonal Referral Hospital among others,” said the minister at the report’s launch in May.

Later, in August, alarms were raised that the NHIF was vulnerable to collapse, particularly in view of the ongoing increase in non-commu­nicable disease in Tanzania. “Our health insurance [NHIF] could soon collapse as it is overwhelmed by a rise in claims which are related to non-communicable disease (NCD),” warned the minister.

Insurance and social security experts told The Citizen newspaper that as a short-term measure, the government should bailout the fund. They also said that its benefits and price level should also be restructured while health insurance must be made compulsory for all Tanzanians.

In explaining the delay to the bill, the Minister said the bill would return with some major changes, including removal of conditions that were made mandatory for someone to have health insurance in order to access services such as travel documents, Taxpayer Identification Number (TIN), sim card registration and national ID.

The changes will include introduction of two levels of insurance cover­age: one that will enable beneficiaries to receive treatment at public and private hospitals all over the country, and a second that will comprise a low cost basic bundle that will enable beneficiaries to be treated at dispensaries, health centres and district hospitals, with contributions expected to be in the range of TSh 50,000-60,000.

The Minister added that a further change would be to allow more family members to be included on one family member’s insurance.

Tanzania praised for work combatting HIV/AIDS, re-doubles efforts
In launching a new report in Dar es Salaam in November, the Executive Director of the United Nations Programme on HIV/AIDS (UNAIDS), Winnie Byanyima, commended Tanzania for its achievement in reduc­ing HIV infections. Between 2010 and 2021, she noted, the number of new HIV infections and AIDS-related deaths in Tanzania had fallen by 50%.

“The country’s new generation has no idea what AIDS looks like because Tanzania has managed to get 80% of HIV patients on treat­ment,” she said.

Tanzania’s Health Deputy Minister Godwin Mollel said, “Tanzania is estimated to have 1.7 million people living with HIV, 1.5 million have been reached [with anti-retroviral therapy]. By 2026, the ministry aims to have attained the “three 95s,” meaning “identifying 95% of people living with HIV, dispensing medicines to 95% of them, and curbing infections by 95%.”

President Samia Suluhu Hassan was similarly ambitious. In launching Tanzania’s fifth multisectoral strategic framework for HIV and AIDS in December, she announced that Tanzania seeks to achieve “three zeros”: zero new HIV infections, zero discrimination, and zero AIDS-Related deaths, by 2026. The global target is to achieve the three zeros by 2030.

She added that studies have shown that despite overall progress, new infections among those aged 15-24 years are on the rise. She emphasised that more effort should be made to reduce this, otherwise it would be virtually impossible to end HIV/AIDS. “If these young people are affected now, they will be provided with all the medical attention they need, which includes prescribing them with antiretrovirals, but our quest to end HIV/AIDS will be tougher.”

“We need to put in more effort by creating awareness. Let’s campaign by providing them with skills to reduce new infections. Let’s work together as we have been doing and make some notable achievements,” the President said.

Ms Byanyima pointed out another weak spot, noting that girls and women are three times more likely to be infected with HIV than boys and men of the same age. “In fact, out of four people who are infected, three are girls or women,” she said. “In Tanzania, we estimated that 54,000 were infected last year. Those aged 14-24 made up about 30%, with 74% of those being girls or young women. We have a problem there, but we know the solution – educa­tion, which is a powerful equalizer.”

by Ben Taylor

Progress on health insurance schemes
The government announced in May that it was at an advanced stage of enacting a universal health insurance scheme regulation. They also revealed the findings of a study that found three quarters of citizens were willing to subscribe to the universal health insurance fund. The study was conducted by the National Institute for Medical Research (NIMR).

The fund is in line with Tanzania’s 2007 Health Policy which requires all Tanzanians who are economically capable to contribute towards their health expenses whenever they need them.

Data presented in Parliament by Health Minister Ummy Mwalimu on Monday, showed that up to December 2021, a total of just over 9 million Tanzanians (around 15% of the population) had enrolled with a health insurance cover. This means that 85% of the country’s population were still using cash when accessing health services.

The Minister reported that the NIMR study found that Tanzanians are able “to contribute TSh 65,000 per year for the purpose” and in return, they will access health services at all health facilities in the country including the Muhimbili National Hospital and Bugando Zonal Referral Hospital among others.

