The economic consequences of climate change in Tanzania

by Romaisa Hussain & (Junna) – Art in Tanzania internship

Climate change has emerged as a potentially existential threat all across the globe that poses a serious risk to the survival of mankind and sustainable development. Over the last few decades, the world has witnessed changes in weather patterns as a result of global warming and human-caused greenhouse gas emissions. Based on a numerous lines of evidence, it is now more certain than ever that climate change is a threat multiplier that can amplify the effects of existing dangers. These threats include human security, scarcity of natural resources, environmental degradation, and poor economic growth.

The United Nations General Assembly set up the 17 Sustainable Development Goals in 2015 which serve as a blueprint for a sustainable future to be achieved by 2030. The 13th Sustainable Development Goal of the United Nations talks about Climate Action. The goal discusses the critical impact of climate change and encourages developing countries to move towards low-carbon emission in the environment. The United Nations Environment Programme (UNEP) is a separate organ working within the UN that deals with climate change and other environmental issues. The UN aims to adapt to low carbon development especially in the vulnerable regions that contribute towards climate action and sustainable natural resource management through collective action. Most of the states in the world are affected by climate change with East Africa being one of the most affected regions.

Tanzania is suffering the brunt of the consequences of climate change in East Africa. The agricultural-based economy of Tanzania has become vulnerable to the extreme climatic conditions. The majority of the population is located in the rural areas which heavily relies on agriculture and farming that is threatened by rising temperatures, droughts and extreme rainfalls. The country is home to the world’s largest river system, the River Tanzanian. Despite immense water resources, Tanzania struggles with a shortage of water both spatially and temporally which is worsened by the climate on its nine main river basins. In the recent years, there has been a severe decline in the water level in Lake Tanganyika, Lake Victoria and Lake Jipe as well as a decrease in the water level of about 7km in Lake Rukwa during the last fifty years. These are connected with climate change and are endangering towards socio-economic activities. The effect also puts the country’s hydropower system at risk. Furthermore, diseases such as diarrhea and malaria remain one of the prime causes of casualties in the country especially in the urban settlements consisting of poor infrastructure prone to flooding and increased temperatures. 

Tanzania’s economy relies on its natural and environmental resources where a good number of people depend on fisheries for their income which are at risk from rising sea waters and freshwater temperatures. Tourism is another aspect that has the potential to boost the economy of Tanzania as the country has a tropical climate and is home to wildlife, forests, beaches, mountains, rivers, lakes and minerals. The attractions are found in abundance in national and marine parks, historical and cultural sites and recreational sites. Currently, tourism generates 17.5 per cent of GDP and 25 per cent of export revenues, making it an important economic sector but climate unpredictability endangers the ecosystem services on which tourism relies. For example, the Serengeti National Park has been famous for tourism wildlife migration for decades which contributes significantly to Tanzania’s economy and serves as a key source of employment. There is a growing fear that the climate has shifted dramatically, potentially affecting wildlife tourism. 

Threats to the sustainability of the natural resources and environmental degradation remain an issue in Tanzania such as the untimely harvesting and usage of natural resources, unsupervised cultivation process, and trespassing on water sources. Collectively, these can seriously affect the sustainable development goals of a country. Due to the unsustainable consumption of resources, there can be problems in the production of sources that may affect livelihoods. In addition to that, they can lead to the deficiency of food which could eventually lead to poverty. An increase in the population and high reliance on agriculture becomes rather burdensome on the environment and its natural resources which contribute negatively to climate change and water-deficient regions. 

One of the leading factors that contributes to the environmental degradation is the unsustainable management of land and watershed. Many challenges are still needed to be tackled to reduce this issue including unexpected growth of human settlements, wildlife hunting, illegal farming and livestock, uncontrollable bushfires, weak inter-sectoral association and stakeholder linkages. This may lead towards the social and economic development of the country as well as reduce poverty. The Tanzanian Government has marked the water-oriented issues as a major factor that has affected the environment which is why it has been implemented in national policies and necessary plans and strategies needed to tackle it. The visibility of climatic changes in Tanzania is increased by 60% which are seen in the form of a decrease in water sources, land degradation and the reduction in agricultural land. The Government also tends to focus on carbon emission with the protection of ecosystems and biodiversity, the saving of wildlife to abolish the hunting system as a means of income, reducing vehicle usage and improving urban planning in the country to promote urbanization. It also placed environmental sections under the sector ministries to ensure and monitor the environmental issues as well as raising awareness amongst the community. The Government also needs to guarantee that efforts are being made in terms of the development of the environment and climate change in national as well as subnational plans. 

A National Adaptation Programmes of Action (NAPAs) was developed by Tanzania’s government in 2007, as required by the UN Framework Convention on Climate Change. According to NAPA, the most affected areas in Tanzania that suffer from the impacts of climate change are agriculture, water, health, and energy. In 2012, Tanzania’s government devised a strategy to address the growing concern about the detrimental effects of climate change on the country’s economy and environment. Furthermore, the Government of Tanzania initiated the first phase of the Global Climate Services Framework (GFCS), held in 2014-2016, to strengthen the resilience of individuals who are most exposed to the effects of weather and climate-related disasters. On September 18, a ceremony in Dar es Salaam marked the start of the second phase from 2016-2019. It was conducted in partnership with the International Red Cross Federation and Tanzania Red Cross Society, Ministry of Health, Gender, Elderly Affairs, World Health Organization (WHO), Ministry of Agriculture, Tanzania World Food Program, and Tanzania Meteorological Agency.

The United Nations Development Program (UNDP) is one of the partners of the Government of Tanzania that has aided the development of the environment and contributed to measures regarding natural resources and climate change issues. The UNDP encourages the Government and respective communities in terms of sustaining the environment and contributing to the reversal of environmental degradation. As long as the correct policies are implemented, the chances for preserving the ecosystems in terms of food, energy, wood i.e. timber, clean water, consistent climate etc. are possible. Over the past few years, Tanzania has recently experienced high growth rates of about 7.4%.

The impact of climate change has had a huge effect on the incomes of the people in Tanzania. It has had a severe impact on the economy, agriculture, natural resources and livelihoods of people which exposes the vulnerable part of the country. It is, to say the least, the Government of Tanzania is to be respected for the progress it has made regarding the development and exercising of policies and strategies to prevent degradation and the protection of the environment. The Government tends to cater to the environmental needs of the country and maintain its natural resources as a means of saving economic and social development. This would mean effectively establishing immediate measures to improve the damages caused. The Government also needs to guarantee that efforts are being made in terms of the development of the environment and climate change in national as well as subnational plans.

Corporate Social Responsibility in Tanzania

Art in Tanzania internship report

What it is, why it matters and how it can help Tanzania

Corporate Social Responsibility (CSR) is a consistently used business practice in Tanzania, with huge corporations such as MIB Bank. Twiga Cement and Coca-Cola endorsing and investing in a large number of CSR schemes.

Despite its potential to greatly help local communities, it is a concept that has not taken root in Tanzania. For a number of reasons, whether it be poor organization, a failure to engage and educate local communities or businesses being held back by a desire to put its shareholders and profits first, CSR seems to be misunderstood and at times misused.

This holds Tanzania back, especially considering how important sustainable practices and further community engagement could greatly help both Tanzania and the corporations that operate within them. It can improve employment prospects for Tanzanian men and women across all sectors, help Tanzania’s environment become cleaner and safer and it can ensure sustainable and continued economic growth for Tanzania, which benefits everyone from the business directors to the local farmer.

What is CSR?

CSR stands for social corporate responsibility. It involves companies using their resources and money to try and benefit the communities they work in. This includes keeping pollution down, providing more energy and resources to the community and working alongside the community to improve conditions for the local people.

This can take many forms, from making its manufacturing or extracting processes more sustainable to helping pay for classroom equipment to ensure local students have the tools to succeed. It can also involve companies donating some of its profits to local projects such as building new irrigation systems or helping refurbish local community centers.

By providing these resources and funding, the companies can enhance their reputations both locally and across the region they operate in by helping to gain a loyal customer base, who trust and support the business due to their positive investment in the community.. When done well, CSR has the potential to improve society for the better and benefit everyone within it.

Why is CSR important to Tanzania?

While CSR schemes can be a huge benefit to any country or region willing to embrace them, it can be even more important for Tanzania. Firstly, by working with businesses to implement sustainable practices, it can ensure that Tanzania can maintain its key resources.

