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.

Tanzania UK Healthcare Diaspora Association (TUHEDA) making post-Covid progress
by Dr Gideon Mlawa

Dr Gideon Mlawa and other TUHEDA members during their visit to Tanzania

Tanzania UK Healthcare Diaspora Association (TUHEDA) members are continuing to carry out TUHEDA objectives which include collaboration in areas of medical education through knowledge sharing, research activities, and clinical care. Recently TUHEDA members visited Zanzibar and Tanzania Mainland.

In Zanzibar, Dr Gideon Mlawa, Dr Nasibu Mwande, Tania Leach, and Dr Daniel Leach visited the Ministry of Health, Mnazi Mmoja Hospital (Emergency Medicine department and Diabetes Unit), the State University of Zanzibar (SUZA) Medical College and the Diabetes Association of Zanzibar (DAZ) headquarters. The team also visited Tumbi Hospital in Kibaha and received feedback on simulation training program set up 3 years ago as part of the TUHEDA-TUMBI(TUTU) collaboration.

TUHEDA and friends of TUHEDA were honoured to have an audience with the President of Zanzibar, Dr Hussein Mwinyi. The team had an opportunity to discuss the purpose of their visit as well as to set up the simulation training using high fidelity simulation manikin, nicknamed Rajab. Rajab’s new home will be at the State University of Zanzibar (SUZA) Medical College. In addition, 300 glucose meters will be donated to the Diabetes Association of Zanzibar and Mnazi Mmoja Hospital.

Dr Nasibu Mwande visited Kyela (Mbeya) to meet a community of people with albinism. This was a collaboration between TUHEDA and Kyela FM. Dr Mwande presented them with skincare lotion, sunglasses, and sun hats.

Dr Gideon Mlawa presented on Medical Management of Pituitary Tumours at the Neurosurgery-Pituitary Conference held at Muhmibili University Hospital (MOI). This is an initiative by TUHEDA team and Neurosurgery team at Muhimbili University Hospital (MOI) collaboration through the exchange of knowledge and skills and shared learning.

by Ben Taylor

Omicron wave reaches Tanzania
The Omicron variant of Covid-19 has reached Tanzania and spread widely. This conclusion is not based on analysis of official data on case numbers, hospitalisations and deaths, but instead on anecdotal (but very widespread) reports of case numbers having risen sharply in December 2021 both in health facilities and in the community.

On November 27, the government urged Tanzanians to take all the necessary precautions to prevent the spread of the coronavirus as the new Omicron variant of the Covid-19 virus threatened to roll back the global fight against the disease. A statement issued by Tanzania’s chief medical officer, Dr Aifello Sichwale, said the fourth Covid-19 wave caused by the new variant was “deadly”.

There is still very little official data being released on the state of the pandemic in Tanzania (with the exception of data on vaccines – see below). The government has released some data – for example Situation Report No.14, dated December 20th, 2021, reported 1,366 new confirmed cases in the previous week, 92% of which were in Dar es Salaam, bringing the reported total since the start of the pandemic to 27,849, with 737 confirmed deaths. However, such releases have been highly sporadic and inconsistent. Moreover, the figures they contain are thought to be massive underestimates.

Nevertheless, in contrast to earlier phases of the pandemic, doctors and others are far more willing now to speak openly about what they are seeing. The story they tell is remarkably consistent from different parts of the country, and paints a mixed picture.

“We’re seeing a lot of patients arrive at the hospital,” said a senior doctor at Muhimbili National Hospital, “but most do not actually need to be admitted.” A doctor in Iringa said there were clear signs that the virus was spreading widely in the community – “everybody has it”, he said – but that for most people it was proving no more serious than an unpleasant flu.

The Situation Report cited above also included a revealing chart showing confirmed case numbers across the full period of the pandemic. The chart is interesting not so much for the specific figures (which are likely to be underestimates) as for the pattern of numbers rising and falling in particular periods. These waves match closely those experienced in Kenya and Uganda where data has been released regularly throughout.

Even more interesting still, however, is the fact that the chart shows case numbers from times when Tanzania was not officially collecting such data, and indeed when the government was publicly making the claim that the country had defeated the virus and was experiencing no cases.

fig 1 (Source: Tanzania Ministry of Health Situation Report No.14, Dec 20, 2021)

STOP PRESS: At the time of writing, President Samia Suluhu Hassan announced a cabinet reshuffle, which returned former Minister of Health, Ummy Mwalimu, to the position, replacing Dr Dorothy Gwajima. Mwalimu had previously served as Minister of Health from 2015 to November 2020, when she was removed from the post, reportedly as a result of disagreements with the President over the national response to Covid-19.