The project manager for Swiss Tropical and Public Health Institute (Swiss TPHI), Mr Ally Kebby, said the organisation was impressed with steps being taken by the government towards universal health insurance coverage.

Vice President Philip Mpango called for full participation of the private sector in funding research and innovation as a solution to emerging global health challenges. “There is need for the involvement of the private sector and others to take full part in funding, this is the only way we can conquer this challenge,” he said. (The Citizen)

Renewed partnership with the World Health Organisation
In April, the Government of Tanzania launched a new five-year country cooperation strategy with the World Health Organisation (WHO), worth an estimated USD $73 million. This effectively cements a reset of the relationship with the WHO that had deteriorated when the government of President Magufuli declined WHO advice during the Covid-19 pandemic.
Addressing a news conference during the strategy launch, Minister of Health Ummy Mwalimu, said that the strategy will manage different health activities between the government and WHO.

The strategy will focus on five areas including health and equity situation, gender equity and human rights, health emergencies, health information systems, partnership and setting the strategic priorities.
According to Ahmed Mazrui, Minister of Health In Zanzibar, the policy is set to redefine the shared goals of Tanzania and the WHO’s. “With this strategy, the country will be able to target at bettering different key areas in the health sector,” said Mr Mazrui.

“I commend the strong partnership between WHO, other sister UN Agencies and the Ministry of Health in Mainland and Zanzibar which has facilitated delivery of complimentary mandates,” said the UN Resident Coordinator, Mr. Zlatan Milišić. “This Country Cooperation Strategy is therefore timely as we all have the responsibility to work together. I am confident that through continued partnership, the health sector will be able to meet its ambitious goals towards improving the health and well-being of the population.”

Under the new partnership, the WHO’s support in the next five years will focus on:
• Strengthening health systems to ensure universal access to quality reproductive, maternal, newborn, child and adolescent health (RMNCAH) and other essential health services.
• Protecting communities against emergencies of infectious diseases and other public health events.
• Reducing exposure of individuals to risk factors that threaten their health and well-being.
• Improving efficiencies in the health sector through better, equitable health governance, leadership, and accountability.
WHO Tanzania Representative, Dr. Tigest Ketsela Mengestu acknowledged the efforts and contributions that led to the development of the strategy. “Today, WHO renews its commitment to collaborate with the Government of the United Republic of Tanzania for the next five years towards achieving health sector goals in improving the health of its population and bringing in transformative changes in the health sector. We are confident that working together and guided by this strategy, the Ministry of Health, WHO and health partners in Tanzania will contribute towards a common mission to promote health, keep the world safe and serve the vulnerable.” (The Citizen, WHO)

WHO estimates as many as two-thirds of Africans have had Covid-19
The World Health Organisation has published a report suggesting that across the continent, more than two-thirds of Africans may have contracted Covid-19 over the past two years, around 97 times more than officially reported infections.

Lab tests reported in official data have detected 11.5 million Covid cases and 252,000 fatalities across the African continent. However, according to the report, by September 2021 some 800 million people could have already been infected. The WHO Africa region said its study suggests the officially confirmed numbers were “likely only scratching the surface of the real extent of coronavirus infections in Africa”.

“This meta-analysis of standardised sero-prevalence study revealed that the true number of infections could be as much as 97 times higher than the number of confirmed reported cases,” said WHO Africa boss Matshidiso Moeti.

The global average of true infection numbers is believed to be 16 times higher than the number of confirmed reported cases. With limited access to testing facilities for much of Africa’s populations, many infections went undetected, as testing was mainly carried out on symptomatic patients in hospitals and travellers requiring negative PCR results.

“The focus was very much on testing people who were symptomatic when there were challenges in having access to testing supplies” and this resulted in “under-representing the true number of people who have been exposed and are infected by the virus”, Moeti told journalists.

While the pandemic has had a catastrophic impact on some parts of the globe, Africa appeared to have escaped the worst and was not as badly hit as initially feared at the start of the pandemic. With weak health facilities and services, many experts had feared the systems would be overwhelmed. Several analyses have been made of the pattern of the pandemic in Africa, with some concluding that the continent’s youthful population acted as a buffer against severe illness. An estimated 67% of infections on the continent were symptomless.