Around a quarter of Tanzania’s economy is taken up by mining, industry and construction. In particular, as of 2013, 89% of Tanzania’s mineral export wealth comes from gold, although diamonds and tanzanite also contribute to Tanzania’s export wealth. Therefore, it is vital that businesses mine these resources sustainably so that more people can use and profit from their natural resources for many generations, not just for short term profitability.

Another key aspect of the Tanzanian economy is farming, with agricultural workers representing around half of the employed workforce in Tanzania. However, climate change and unsustainable irrigation and farming practices mean that it is becoming harder and harder to farm successfully in Tanzania. Due to these challenges, people will struggle to grow crops or earn money, in turn leading to more people in poverty.

CSR projects take many different forms, but a key aspect is that they encourage businesses to use sustainable practices. This includes reducing water, soil and air pollution that can badly damage the farming land and environment. This will hugely benefit local farmers, who with more clean water and high quality land can continue to grow crops and farm successfully.  

It also means convincing extractive industries that they can still grow and produce profits for its shareholders without drying up Tanzania’s natural resources, which need to be preserved to ensure long term profit and economic growth for Tanzania. Therefore, CSR can be crucial in protecting Tanzania’s economic and environmental future.

Another factor to remember is the disparity between the economic growth in Tanzania and how much of it is reaching the people of Tanzania. In a recent World Bank report, they state how while the country has enjoyed sustained economic growth for the past 20 years, Tanzania’s wealth per capita- the sum of all its human, physical and natural capital has decreased.

This reflects how Tanzania’s natural resources, which as mentioned previously contribute heavily to Tanzania’s wealth overall, are not being managed effectively and are therefore not creating sustainable economic growth for the whole of Tanzania.

Tanzania also has one of the largest poor populations in Africa, with around 21.3 million citizens living below the poverty line. The World Bank report also states how with the population in Tanzania set to grow exponentially (the Tanzanian population is expected to triple to 138 million by 2050), there will be huge pressure on natural resources and necessities.

This will be compounded by increased urbanisation and climate change. In simple terms, more people (who are already struggling with poverty and rely on natural resources) will have to compete for less space, farmable land, water and reliable energy supplies.

CSR can help manage the worst affects. By getting businesses to commit more funding and expertise to local communities, they can help limit the worst effects of poverty, whether it be improving energy supply, helping to educate people and protecting the land from environmental damage, or by introducing schemes that will help jobseekers gain further qualifications and skills that will help them earn the money to improve their living standards.

How is CSR operating in Tanzania now?

The good news is that progress is being made. Government legislation implemented in 2017 has made sure businesses carry out their social responsibilities to the areas they operate in, whether through education and training, more sustainable practices or through providing funding equipment and facilities in the local communities. It also forces them to commit a small percentage (around 0.7%) of their income to CSR schemes. It is a huge step forward from businesses using their own discretion when deciding what their social responsibilities were.

In a recent article by the Citizen, they report on and highlight the key points of a recent social responsibility forum held in Dar Es Salaam focusing on women employment in extractive industries. At this forum, they commend extractive industries for their steps towards taking up greater social responsibility.

However, they also recommend that more should be done to educate girls at the school and university level. More women should be trained and educated in these industries to ensure in the future that these companies can cultivate local women to help them implement more effective and sustainable practices. They emphasized how it would be both economically valuable and socially beneficial to include more women in the extractive industries. What this conference reflects is that while steps are being made to make CSR better understood and more effective and better understood, more can always be done, especially at the local level.

Without continuing to highlight the importance of CSR schemes to both businesses and the community, their positive impact is reduced as companies sacrifice genuine positive change for profitability or some quick publicity. This is reflected in a 2017 study looking at the CSR policies implemented in the Msalala district of Tanzania by extractive and mining industries.

While the Bulyanhulu Gold Mine Company did provide dispensaries, latrines and school desks, the majority of the public response from those surveyed was negative. They felt they were not included in the use of CSR funds and companies in the region also scored poorly amongst the public on dealing with issues of environmental pollution, inflation, healthcare and poverty. This shows how even with the legislation, CSR schemes can still struggle to deliver positive change to local communities

This is not just an isolated case. A comprehensive study of CSR in Tanzania done by a student at the university of Dar Es Salaam concludes that while businesses are quick to proclaim how effective their CSR schemes are, in reality these companies often use these schemes to generate further publicity and create a greater demand for their service/product.

Supporting the local community is often a secondary concern. To solve this, the study concludes that more needs to be done to educate and involve the community in CSR schemes and help push the government to act as a coordinator and enforcer to ensure these schemes are a huge success for both businesses and the local people. This reflects that there is still much more that can be done to raise awareness of the concept in the local communities and ensure businesses help communities by aiding gender equality in employment, implementing sustainable business practices and helping to engage and solve problems within the local community.

So, what more can be done? 

With this article looking at how useful CSR is and how it can benefit Tanzania, it is also important to outline the steps that are needed to make it successful.

Community engagement is a key aspect, and ensuring that local businesses, schools, workers and groups are aware of CSR schemes and become more and more invested in making sure that these schemes truly benefit the community.

As part of this, it also involves educating people on the key reasons why CSR schemes are important. It is also crucial that young students are educated on the importance of CSR, as they can then take these ideas with them as the progress into further studies and a career. Therefore, outreach into schools and universities is important, whether it be through lectures, debates, seminars or even longer educational programs.

These ideas will help them become more employable but also help integrate these important ideas into whatever sector they go into, whether that be the private sector industries, into government or just into public life. This can then create more engagement on these issues with businesses, meaning there are more people who are ready and willing to work in tandem with businesses to ensure the greatest benefit to the local people and communities.

Alongside this, a crucial step is trying to continue to push businesses to invest in the local community. This can be done not only through creating demand for CSR schemes by educating the markets and consumers these businesses are selling too, but through negotiating agreements between non profits, businesses and local institutions that will bring about even more mutually beneficial CSR schemes.

In the long run, it will also be vital that the government becomes increasingly involved in co-ordinating CSR schemes to ensure that both business and societal interests are met. In an ideal world, they will come up with even stricter guidelines that ensure companies are forced to carry out their responsibilities and that they work with local communities to ensure that the local people are able to participate and improve their areas.

CSR therefore offers plenty of opportunity for businesses and communities to work together and create truly positive change, but there is plenty of work to do to ensure that the CSR concept can deliver on its huge potential.


-Citizen Article on CSR forum, March 30th 2019:

-World Bank Report May 2019:—new-world-bank-report

-2017 Study on the impact of CSR studies in the Msalala District by Jonas Kilave:

-Shukrani Mbirigend, Corporate Social Responsibility in Tanzania, Misconception, Misuse and Malpractices, Chapter 7 in particular, Dar Es Salaam Student Study:  

-All Statistics not found within other cited works were taken from the publicly available archives of the National Bureau of Statistics, done by Tanzania’s Ministry of Finance

Tackling Cardiovascular Diseases in Tanzania


Cardiovascular Diseases (CVDs), a group of disorders that affect the heart and/or blood vessels are the leading causes of deaths and disability-adjusted life-years (DALYs) globally. In 2017, CVDs were responsible for an estimated 17.8 million deaths, with more than 80% occurring in low- and middle-income countries (LMICs). LMICs are experiencing a higher burden of CVD deaths due to rapid urbanization, aging, and health and nutrition transitions. It is projected that by the year 2030, CVDs will cause more than 23.6 million deaths with stroke and coronary heart diseases being the main contributors if no appropriate measures are taken to alleviate the problem [1].

Tanzania, like other developing countries, is also facing a higher burden of CVDs. CVDs alone account for 13% of the total deaths caused by non-communicable diseases in Tanzania with adults aged 25–64 years being affected the most [2]. Age-standardized mortality rates attributed to CVDs were reported to be higher among Tanzanian men compared to women (473 versus 382 per 10,000 population) [3].

Trends of CVD death rates in SSA, including Tanzania, are highly driven by lifestyle changes, characterized by low levels of physical activity, excessive alcohol consumption, tobacco use and unhealthy eating. Poor management of these factors has resulted in intermediate risk factors such as raised blood pressure, raised blood cholesterol, diabetes, overweight and obesity, that have direct linkage with CVDs. All these factors occur as a result of rapid urbanization, modernization, socio-economic status and increased advertisement of the Westernized food market [3].

Despite the rising prevalence of CVDs in Tanzania, knowledge about their risk factors and warning signs in the Tanzanian general population is generally low, especially among individuals from rural areas. However, even those with adequate knowledge of CVDs are subjected to the risk of developing them due to disparity between their health literacy and lifestyle choices [4].