Tanzania hits 2,000,000 Covid-19 vaccines milestone
Shortly before the end of 2021, Tanzania reached the figure of two million people having received at least one dose of a vaccine against Covid-19 (3.4% of the population). This puts the country at a similar level to Zambia and Malawi, but well behind Kenya (over 7 million people vaccinated), Uganda (8 million) and Mozambique (9 million).

fig 2 (Source: Our World In Data, January 7, 2022)

Tanzania started later than many other countries in providing vaccines, with the vaccine rollout not getting underway in earnest until August 2021, compared to February or March for many of the country’s neighbours.

This is a direct effect of the anti-vaccine stance of the late President John Magufuli, who had refused offers of vaccines, arguing that they did not work and could even be dangerous. President Samia Suluhu Hassan changed this position, joining the global COVAX initiative that supplies vaccines free of charge to poorer countries and accepting offers of vaccines donated by the USA and China. Between July and December, Tanzania received a total of 4.8 million doses of the Moderna, Pfizer, Johnson & Johnson and Sinopharm vaccines from various sources.

Nevertheless, the relatively slow pace of vaccination in Tanzania reflect two separate legacies of President Magufuli’s idiosyncratic response to the Coronavirus pandemic, in addition to the late start.

First, in contrast to her neighbours, health authorities and service providers in Tanzania had not been making preparations for a nationwide vaccine rollout. Nor had they shifted to pandemic-footing more generally – with no systematic monitoring of case numbers, for example, or efforts to raise public awareness of the virus. Indeed, under President Magufuli, there were concerted efforts to downplay the pandemic’s seriousness.

Second, many Tanzanian citizens who a few months earlier had heard their much-loved President tell them that the vaccines were ineffective and dangerous, are now reluctant to put their trust in those very same vaccines. A recent survey of public opinion by Twaweza , a civil society organisation working in Tanzania, Kenya and Uganda, found that just half of Tanzanian citizens (54%) would be willing to get vaccinated against Covid-19, compared to 76% in Kenya and 85% in Uganda.

fig 3 (Source: Sauti za Wananchi, Twaweza). Disclosure: the author of this article works for Twaweza

Overcoming such resistance will not be straightforward.

Malaria vaccine approved for widespread use
The World Health Organization in October endorsed the first vaccine against Malaria, a disease that kills more than 400,000 people a year, mostly African children. The decision followed a review of data from trials of the vaccine developed by GSK, conducted since 2019 in Ghana, Kenya and Malawi in which more than two million doses were given of the vaccine.

After reviewing the evidence, the WHO said it was “recommending the broad use of the world’s first malaria vaccine”, the agency’s director general Tedros Adhanom Ghebreyesus said. The WHO said it was recommending children in sub-Saharan Africa get four doses up to the age of two.

Findings from the vaccine trials showed it “significantly reduces severe malaria which is the deadly form by 30 percent,” said Kate O’Brien, Director of WHO’s Department of Immunization, Vaccines and Biologicals. The vaccine is “feasible to deliver”, she added and “it’s also reaching the unreached… Two thirds of children who don’t sleep under a bed net in those countries are now benefiting from the vaccine.”

Many vaccines exist against viruses and bacteria but this was the first time that the WHO recommended for broad use a vaccine against a human parasite.

“From a scientific perspective this is a massive breakthrough,” said Pedro Alonso, Director of the WHO Global Malaria Programme.

The estimated cost of malaria in sub-Saharan Africa is over 12 billion dollars a year, Alonso said at a news conference following the announcement. The GAVI vaccine alliance said they will consider whether and how to finance a new malaria vaccination programme for countries in sub-Saharan Africa.

The WHO also hopes this latest recommendation will encourage scientists to develop more malaria vaccines.

Separately, the fight against malaria earlier in 2021 received a major boost when researchers from Britain’s Oxford University announced that their Matrix-M vaccine candidate had become the first to surpass the WHO’s threshold of 75-percent efficacy. Germany’s BioNTech, which developed a coronavirus vaccine with US giant Pfizer, also said it aimed to start trials for a malaria vaccine next year using the same breakthrough mRNA technology.

The Oxford team launched a phase-3 trial in summer 2021, enrolling 4,800 children in Burkina Faso, Mali, Kenya and Tanzania. If all goes as hoped, results could be submitted to regulators in late 2022.

Adrian Hill, Director of the Jenner Institute at the University of Oxford said that “in Africa, malaria has probably caused four times as many deaths as COVID-19 over the past year”.

by Ben Taylor

January to March 2021
The early months of 2021 saw rising alarm in Tanzania over a possible new wave of Coronavirus infection, with anecdotal evidence from hospitals and other sources across the country suggesting a rise in case numbers. Nevertheless, throughout January the government continued to insist that the country had defeated the pandemic. No new data on case numbers or fatalities was reported (as has been the case now for over 12 months).

And more significantly, the government signalled that it had no intention of participating in COVAX, the international effort to supply Coronavirus vaccines to developing countries. On February 1st, the Minister of Health, Social Development, Gender, Elderly and Children, Dr Dorothy Gwajima, said the government had no plans of procuring the Covid -19 vaccine which is already in use in other countries, and Tanzania was conspicuous by its absence from the initial COVAX distribution list, published on February 3rd. It was (and remains) unclear whether the country would even license the vaccines, which would allow private hospitals to import the vaccine and individual citizens to get vaccinated.