Most Covid cases on the continent have been recorded in South Africa – with over 3.7 million infections – which conducted most tests and boasts of better-resourced health facilities compared to most sub-Saharan Africa countries. (The Citizen)

New private cancer hospital to be constructed
Indian medical firm, Apollo Hospitals, has signed a Memorandum of Understanding (MoU) with the Eclipse Group Africa to set up a stateof-the-art diagnostic centre for cancer in Tanzania.

The MoU agreement was signed in August at the Indian High Commission in Dar es Salaam, witnessed by various people including Indian High Commission Mr Binaya Pradhan.

Speaking during the signing of the agreement, Eclipse Group Africa Chairman Mr Zahir Damji said that through the partnership Apollo Hospitals will provide health care services with advanced cancer care treatment. “The construction of the hospital will greatly help Tanzanians and many other African countries to be treated here in Tanzania,” said Mr Zahir. He added that the project will start with 60 beds that will provide comprehensive care for cancer from diagnosis to treatment.

“In line with the vision of Apollo Hospitals, the centre will offer bestin-class treatment and care with a team of experienced oncology, cancer care management and the world’s finest technology to make quality cancer care to over 55 million people in Tanzania,” said Mr Zahir.

The Indian High Commissioner in Tanzania Mr Binaya Pradhan said that health has been an important area of collaboration between the two countries, adding that Tanzania and India have been development partners for many years. (Daily News)

by Ben Taylor

Tanzania concludes review of Covid response, aims to speed up vaccine rollout
The Ministry of Health in the United Republic of Tanzania, with technical support from WHO and other development partners including UNICEF, USAID, British Council, the Jon Snow Institute (JSI) and US Centers for Disease Control (CDC), has concluded a second review of the country’s response to the Covid-19 pandemic. Since the previous review, conducted in October 2021, Tanzania had intensified immunisation activities, including expansion of outreach sessions and updated the existing National Vaccine Deployment Plan (NVDP).

Vaccine Deployment Manager, Dr Florian Tinuga, said the review was critical to assess the operational capacity of the system for a robust response to the pandemic. “The main purpose was to appraise the functional capacity of the Covid-19 response system at the national and sub-national levels following the introduction of additional vaccines (Sinopharm, Moderna and Pfizer vaccines),” he said. He added that the focus is to assist the country to identify best practices and challenges to further improve the vaccination roll-out.

The WHO focal person for Immunization and Vaccine Development (IVD), Dr William Mwengee reiterated WHO’s commitment to providing needed technical leadership of the Tanzanian response. “Although Tanzania had setbacks at the beginning of her response to COVID-19 pandemic, WHO will continue to provide needed technical leadership of the overall response to ensure that Tanzanians in Mainland and Zanzibar are largely protected from Covid-19 infections,” he said.

Best practices identified include intensified outreach services in Ruvuma region, characterised by the use of contextualised local slogans “Timua vumbi” that have enabled Ruvuma to reach the highest Covid-19 coverage of 12%, more than double the national average of 4%. In Dar es Salaam, the integration of Covid-19 vaccination in routine HIV/AIDS Care and Treatment Clinics with the support of Management and Development for Health (MDH) increased the vaccination rate of People Living with HIV/AIDS from 2,000 to 5,000 per day. Engagement of vaccine champions in the communities have also helped to address misconceptions, rumours and misinformation.

Vaccination coverage in Tanzania remains significantly lower than the global and regional targets established for countries. At the time of writing (April 12, 2022), the latest official figures are that just under 4 million people in Tanzania have received one or more dose of a Covid-19 vaccine, representing 6.4% of the population. This compares to over 21% in Kenya and 32% in Uganda.

Key challenges responsible for low vaccination rates in Tanzania include delayed introduction the vaccine into the country, and low demand due to misinformation about Covid-19. Qualitative findings also indicate that many Tanzanians are unwilling to receive external Covid-19 vaccine due to uncertainties towards its effectiveness as deaths are still occurring in countries where people are vaccinated.