5 Most Common Cardiovascular Diseases

  1. Heart Attack

A heart attack, also known as myocardial infarction, refers to death or permanent damage of an area of the heart muscle which occurs when it is cut off from the oxygen it needs to operate. It is a medical emergency which happens because the blood flow delivering that oxygen has been significantly reduced or stops entirely. This is due to atherosclerosis, or the slow buildup of plaque, which includes fat, cholesterol, and other substances, in the coronary arteries. Blood clots can then form around the plaque, which tend to slow or block the blood flow and cause a heart attack. A heart attack may be severe enough to cause death or it may be silent.

  1. Stroke

Stroke is considered a heart disease because the condition centers around blood flow. However, a stroke is due to problems with blood flow to the brain rather than the heart. Ischemic strokes account for 87 percent of all strokes and occur because of blockage in a blood vessel that delivers blood and oxygen to the brain. Without blood and oxygen, parts of the brain can suffer damage or die off if not treated quickly. Hemorrhagic strokes make up about 13% of stroke cases and occur when weakened blood vessels in the brain rupture or burst resulting in bleeding in the brain. When blood accumulates in the tissue around the rupture, it puts pressure on brain cells and damages them. Hemorrhagic strokes may have various causes such as a vascular malformation or abnormal growth of brain blood vessels.

  1. Heart Failure

Heart failure, also called congestive heart failure, refers to the heart not pumping blood as well as it should. It does not mean the heart has stopped beating entirely, as the name might suggest. The heart continues to pump blood, but not at a high enough rate for the body to continue to function. The fatigue and shortness of breath that can result from untreated heart failure can greatly interfere with everyday activities like walking or climbing stairs.

  1. Arrhythmia

A heart arrhythmia is any abnormal rhythm of the heart: too slow, too fast, or at an irregular beat or tempo. Without proper rhythm, the heart doesn’t work as effectively. The heart may not be able to pump enough blood to deliver oxygen and nutrients to other organs.

  1. Heart Valve Complications

Like arrhythmias, heart valve complications can cover a variety of different abnormalities. Stenosis means the valves in the heart don’t open enough to allow blood to flow through normally. Regurgitation occurs when the heart valves do not close correctly, which enables blood to leak through. Like the arteries in your heart, the heart valves also need to operate properly to stave off life-changing complications [5].

Risk Factors

Risk factors for CVDs fall into three broad categories: intermediate, modifiable/behavioural, and non-modifiable as illustrated in the schematic below [3].

Intermediate risk factors

Intermediate risk factors are health/medical conditions that appear as a result of uncontrolled behavioral risk factors. Key intermediate risk factors for CVDs include raised blood pressure (hypertension), diabetes, raised blood cholesterol, and overweight and obesity.

1.     Hypertension

Uncontrolled blood pressure can result in more health complications, including CVDs such as myocardial infarction, aneurysms, and stroke and other heart diseases. According to the 2014 WHO country profile report for non-communicable diseases (NCDs), approximately 31.6% of men and 29.4% of women in Tanzania were hypertensive. Moreover, there is a rapid increase in prevalence of hypertension in Tanzania, with significant variation between rural and urban settings that is characterized by sedentary lifestyles, urbanization and aging population. Results from prospective observational study conducted at the Cardiovascular Center of Muhimbili National Hospital in Dar es Salaam showed that, 45% of the heart failure patients were hypertensive. Despite a higher prevalence of hypertension in different areas of Tanzania, many people are not aware of the related risk factors, with low rate of diagnosis and treatment [3].

2.     Raised cholesterol

It is known that raised blood cholesterol is a common risk factor for CVDs, including ischemic heart diseases, stroke and heart failure. Prevalence of raised blood cholesterol is influenced by sedentary lifestyles and rapid urbanization. Furthermore, poor dietary diversification contributes to increased blood cholesterol. Lower intake of fruits and vegetables and higher intake of red meat have been linked to increased levels of blood cholesterol. Nearly 20% of males and 24% of females in Tanzania had high blood cholesterol >5 mmol/L according to WHO estimates in 2010. Kilimanjaro region have been reported with highest prevalence of raised cholesterol (17.4% of men and 19% of women) compared to other regions of Tanzania like Morogoro (5% of men and 6.7% of women) and Mara (4.8% of men and 6.9% of women) [3]. 

3.     Diabetes

Diabetes is a prime risk factor for cardiovascular disease (CVD). Vascular disorders include retinopathy and nephropathy, peripheral vascular disease (PVD), stroke, and coronary artery disease (CAD). Diabetes also affects the heart muscle, causing both systolic and diastolic heart failure. According to 2017 International Diabetes Federation estimates, more than 1.7 million people living in Sub-Saharan region are diabetic and Tanzania has been mentioned as among the country with the highest prevalence of diabetes. Results from the 2012 national survey showed that more than 9% (8% of men and 10% of women) of adult population aged ≥25 years were diabetic. Higher prevalence of diabetes is highly driven by rapid urbanization, sedentary lifestyles, and nutrition transition, which tend to promote overweightness and obesity [3].

Lack of diabetes guidelines, screening tools, poor reporting system, inadequate drug therapy and lack of training among healthcare providers and beneficiaries have been found to be potential reasons as to why many dispensaries and healthcare centers fail to provide valuable diabetic care in Tanzania. All these lead to the increased diabetic complications including angina, myocardial infarction, stroke, peripheral artery disease, and congestive heart failure. Despite the growing trends of diabetes in Tanzania, still there is low rate of awareness on diabetes and its complications in the population [3].

4.     Overweight and obesity

Overweight and obesity are defined as a body mass index of ≥24.9 and ≥29.9 kg/m2, respectively. The likelihood of chronic diseases such as diabetes, hypertension, as well as CVDs including coronary artery disease and and stroke, increases with increased body mass index (BMI ≥24.9 kg/m2). Both socio-demographic characteristics and economic factors influence occurrence of overweight and obesity in the population. However, lack of enough statistics, together with socio-cultural beliefs, create greater challenges in understanding the trends of overweight and obesity as public health challenges in African countries, including Tanzania. Findings from multi-country cross-sectional study conducted in 2016 in four SSA countries showed higher prevalence of overweight and obesity of 46% in rural Uganda, 48% in peri-urban Uganda, 68% in urban Nigeria, 75% in urban Tanzania and 85% in urban South Africa. Prevalence of overweight and obesity are still increasing in Tanzania as reported in the STEPwise survey conducted in the country in 2012, which showed 26% of the adult population aged >25–64 years were overweight and obese, with women being more affected than men (37% of women versus 15% of men). Few studies conducted in the country, especially in urban Der es Salaam, showed higher prevalence of overweight and obesity among school-age children. For example, a study by Mpembeni and colleagues reported the prevalence of overweight and obesity of 15% (10.1% boys and 19.4% girls) among primary school children in Dar es Salaam, Tanzania [3].

Modifiable risk factors

Modifiable/behavioral risk factors are most common preventable risk factors that underlie the development of CVDs. These include unhealthy eating, tobacco use, excessive alcohol intake, and physical inactivity. Poor management and prevention of these risk factors leads to metabolic/physiological changes that accelerate the development of CVDs.

  1. Alcohol use

Alcohol consumption has been associated with increased risk of developing CVDs including atrial fibrillation (an abnormal cardiac rhythm), cardiomyopathy, acute myocardial infarction, hemorrhagic stroke, and ischemic stroke as it promotes raised blood cholesterol, high blood pressure, platelet coagulation and increased fibrinolysis.  In 2012, prevalence of alcohol consumption among men and women in Tanzania were reported to range from 23–38% and 13–13%, respectively. Further results showed that 29.4% (38.3% men and 20.9% women) of the adult population were current alcohol users. Among them, 27.4% of men and 13.4% of women were binge drinkers. Moreover, 17.2% of adults aged 15–59 years were reported as current alcohol users in urban settings, and this was associated with socio-economic status of urban dwellers. Some of the chronic diseases such as hypertension, and diabetes are increasing in Tanzania due to the high number of alcohol drinkers. Higher prevalence of hypertension (50%) was reported among alcohol users compared to non-alcohol users (49.3%) in a study conducted in Mafia Island. Furthermore, alcohol consumption was related to increased CVD risk factors, such as diabetes (9.8%) hypertension (53.3%), overweight and obesity (73.3%) among study participants [3]. 