“The ministry has its own procedure on how to receive any medicines and we do so after we have satisfied ourselves with the product,” said the Minister. This came a week after President Magufuli warned the ministry of the danger of foreign vaccines, doubting their effectiveness and saying they came with ulterior motives.

Instead, the ministry encouraged people to take other precautions against “viral infections”, without specifically mentioning Covid-19: “We must improve our personal hygiene, wash hands with running water and soap, use handkerchiefs, herbal steam, exercise, eat nutritious food, drink plenty of water, and natural remedies that our nation is endowed with because we have quite many of these natural remedies, ”said Dr Gwajima. “Through the Chief Government Chemist, the Ministry has been working to inspect a number of natural remedies that have met the safety standards for use, are already in use and they have helped Tanzanians, including me and my family.”

A few weeks into February, however, there were signs that the government was edging towards an acceptance that the virus was still present and causing serious problems, perhaps pressed to do so by the growing weight of evidence.

The illness of the Vice President of Zanzibar, Maalim Seif Sharif Hamad, who was admitted to hospital with respiratory problems on January 31st after testing positive for Covid-19, and passed away on February 17th (see obituaries section), made the true situation harder to deny. On February 11th, an MP from the ruling CCM party, Zacharia Isaay, spoke in parliament to express concerns at the alarming number of “pneumonia” patients in his constituency – concerns that were echoed by other MPs.

Around the same time, several other prominent figures passed away, all with symptoms consistent with the Coronavirus. This includes Prof. Benno Ndulu, former Governor of the Bank of Tanzania, and the Chief Secretary, Amb. John Kijazi (see obituaries section). Tanzania Episcopal Conference (the Roman Catholic church in Tanzania) reported that more than 25 priests, 60 sisters and two elders of the laity had died within the past two months of various causes including respiratory challenges.

On February 20th, amid claims of a worrying rise in cases and deaths attributable to the pandemic, the government announced measures to contain the spread of the virus. In contrast to its previous stance, the government now asked Tanzanians to adopt preventive measures: prayer, handwashing, sanitisers, face masks, physical exercise, shielding for the vulnerable, improved diets and traditional remedies, but no lockdown measures.

The same day, President John Magufuli told worshipers at the Roman Catholic St Peter’s Parish in Dar es Salaam that Tanzanians should take precautions against the Coronavirus. He stated that the government hasn’t prohibited the use of face masks in the war against Covid-19, but stressed however that locally made masks – especially those from the Medical Stores Department (MSD) – should be used rather than imported masks. And he advised people to adopt traditional methods of containing respiratory diseases, including steam treatment, and to avoid fear which can itself have negative impacts. He reiterated that Tanzanians must continue to put their trust in God.

Also on the same day, the Director General of the World Health Organization (WHO), Tedros Adhanom Ghebreyesus, called upon Tanzania to take “robust action” to combat Covid-19. He noted that a number of Tanzanians travelling to neighbouring countries and beyond have tested positive for the coronavirus. “This underscores the need for Tanzania to take robust action both to safeguard their own people and protect the population beyond,” he said. “This situation remains very concerning. I renew my call for Tanzania to start reporting Covid-19 cases and share data.”

Two days later, on February 23rd, Minister Finance and Planning, Dr Philip Mpango, held a dramatic press conference from a lobby area within Benjamin William Mkapa Hospital in Dodoma, where he himself had been receiving treatment. Clearly exhausted, and coughing and crying as his spoke, he praised the hospital and its doctors for keeping him alive, and President Magufuli for his support. He spoke of having needed oxygen, but did not mention the Coronavirus by name.

By mid-March, however, events took a different turn. The possibility of President Magufuli changing course began to be overshadowed by the fact that he had not been seen in public since February 27th. Rumours around his own health began to grow.

Coronavirus update – April 2021
On April 6, President Samia Suluhu Hassan (see main article) announced what could be the start of an attempt to change the government’s stance on the pandemic. She stated her intention to form a committee of experts to professionally assess the state of the Covid-19 pandemic and advise the government on the way forward.

“We cannot isolate ourselves as if we are an island, but also we cannot accept everything brought to us. We cannot continue just reading about Covid-19 worldwide, but Tanzania is all blank – it makes no sense.”
Two weeks later, the President spoke at a national conference organised by religious leaders to remember ex-President John Magufuli and pray for the new leaders. She called on religious leaders to advise worshippers to take precautionary measures against the virus, and also reported that the committee of experts had been formed.

“I’m expecting to meet its members and representatives of the Ministry of Health and those from the Ministry of Finance and Planning in the near future in order to establish the way forward,” she said.

At the time of writing (April 27), the committee is yet to report, and no substantive change of policy has been introduced. There has been no new release of data on testing, for example, and no change in the country’s position regarding vaccines.