Going forward, the review highlighted the need for advocacy with high-level political, community and religious leaders and increased access to vaccines. In addition, a mass campaign to scale up vaccination activities with adequate resource mobilisation is needed in the coming months.

Separately, at a joint meeting of the Ministry of Health and development partnership, the WHO has called on development partners and agencies for a renewed commitment to strengthen the country’s effort to urgently interrupt ongoing transmission.

“Tanzania has an impressive routine immunization programme,” said Dr Tigest Ketsela Mengestu, the WHO Country Representative for Tanzania, “so I am confident that if partners and the government work harder together, Tanzania can surprise the world by scaling up Covid-19 vaccination coverage and be on track to achieving the targets”.

The Permanent Secretary of the Ministry of Health, Professor Abel Makubi, reiterated the Tanzanian government’s commitment to scale up Covid-19 vaccination and ensure that her citizens are protected from the pandemic. He noted that Tanzania is still far from the national target of 60% of fully vaccinated population by June 2022. “The country is set to achieve the target but this requires the cooperation and support of the partners and donors”, he added.

Study on Covid-19 patients in Tanzania
The first study in Tanzania to examine the characteristics of Covid-19 patients and the outcomes of their treatment reveals about three-quarters of all patients were under the age of 60. Scientists studied the COVID-19 patients in the early months of the outbreak amid scarcity of data on the pandemic. Results of the study were published in IJID Regions, an official journal of the International Organization for Infectious Diseases (ISID).

Researchers tracked 112 patients at two referral hospitals in Dar es Salaam between April and May 2020. Of these, 93% were hospitalized, while 9 patients (7%) were out-patients.

According to findings of the study on characteristics of COVID-19 patients in Tanzania, the age of the studied patients reflects the number of people infected with the coronavirus in Africa. The average age of all patients was 41 years, while the average age of the patients who lost their lives was 58 years. Six out of 10 patients in the study were men. The average age is similar to that reported in South Africa but slightly lower than that reported in China, Libya, the United States (New York) and Italy in early stages of the pandemic, where the average age was higher, with patients being older compared to Tanzania and South Africa.

Headache was the commonest symptom reported among 55% of patients, followed by fever reported by 49%.

Professor Sayoki Mfinanga, a public health Specialist and researcher from the National Institute of Medical Research (NIMR) is the lead author of the study. He says that the symptoms found among patients during the study are similar to those reported worldwide. But he says, “…symptoms such as shortness of breath, altered consciousness, and neurological signs were significantly associated with mortality in the COVID-19 patients.”

“This is important because it is from Tanzania, the place where data was almost absent and the Covid story was only told by a political narrative,” said Mwidimi Ndosi, Associate Professor of Rheumatology Nursing at Bristol School of Health and Social Welfare in the UK.

“It calls into question all the previous government data and its interpretation that drove the policy, the implications of which are still affecting Tanzania now.” However, he adds: “This study opens the minds of some people who once believed that this is a disease that affects only the elderly,” says Ndosi.

Most Tanzanians use traditional medicines
The acting director of Healthcare Services at the Health Ministry, Dr Caroline Damiani, has said that over 60% of Tanzanians use traditional medicines to treat different diseases before or after trying ordinary health-care centres. Dr Damiani made the remark when opening a training seminar for traditional doctors. The seminar aimed at exchanging experiences among the herbalists and discussing various challenges and strategies of improving the profession of traditional and alternative medicine so that it can continue benefitting Tanzanians.

“Over 60% of Tanzanians, at one time or another, get treated by traditional medicine against various diseases before or after going to our health centres or hospitals providing modern health-care services,” said Dr Damiani. She said the main goal of the seminar was to ensure that traditional medicines were better from the stages of growing, harvesting, manufacturing, preserving to the stage of reaching the consumer so that there should not be side-effects.

According to Dr Damiani, the Health Ministry, through the Traditional and Alternative Health Practice Council, has registered 73 types of traditional medicine, out of which 20 had positive results during the period of fighting against the Covid-19 disease.

For his part, the representative of traditional and alternative medicine doctors, Mr Shaban Omary Shekilindi – who doubles as the Lushoto MP (CCM) – praised the ministry and its traditional and alternative medicine unit, for organising the seminar.