  1. Unhealthy diets

Diet plays an essential role in the etiology and pathophysiology of different CVDs. Diet and nutrition have been recognized as major contributors atherosclerotic plaque formation and development of CVDs, including coronary heart disease and stroke. Unhealthy diet is linked to other CVD risk factors such as high blood pressure, elevated blood cholesterol, diabetes, overweight and obesity. According to a subnational STEP survey conducted by WHO in 2012, only 9.2% of individuals aged 25–64 years in Tanzania consumed at least less than 5 servings of fruits or vegetables on average per day. A study conducted in peri-urban Tanzania revealed the association between use of palm oil as cooking oil, inadequate consumption of fruits and vegetables and high intake of meat with increased blood cholesterol. Higher prevalence of hypertension in urban areas, especially among women, has been related to higher consumption of meat and coconut oils. Moreover, higher consumption of protein-rich foods, particularly meat, milk and blood with an inadequate intake of fruits and vegetables were associated with increased risk of hypertension among Maasai living in Simanjiro district. Higher consumption of highly processed foods, dietary salt with low levels of physical activity, and low knowledge of dietary choices were associated with increased prevalence of hypertension in different settings of Tanzania [3].

  1. Physical inactivity

People who do not engage in regular exercise or physical activity are more likely to have hypertension, high blood cholesterol and be overweight or obese. In Tanzania, low levels of physical activity have been associated with increased body weight, diabetes, unfavorable lipid patterns and other CVD risk factors in rural and urban settings. Urban settings represent lower levels of physical activity compared to rural areas, which might be due to sedentary lifestyles adopted by urban dwellers as opposed to manual activities performed by rural dwellers. Therefore, the urban population in Tanzania faces a higher incidence of overweight, obesity, and elevated blood cholesterol levels than the rural population. A prospective cohort study conducted in Tanzania showed that migration from rural to urban areas reduced the level of physical activity by 52.9% (79.4% to 26.5%) in men and 21.9% (37.8% to 15.6%) in women [3].

  1. Tobacco use
Smoking is a major contributor of CVDs as it can potentially cause atherosclerosis and raise blood pressure. Currently, there is no much information concerning the use of tobacco in Tanzania, however, few studies have documented higher incidence of tobacco use among men and women. In 2018, the prevalence of smoking in Tanzania was 13.30%, a 0.8% decline from 2016 [6]. This refers to the percentage of men and women aged 15 and over who currently smoke any form of tobacco product including including cigarettes, cigars, and pipes, and excluding smokeless tobacco on a daily or non-daily basis. The rates are age-standardized. Additionally, the prevalence of hypertension was observed to be higher (52%) among smokers compared to non-smoker (26.1%) in a study conducted in Dar es Salaam [3].

Non-modifiable risk factors

Non-modifiable risk factors are factors that cannot be changed which include age, sex, race or ethnicity, and family history. The more of these risk factors you have, the greater your chance of developing CVDs.

  • Increasing Age. The majority of people who die of coronary heart disease are 65 or older. While heart attacks can strike people of both sexes in old age, women are at greater risk of dying (within a few weeks).
  • Male gender. Men have a greater risk of heart attack than women do, and men have attacks earlier in life. Even after women reach the age of menopause, when women’s death rate from heart disease increases, women’s risk for heart attack is less than that for men.
  • Heredity (including race/ethnicity). Children of parents with heart disease are more likely to develop heart disease themselves. African-Americans have more severe high blood pressure than Caucasians, and a higher risk of heart disease. Most people with a significant family history of heart disease have one or more other risk factors. Just as you can’t control your age, sex and race, you can’t control your family history. So, it’s even more important to treat and control any other modifiable risk factors you have [7].

Tanzania is experiencing rapid growth of modifiable and intermediate risk factors that accelerate CVD mortality and morbidity rates. In both rural and urban settings, cardiovascular risk factors such as tobacco use, excessive alcohol consumption, unhealthy diet, hypertension, diabetes, hyperlipidemia (high level of cholesterol or triglycerides in blood), overweight, and obesity, are documented to be higher. Increased urbanization, lifestyle changes, lack of awareness and rural to urban movement have been found to increase CVD risk factors in Tanzania. Despite the identification of modifiable risk factors for CVDs, there is still limited information on physical inactivity and eating habits among the Tanzanian population that needs to be addressed [3].



[2] orecard-Tanzania.pdf






Fight Against Tuberculosis

by Senthamaraiselvan Pooja – Art in Tanzania internship

Background of Tuberculosis

Tuberculosis (TB) is an airborne infectious disease caused by a bacterium called Mycobacterium tuberculosis. The United Republic of Tanzania is one of the 30 countries with the highest burden of TB in the world. According to WHO, 142 000 people (253 per 100 000 population) fell ill with TB in 2018 [1].

A large proportion of persons with the illness (90% to 95%) have latent TB infection (LTBI) in which case they do not exhibit any symptoms as the immune system will contain and control the infection. However, the infection typically does not get eliminated and most people with LTBI do not know that they are infected because they do not feel sick.

The bacteria can remain inactive for many years and the chance of developing active TB decreases over time [2].

Approximately 5% to 10% of individuals are not able to control the initial infection and will develop primary tuberculosis. The dormant bacteria can also become active again in a few of those with LTBI due to various factors that compromise the immune system. Active tuberculosis among this group is referred to as reactivation tuberculosis [3].

Main Differences between Latent and Active TB
Latent TB
●                     TB bacteria are “asleep” in your body
●                     You do not have symptoms and you feel well
●                     You cannot pass TB on to others
●                     It can only be detected through a blood test or TB skin test
Active TB
●                     TB bacteria are “awake” and making you ill
●                     You will have symptoms that make you feel unwell
●                     You can pass TB to others if it is in your lungs
●                     It shows up on a chest x-ray if you have TB in the lungs [4]
Symptoms of Active TB
Tuberculosis most often affects the lungs and respiratory tract. This is known as pulmonary TB. However, TB can affect almost any organ system. Active tuberculosis can manifest as pulmonary or extrapulmonary disease irrespective of whether the individual is a primary or reactivation case. However, approximately 80% of clinically manifested tuberculosis is pulmonary among individuals with good immune function, while extrapulmonary tuberculosis can be seen more frequently in immunocompromised people.
Pulmonary TB can be mild or severe and present with any of the following symptoms: excessive coughing (sometimes with blood in the sputum), chest pain, general weakness, lack of appetite, weight loss, swollen lymph glands, fever, night sweats, chills, and fatigue. Extrapulmonary TB can also present with fever, fatigue, night sweats, and progressive weakness, but prominent symptoms will typically stem from the affected organ system.
Extrapulmonary TB commonly involve the pericardium (thin sac surrounding the heart), lymph nodes (small, oval-shaped cluster of immune cells located throughout the body), urogenital area, gastrointestinal tract, central nervous system, adrenal glands, bones, eyes, and skin [3]. If untreated, active TB can be life-threatening.

TB Transmission

TB is spread to susceptible individuals when they breathe in contaminated droplets that are released into the air when an infected person (with Active Tuberculosis) nearby sneezes, coughs, talks or laughs. Humans can also get ill with TB by ingesting unpasteurized milk products contaminated with Mycobacterium bovis, also known as Bovine Tuberculosis [2].

Risk Factors for Progression and Development of Active TB Disease

In general, people at high risk for developing active TB once infected with M. tuberculosis include:

  • People living with HIV/AIDS
  • Children younger than 5 years of age
  • Persons who are receiving immunosuppressive therapy
  • Persons who were recently infected with M. tuberculosis (within the past 2 years)
  • Persons with a history of untreated or inadequately treated TB disease
  • Persons with silicosis, diabetes, chronic renal failure, leukemia, lymphoma, or cancer of the head, neck, or lung
  • Persons who have had a gastrectomy or jejunoileal bypass
  • Persons who weigh less than 90% of their ideal body weight
  • Cigarette smokers and persons who abuse drugs or alcohol
  • Populations defined locally as having an increased incidence of TB disease, possibly including medically underserved or low-income populations [5]

TB Control and Prevention

Individual Level

  • Keep your immune system strong by eating healthy and exercising
  • Avoid exposure to people known to who have active TB.
  • Surgical masks should be worn by patients with active TB to prevent infectious droplets from being expelled into the air.
  • Only consume pasteurized milk products.
  • Travellers at higher risk should have a pre-departure tuberculin skin test (TST) and be re-tested upon their return home.
  • Those at increased risk should also consult their healthcare provider to determine if the Bacillus Calmette-Guérin (BCG) vaccine is recommended [2].

Community Level

There are several critical factors that need to be taken into account to implement an effective tuberculosis control and prevention program to protect the community.

  1. Significant resources including public health infrastructure and personnel are required to enact and sustain tuberculosis control programs. Sustainability is critical because control of this disease requires a long-term effort. As such, a strong commitment by government agencies, which can mobilize the necessary resources and infrastructure, is essential for regional control of tuberculosis.
  • Rigorous case finding and treatment is obviously critical to save the affected individuals as well as stop transmission of infection to contacts. Case identification must combine microscopy and clinical symptoms, and treatment should consist of the short-course of directly observed therapy (DOTS) elaborated below.
  • Exhaustive contact tracing for contacts of each active tuberculosis case should be carried out in the field so that new infections can be identified and treated before becoming active cases.
  • A good surveillance system is fundamental to the control of any infectious disease. An administrative system for recording cases and monitoring outcomes is necessary to estimate the occurrence of disease and identify temporal trends and spatial clusters.
  • An adequate supply of tuberculosis medications must be available to populations with endemic tuberculosis. This may seem obvious, and it is, but unfortunately the lack of a consistent supply of medication has hampered many control programs particularly in poor areas of the developing world [3].


Germicidal ultraviolet lamps can be installed to kill airborne bacteria in buildings where people at high risk of tuberculosis live or congregate. A germicidal lamp is an electric light that produces ultraviolet C (UVC) light. UVC light kills tuberculosis bacteria, including drug-resistant strains, by damaging their DNA so they cannot infect people, grow or divide [6].

TB Treatment

Treating tuberculosis requires a long-term commitment. Specifically, at least 6 months of treatment are required because of the heterogeneous population of M. tuberculosis in an infected individual, which is composed of bacteria in active and dormant states. Medication that is effective against active mycobacteria may not work against latent mycobacteria and, thus, extended treatment ensures that the whole population of M. tuberculosis will eventually be exposed to the drug. Inactive tuberculosis may be treated with an antibiotic, isoniazid (INH), to prevent the TB infection from becoming active. Active tuberculosis is treated, usually successfully, with isoniazid in combination with one or more of several drugs, including rifampin, ethambutol, pyrazinamide, and streptomycin.

However, drug-resistant TB is a serious, as yet unsolved, public-health problem, among several regions including Africa. Undergoing treatment over a long time favors the emergence of drug-resistance gene mutations in the M. tuberculosis population.

Thus, at least two effective drugs must be administered: this reduces the probability of developing drug-resistant bacilli.

Poor patient compliance, lack of detection of resistant strains, and unavailable therapy are also key reasons for the development of drug-resistant TB. Non-adherence can lead to treatment failure in the individual as well as the development of antibiotic resistant forms of M. tuberculosis.

Therefore, adherence to treatment with the full regimen is essential for treatment success. To effect complete resolution of infection in the individual and mitigate the spread of antibiotic resistance in the population, WHO recommends the short-course strategy of directly observed therapy (DOTS) regimen, comprised of four drugs (typically isoniazid, rifampicin, pyrazinamide, and ethambutol) for two months, followed by two drugs (typically isoniazid and rifampicin) for four months.

DOTS regimen requires a healthcare worker to monitor each tuberculosis patient closely and observe the patient taking each dose of anti-tuberculosis medication to ensure proper compliance [3].








ENVIRONMENTAL POLLUTION (Causes, effects and remedies)

by Maria Mazzoli, –  Art in Tanzania internship

What is pollution?

Pollution is the introduction of harmful materials into the environment. These harmful materials are called pollutants.

•Trash and runoff produced by factories are examples of pollutants created by human activity.

•Pollutants damage the quality of air, water and land.

•Many things that are useful to people produce pollution (cars spew pollutants from their exhaust pipes).

•All living things depend on Earth’s air and water. When these resources are polluted, all forms of life are threatened.  

Pollution is a global problem:

Although urban areas are more polluted than the countryside, pollution can spread to remote places where no people live.

In the middle of the northern Pacific Ocean, a huge collection of microscopic plastic particles forms what is known as the Great Pacific Garbage Patch.

Air and water currents carry pollution.

. Which are the different types of pollution?

We can identify several types of pollution on Earth:

Air pollution:

• The main sources of air pollution are gases pouring from the exhaust pipes of factories and burning fossil fuels (coal, oil, and natural gas).
• When fossil fuels are burned, they produce carbon monoxide, a colorless, odorless gas, which is harmful in high concentration.
• Polluted air makes people’s eyes burn and make them have difficulty breathing.

Water pollution:

Polluted water looks muddy, smells bad, and has garbage floating in it.

Some polluted water looks clean, but it is filled with harmful chemicals you can’t see or smell.

Polluted water is unsafe for drinking and swimming.

Sometimes, people get sick because they eat fish that lived in polluted water.

Sources of water pollution:

•When Chemicals and oils from factories are dumped into waterways, they create a toxic environment for aquatic life. •Mining and drilling can also contribute to water pollution.

=>Acid helps miners to remove coal from the rocks, but when it is washed into rivers, it releases chemical sulfur, which is toxic to plants, fish, and humans.

=>Oil spills can produce large plumes of oil under the sea and oil slick on the surface killing marsh plants and aquatic organisms

=>In 2010 more than 2 million animals died as a result of the Deep-water Horizon oil spill.


Fertilizer is material added to soil to make plants grow larger and faster.

Rainwater washes fertilizers into streams and lakes, where chemicals contained in the fertilizers cause harmful algal blooms.


There are certain rivers that have so much garbage floating in them that you cannot even see the water.

Floating trash makes it difficult to fish in.

Trash is a threat to fish and seabirds, which mistake the plastic for food.

Land pollution:

•Many of the same pollutants that foul the water also harm the land.

•Mining leaves the soil contaminated with dangerous chemicals.

•Pesticides and fertilizer from agriculture are blown by the wind, and can harm plants, animals and people.

•Trash mar the landscape. Litter makes it difficult for plants to grow well. Garbage contains pollutants as oil, chemicals and ink.

Focus on Greenhouse gases (GHGs):

GHGs are the main source of air pollution.

GHGs such as carbone dioxide (CO2) and methane (CH4) occur naturally in the atmosphere.

They absorb sunlight reflected from earth, preventing it from escaping into space.

By trapping heat in the atmosphere, they keep Earth warm enough for people to live. This is called greenhouse effect.

What happens when the level of GHGs is too high?

Some human activities, such as burning fossil fuels, increase the amount of GHGs in the atmosphere.

More GHGs in the atmosphere result in increased heat across the globe.

This is called global warming.

Global warming is causing ice sheets and glaciers to melt.

Melting ice is causing sea levels to rise.

This will flood low-lying coastal regions.

Entire regions (such as Maldives) are threatened by this climate change.

Global warming also contributes to the process of ocean acidification.

It means that the ocean absorbs more CO2 from the atmosphere and becomes acid.

The ocean food web is threatened as plants and animals such as coral  fail to adapt to more acid oceans.

Global warming is causing increases in storms, droughts, and flooding.

Since more greenhouse gas emissions are released into the air, causing air temperatures to increase, more moisture evaporates from land and lakes, rivers, and other bodies of water.

Warmer temperatures also increase evaporation in plant soils, which affects plant life and can reduce rainfall even more.

And when rainfall does come to drought-stricken areas, the drier soils it hits are less able to absorb the water, increasing the likelihood of flooding.

The commitment of the International community:

The Paris Agreement is the most recent international treaty on climate change.

 It was adopted by 196 countries (among which Tanzania) in Paris (France), on 12 December 2015.

Its goal is to limit global warming, by reducing greenhouse gases.

Tanzania’s commitment includes adaptation and mitigation measures such as planting adequate trees and sustainably using existing forest and woodland resources.




Welcome to carry out a Paint and Prevent workshop! This workshop framework introduces an evidence-based, piloted day of fun, mixing visual arts and facts about the importance of handwashing in infection prevention.

The workshop you are about to carry out aims at teaching the participants handwashing skills and knowledge. It consists of two parts: first, engaging the participants in a conversation about handwashing, and second, strengthening their memory with a painting session.

The framework was created as a part of two Global Health and Crisis Management Master’s students’ thesis project in Finland. The workshops will be carried out for the first time in March 2021. The outcomes of these first workshops will be studied by comparing before and after intervention surveys from the participants.

This is the first version of the framework. The partners of the project are Laurea University of Applied Sciences, Finland, and Art in Tanzania, Tanzania and Finland. This study is organized by Global Health and Crisis Management students Emmi Hamara and Noemi Watson and the main supervisor of this research is principal lecturer Teija-Kaisa Aholaakko from Laurea University. The partner organization in the study is Art in Tanzania.

  1. The Ten Hand washing Topics

Familiarise yourself with the ten handwashing topics on page 10 and the additional material in the links on page 12. The more you know about the topics, the better.

2. Materials

You will need a room or outdoors space, which comfortably accommodates the participants and you. You may choose between having desks or just everyone sitting on the floor or ground, as long as there is enough space for everyone to do their art.
You will also need art supplies for painting or drawing, and the more the better! Paper used should be sturdy, and there should be at least a couple of sheets per participant. Carboard is fine, too. A small hand soap will also be given to each participant after the workshop. The workshop could take anything between 2 to 4 hours.

3. Structure

The workshop starts with you telling the participants why they are there. They have been invited to the workshop to learn about handwashing skills and knowledge. Emphasise the fact they are all there to have fun and to learn about handwashing!

All participants, as well as you, introduce themselves. You may ask them also if they like drawing or painting. Let everyone have a chance to speak. This may take 10 to 20 minutes.

After this, start the discussion about the ten topics. The structure is simple: Bring up any of the topics by asking a leading question about the participants’ habits and knowledge. For example:

“How many of you use soap if it’s available, when washing their hands?”

“Do you have running water available when washing your hands? Do you use it? Do your friends have access to running water?””

“Do you think it is important to wash your hands more because of the Covid-19 pandemic?”

“Who could show the correct handwashing technique?”

“How many washed their hands today before breakfast?”

“Do you like to dry your hands after washing them? Why do you think this may be important?”

“Do you think you can prevent illnesses by washing your hands?”

“Do you think your hands may be extra dirty in certain places?”

“Does anyone know how the germs get into your body from your hands?”

“What other benefits could one get from washing their hands?”

After each question, allow discussion. Encourage the participants to give out their opinion and share their thoughts and ideas. “Wrong answers” may come up, but in these cases provide the participants with correct information. During the conversation on each topic, at some point, provide the correct information. The participants may come from different backgrounds, and their ideas may be different, or they reflect their habits against how accessible hand washing facilities are for them. This is fine. The information given during the workshop should increase their knowledge so that they can understand the importance of aiming at as good hand washing practices, as possible. 

The discussion should take about 30 to 60 minutes. Make sure you go through each one of the ten handwashing topics.

After you have talked about each of the topics, start painting! Introduce the task: everyone can paint or draw about their feeling or thoughts about the discussion. Give them some ideas: they could for example visualize a situation where they are using correct hand washing technique, or draw germs, or paint something about their current hand washing habits. Anything goes! Remember to provide help with using the art supplies, as well. Creating the visual art pieces may take anything from 30 to 60 minutes or even longer, depending on the participants, and the time you have reserved for the workshop.

Finally, it is time for a little art exhibition! In this part, hang or lay out the artwork on a wall, desks or ground. Let everyone introduce what they have done and encourage discussion. There are no “wrong answers” in this part, and the artwork are not graded or critiqued. This is also a fine opportunity to provide the participants with correct information on the 10 hand washing topics, if you notice something is still misunderstood.

Last, give the participants their artwork to take home with them and to remind them of what they have just learned!

The hand washing topics

Ten key items:Identifying learning needs:Transferrable knowledge:
SoapIdentifying the relevance of soap in handwashing manners.Soap should be used every time hands are washed, to remove pathogens efficiently.
TimingIdentifying when washing your hands is necessary.The correct handwashing times: Before, during, and after preparing food; before eating food; before and after caring for someone at home who is sick with vomiting or diarrhoea; before and after treating a cut or wound; after using the toilet; after changing diapers or cleaning up a child who has used the toilet; after blowing your nose, coughing, or sneezing; after touching an animal, animal feed, or animal waste; after handling pet food or pet treats, and after touching garbage
DryingIdentifying the importance of drying hands regarding infection prevention.Hands should be dried completely dry with a clean towel after washing your hands, to prevent pathogens from attaching to the skin
TechniqueIdentifying the need to cover each part of your hands, while washing your hands. Identifying the correct order and duration of handwashing.The correct order for handwashing is: add water, add soap, scrub, rinse, dry. Hands should be scrubbed together 20 seconds after adding soap to remove pathogens efficiently.
Running water  Identifying the importance of running water.Running water is an important part of handwashing for removing pathogens and soap efficiently, also in the reduction of skin irritation from soap. It is also safer than stagnated water. Water does not have to be hot. Cool water may cause less skin irritation and is more environmentally friendly than warmer water
Preventing illnessIdentifying that handwashing prevents diarrheal disease and respiratory infection related illness and deaths.Washing hands regularly prevents respiratory infections and diarrhoeal diseases, common cold, flu and the spread of anti-microbial resistant bacteria.
Locating pathogensIdentifying the locations and pathogens living on one´s hands.Most of the microbes on one´s hands live under the fingernails. Normal human flora (germs) can be dangerous in wrong places.
Routes of transmissionIdentifying the most common ways pathogens move from hands to peopleThrough hands to mouth, nose and ears, as well as surfaces.
Global Infection preventionIdentifying the effects of handwashing in a global health aspect.Handwashing is one of the most effective preventative method regarding infection control, and during the Covid-19 pandemic handwashing should be even more regular. Prevents antibiotic resistant pathogens.
AccessibilityIdentifying global issues with running water and lack of soap.40% of the world´s population live in areas where water and soap are inaccessible. Only 19% of adolescents in Tanzania wash their hands after using toilet.

Additional information at:

Burton, M., Cobb, E., Donachie, P., Curtis, V. & Schmidt, W-P. 2011. The effects of Handwashing with Water or Soap on Bacterial Contamination of Hands. International Journal of Environmental Research and Public Health. 8(1), 97-104.

Centres for Disease Control and Prevention 2020. Hand Washing: a Family Activity.

Centres for Disease Control and Prevention. 2020. When and How to Wash your hands..

Centres for Disease Control and Prevention. 2020. Show me the Science – How to Wash Your Hands.

Centres for Disease Control and Prevention. 2020. Global Hand Washing Day.

Centres of Disease Control and Prevention. 2020. Show Me the Science- Why Wash your Hands.

Jefferson, T., Del Mar, C., Dooley, L., Ferroni, E., Al-Ansary, L., Bawazeer, G., van Driel, M., Nair, S., Jones, M., Thorning, S. & Conly, J. 2011. Physical interventions to interrupt or reduce the spread of respiratory viruses. Cochrane Library.

Ministry of Health, Community Development, Gender, Elderly and Children. 2017. Tanzania Mainland Global School-based Student Health Survey Country Report.

National Health Services. 2019. How to wash your hands.

United Nations Children’s Fund & World Health organization. 2020. Hand Hygiene for All.

World Health Organization. 2009. Hand Hygiene: Why, How and When?

World Health Organization. 2018. Adolescent Health in UR Tanzania.

World Health Organization. 2020a. Country information. Adolescent Health.

World Health Organization. 2020b. United Republic of Tanzania. Statistics.

Text and editing: Emmi Hamara 2021

Drawings and editing: Noemi Watson 2021

Theme photo: Sharon McCutcheon /

Cover photo: Anna Kolosyuk /

For more information or feedback, contact:

Noemi Watson, RMN

Emmi Hamara, RN

Maternal Health in Tanzania

Tiffany Lo-Art in Tanzania Internship

In Tanzania, there are 566 maternal deaths for every 100,000 live births, which represents the sixth highest maternal mortality ratio in the world, according to the Tanzania Demographic and Health Survey (Gailey and McMillan, 2019). The Kigoma Region, which is located in western Tanzania, has the poorest maternal health outcomes in the country (Gailey and McMillan, 2019).

In Tanzania, public health policy and program implementation is overseen by the Ministry of Health and Social Welfare (MOHSW) (Franz, 2015). The point of entry for mothers and children into the public health system is the community-level dispensary, where patients can access exams, medical supplies, medicines, immunization services and seek advice from a nurse or clinical officer (Franz, 2015). Some dispensaries are also prepared for labor and delivery services, and many also offer HIV treatment options and services for prevention of mother-to-children transmission of HIV (Franz, 2015). However, for more comprehensive healthcare services or physician consultations, mothers must visit a health center, which typically offers a wider range of services than the dispensary and may serve several communities (Franz, 2015).

Most maternal deaths are caused by factors that can be attributed to pregnancy, childbirth, and low quality of health services (Shija et. al, 2011). More than 80% of maternal deaths can be prevented if women have access to essential maternity care and skilled attendance at childbirth as well as emergency obstetric care (Shija et. al, 2011).

Maternal Health Indicators:

Antenatal Care Coverage

Antenatal care can help women adequately prepare for delivery and understand warning signs during pregnancy and childbirth (Unicef, 2020). Essential interventions in antenatal care include identification and management of obstetric complications such as pre-eclampsia, tetanus toxoid, immunization, intermittent preventive treatment for malaria during pregnancy, and identification and management of infections such as HIV, syphilis, and other sexually transmitted infections (STIs) (Lincetto et. al, n.d.). Antenatal care is also an opportunity to promote the usage of skilled attendants at birth and healthy behaviors such as breastfeeding, early postnatal care, and planning for pregnancy spacing (Lincetto et. al, n.d.). There have been large increases in the proportion of Tanzanian women who made one to three antenatal care visits from 26.4% in 1999 to 47.0% in 2016 (Rwabilimbo et. al, 2020). In rural areas, 45% of women made at least 4 antenatal care visits compared to 64% in urban areas (Unicef, n.d.).

Skilled Birth Deliveries

Skilled birth attendance is a key factor in indicating maternal health, however, less than 50% of women in sub-Saharan African countries lack the opportunity to be attended by skilled personnel during childbirth (Ngowi, 2017). Major causes of maternal mortality are preventable if a skilled attendant is present during childbirth, and according to the Tanzania Ministry of Health and Social Welfare (MOHSW), only 63% of women delivered at the health facilities and assisted by health care providers and 37% delivered at home, which is below the national target for health facility delivery to be attended by skilled personnel to go up to 80% by 2015 (Ngowi, 2017). There are also disparities between rural communities and urban communities when it comes to skilled birth deliveries—coverage of skilled attendance at birth is 55% in rural communities compared to 87% in urban areas (Unicef, n.d.). One method for reducing maternal morbidity and mortality in Tanzania includes ensuring that all women have access to skilled personnel during childbirth.

Postnatal Care Coverage

Access to care during the postnatal period, which is the six weeks following delivery, is another indicator of maternal health. The postnatal period is a critical phase in the lives of mothers and newborn babies as most maternal and infant deaths occur during this time (WHO, 2020). High quality postnatal care is essential for maternal health, as it provides an opportunity for healthcare providers to facilitate healthy breastfeeding practices, screen for postpartum depression, treat childbirth-related complications, counsel women about family planning options, among other services (Maternal Health Task Force, 2018). However, this is one of the most neglected periods for the provision of quality care (WHO, 2020). In the 2004-2005 Tanzania Demographic and Health Survey (TDHS), it was reported that only 13% women have the recommended one or more postpartum care visit within two days of delivery, with some regions having rates as low as 2% (Mrisho, 2009). Increasing knowledge of and access to postnatal care is essential to improving maternal health in Tanzania.

Modern Family Planning Use

Family planning is critical for preventing unintended pregnancies and unsafe abortions, both of which contribute to lowering maternal and child mortality rates (DSW, 2017). Family planning also helps in poverty reduction and empowers women and men to choose freely and responsibly the number and spacing of children (DSW, 2017). It is estimated that in Tanzania, the unmet needs for family planning are at 22% among married women aged 15-19 years old (DSW, 2017). In other words, one in five married women have an unmet need for family planning (DSW, 2017). Tanzania has worked to establish policies and reforms in maternal health, however, funding and budget allocation for family planning remains low and there are still many misconceptions about family planning (DWS, 2017).

Improvements in Maternal Healthcare in Tanzania

The government of Tanzania has articulated ambitious plans to reduce maternal mortality rates by launching the Sharpened One Plan and Big Results Now programs, which outlined a three-pronged approach for ending preventable deaths of women, newborns, and children by providing voluntary family planning services (Franz, 2015). These plans focus on serving regions that face the most challenges and aim to focus the attention of national, regional, and district-level authorities on improving maternal, neonatal, and child health outcomes (Franz, 2015). However, despite ambitious health goals, in 2015, the Ministry of Health and Social Welfare estimated a funding gap of $169.5 million for reproductive, maternal, neonatal, and child health services alone (Franz, 2015). Despite improvements, there is still much to be done in improving maternal healthcare infrastructure in Tanzania.


DSW. (2017). Family Planning in Tanzania: A Review of National and District Policies and Budgets. Retrieved March 27, 2021.

Franz, P. (2015, May 07). Maternal, neonatal, and child health in Tanzania. Retrieved March 26, 2021.

Gailey, A., & McMillan, S. (2019, June 20). Improving Maternal Health in Tanzania. Retrieved March 25, 2021.

Lincetto, O., Mothebesoane-Anoh, S., Gomez, P., & Munjanja, S. (n.d.). Antenatal Care. Retrieved March 25, 2021.

Maternal Health Task Force. (2018, January 08). Postnatal Care. Retrieved March 26, 2021

Mrisho, M., Obrist, B., Schellenberg, J. A., Haws, R. A., Mushi, A. K., Mshinda, H., Tanner, M., Schellenberg, D. (2009, March 04). The use of antenatal and postnatal care: Perspectives         and experiences of women and health care providers in rural southern Tanzania. Retrieved 26, 2021.

Ngowi, A. F., Kamazima, S. R., Kibusi, S., Gesase, A., & Bali, T. (2017, September 06).        

Women’s determinant factors for preferred place of delivery in Dodoma region Tanzania: A cross sectional study. Retrieved March 25, 2021.

Shija, Angela E et al. “Maternal health in fifty years of Tanzania independence: Challenges and opportunities of reducing maternal mortality.” Tanzania journal of health research vol.13,5 Suppl 1 (2011): 352-64. doi:10.4314/thrb.v13i5.5

Rwabilimbo, A. G., Ahmed, K. Y., Page, A., & Ogbo, F. A. (2020, June 03). Trends and factors associated with the utilisation of antenatal care services during the Millennium Development Goals era in Tanzania. Retrieved March 26, 2021.

Unicef. (n.d.). Maternal and Newborn Health Disparities. Retrieved March 26, 2021.          

Unicef. (2020, October 27). Antenatal care. Retrieved March 24, 2021.

World Health Organization. (2020, March 20). WHO recommendations on postnatal care of the mother and newborn. Retrieved March 26, 2021.  


Tanzania Health Care System

By Goodness Njakoi – Art in Tanzania internship

After past eras of global health focused on the efficiency of interventions, in many low- and middle-income countries (LMICs) policymakers and development partners are gradually directing efforts on improvements in quality of healthcare and equity. The reason for this shift of focus is that the effectiveness and efficiency of investments in health are related to the extent to which healthcare services reach an acceptable level of quality. Moreover, quality of care is a determinant of the use of healthcare services, above all for public health facilities. Quality of healthcare is typically characterized as a three-dimensional construct, the components being resources, processes, and outcomes. Quality of services is closely related to providers’ skills and behavior.

Well-functioning health systems are critical for delivery of quality health services globally. The world health organization (WHO) has named three intrinsic goals that are necessary for a health system to perform namely, improving health of the population, fairness in financial contribution and improving the responsiveness of the health system to the population it serves.

Medical volunteering an internship in village clinic in Tanzania

As Tanzania strives to reach middle income status, the health sector has resolved to give more attention to the quality of health services in tandem with the pursuit of universal access. “At the same time, better health for the entire population has been promoted through the adoption of health in all policies.” (“Heal Me | Fais du bénévolat en Tanzanie 2021”) The country has made impressive gains in reducing under-five and infant mortality, through strengthening immunization services and improved preventive services for malaria and other childhood diseases.

The epidemiological transition with non-communicable diseases has shown an upsurge and a subsequent rise in health care costs. Addressing this depended critically on strengthening of the health service delivery system including human resource. The population in Tanzania has increased in the last 10 years. The health system thereby has been adjusting continuously to provide services to an increased number of people. Health services are provided from the grass root level beginning with community health care, dispensaries, and health centers, and continuing through first level hospitals, regional referral hospitals, zonal and national hospitals, all providing increasingly sophisticated and well-defined services.

Due to constraints of key components of the health system like human resources, supplies of medicines and health products, not all primary health services are of sufficient quality. In certain geographical areas, populations still live far away from health services. This has especially been problematic in terms of maternal and newborn care. (“Heal Me | Volunteer in Tanzania 2020”) The referral system does not always function as needed, sometimes due to a lack of adequate transport to the next level of care or due to an inability at the referral level to provide adequate services. Health sector challenges posed by current financing levels and modalities require change to the way financial access to health care is organized, greater efforts on resource mobilization, transparency, and social accountability, as well as more determined measures to strengthen the health system.

despite the Government’s effort to expand geographical access increasing the number of health facilities and aiming at primary healthcare for all, the performance of health providers in rural areas is not yet satisfactory. Health policy reforms in Tanzania touched upon all the points above, including a wave of decentralization by delegation of decisional and managerial responsibilities towards local government authorities. The reform of LGAs in Tanzania strengthened the steering role of councils over the district health systems, with the goal of better addressing the needs of the population by bridging the gap between health services providers and communities. The current structure of the Tanzanian public health system is parallel to the administrative division of government authorities in the country. The central authorities keep control over the main basket fund for health, allocation, and budget for human resources as well as national referral and specialized hospitals. The 30 regions act as intermediary oversight bodies between central and the local authorities, represented by 173 districts. (“Going operational with health systems governance …”) The President’s Office for Regional Administration and Local Government directly oversees and supports the districts in their steering role over the health system, together with Ministry of Health, 1 Ministry of Finance and Planning as well as Regional Authorities. Each district is solely responsible for the management, supervision, and audit of public health facilities within its boundaries, including primary (dispensaries), secondary (health centers) and tertiary level (district hospitals) structures.

Health facilities are organized in a hierarchical structure that is reflected in the referral flows (bottom-up, from primary to secondary or tertiary level structures) and in the cascade supervision arrangements (top-down). Currently, health facilities have autonomy in the use of funds, both for basket fund (through own bank accounts) and for funds generated locally through user fees and Community Health Funds. (“Going operational with health systems governance …”) In the last decade, the Government of Tanzania approved two strategic plans aimed at improving quality of care: the ‘Human Resource for Health and Social Welfare Strategic Plan 2014–2019’ and ‘The Tanzania Quality Improvement Framework in Health Care 2011–2016’. The implementation of bottom-up accountability mechanisms in the healthcare system has been coupled with a cascade supervision system for public health facilities (from tertiary level down to primary care level) as well as external administrative supervision from council authorities. In addition, specific incentive policies for the retention of health workers have been introduced with the aim of improving motivation and satisfaction of healthcare providers.

Over two-thirds of Tanzanians live in rural areas and rely on local health facilities (such as Dispensaries and Health Centers) run by their Local Government Authorities (LGAs) to provide them with basic health services. Therefore, efforts to achieve major, sustainable improvements in local health outcomes will have to ensure that resources (including health staff, drugs and medical supplies, operational expenses, as well as other health-related resources) reach the primary health facilities that form the front-line of public health service delivery in Tanzania.

Quite a bit is known about the composition of public health expenditures in Tanzania. For instance, the Government of Tanzania spends a considerable amount on the health sector—close to 10 percent of its total budgetary resources. Roughly one-third of these resources are channeled to LGAs in the form of sectorial block grants to fund the salaries of local health workers as well as the operation and maintenance cost of District Hospitals and primary health facilities. On average, LGAs receive around TSH 10,700 per person (USD$6) in recurrent health grants each year. In addition, LGAs receive financial resources and in-kind support for the provision of basic health services from a range of various sources, including—among others—the Ministry of Health and Social Welfare; international development partners; user fees; and Tanzania’s National Health Insurance Fund.

Primary Health Facilities (PHFs)

The two types of health facilities closest to the community in Tanzania are Dispensaries (D) and Health Centers (HC). There are currently approximately 3,250 public dispensaries in Tanzania, in comparison to 340 public Health Centers. The formal distinction between Dispensaries and Health Centers is that while Dispensaries exclusively provide out-patient care, a HC should be able to provide around-the-clock care to patients; therefore, any conditions that require in-patient care are referred from dispensaries to the nearest Health Center. “However, the distinction is less clear as many Dispensaries have been upgraded to provide child and maternal health services.” (“Decentralized Local Health Services in Tanzania”) Health centers and Dispensaries are the frontline in providing primary therapeutic and preventive health services in Tanzania and are the main source of health services for much of the population, particularly in rural areas. Although these facilities run with some degree of autonomy on a day-to-day basis, they are supervised by—and fully accountable to—the District Medical Officer (DMO) for all aspects of their operations.


Heal Me | Fais du bénévolat en Tanzanie 2021. (n.d.).

Heal Me | Volunteer in Tanzania 2020. (n.d.).

Going operational with health systems governance. (n.d.).

Decentralized Local Health Services in Tanzania. (n.d.).

Climate Inequality in Tanzania

By Felicity Checksfield – Art in Tanzania internship

What is climate inequality?

Climate inequality refers to the unequal distribution of greenhouse gas emissions that contribute to the unequal distribution of the effects of climate change. In an Oxfam report, it was revealed that the poorest 50% of the global population contribute to only 10% of total CO2 global emissions yet live overwhelmingly in the countries most vulnerable to climate change (Oxfam, 2015). Contrastingly, the richest 10% of the global population can be attributed to 50% of emissions.

In a world where the top 10% of the population is responsible for 34% of house-hold related carbon emissions, it is clear that there exists a correlation between the amount of money available to a community and their subsequent emissions (Hubacek et al, 2017). In the 2017 report, it was revealed that the average carbon footprint of the lowest income category in the world is 1.6 tons per day but drastically increases to 17.9 tons per day for the highest income category. Consequently, the average carbon footprint of the global elites is about 11 times as high as the carbon footprint of the lowest expenditure group.

Climate change is consequently causing a disproportionate impact on developing countries, particularly small island states and low-lying counties. This raises profound justice issues as the contribution of these states to climate change is very small (Ataputtu, 2018). The resource intensive lifestyles in the global north has contributed to the appropriation of the global South’s resources. This has caused harmful economic and environmental consequences in these regions and has trapped Southern nations in vicious cycles of poverty and environmental degradation (Gonzalez, 2015)

How does climate inequality effect Tanzania?

Multiple stressors make Tanzanians highly vulnerable to predicted climate change impacts. The country is projected to warm by 2-4°C by 2100. Rainfall is predicted to decrease by about 20% in the inner parts of the country, with dry seasons becoming longer and drier. In contrast, rainfall may increase by up to 50% in the northeast and southeast (Hulme et al. 2001). Climate change has disastrous impacts on food production, forests, water resources, human settlements, and human health. This is especially disastrous to rural Tanzanian communities whose livelihoods depend on already risky primary production agricultural sources. The average income levels in the country are among the lowest in the world and a lack of access to technological alternatives accentuate their vulnerability.

Vulnerable communities

It is generally accepted that certain groups within states are also disproportionately affected due to historic marginalization and inequities. Women, children and indigenous peoples, those who are living in poverty, and those who are forced to migrate as a result of climate change are among those groups. The Paris Climate Agreement 2015 identified several categories of vulnerable people. These included indigenous peoples, local communities, migrants, children and persons with disabilities (Preamble).

In Tanzania, the vulnerability of these groups are particularly notable.


Rural groups

Climate change will adversely affect food production, energy and water supplies. These are all important preconditions of well-being for rural households.

Urban groups

In Dar es Salaam, two-thirds of the population (over two million people) live in flood-prone areas (UNEP 2002). With poor urban management, increased flooding as a result of extreme weather events makes these citizens incredibly vulnerable.

Women’s activities, such as tilling fields and collecting firewood and water, will be adversely affected by changing climate. More time will be needed for carrying out these activities and less will be left for other activities such as earning an income.


Nutritional deficiencies, illnesses, and a lack of education are all symptoms of a childhood effected by climate change. These can have irreversible consequences that can burden affected.

How is climate inequality being tackled?

Climate inequality is recognised and formally espoused in instruments of international environmental law and human rights. Article 3(1) of the United Nations Framework Convention on Climate Change 1992 introduced a relative capacity element, highlighting the ‘common but differentiated responsibilities and respective capabilities’ of individual states.

This principle asserts that states that cause environmental harm should bear the primary responsibility for solutions and that richer states should take the lead and bear a greater burden because of their greater economic and technological capacity. This was explicitly acknowledged in the 2015 Paris Climate Agreement (Article 2(2)).

Steps are being taken within the international community to address the acute vulnerability of countries in this region. One of the key initiatives launched at the UN Climate Summit in September 2014 was the Extreme Climate Facility (XCF), developed by the African Risk Capacity (ARC). The aim of the XCF was to secure financing for African governments that would enable them to respond to the impacts of increased climate volatility (Dehm, 2020). Each African climatic region would be tracked for the frequency and magnitude of their extreme weather events. When the index exceeded pre-determined thresholds countries automatically received funds to support pre-determined adaptation plans.

This international financial support is not understood as compensation or reparation for the impacts of climate change from historical polluters, but rather as investments to bolster better climate adaptability. This is an important distinction to make. It is vital that appropriate reparations for climate inequality challenge the narrative of Northern states and NGOs as the “saviors” to Southern states. This narrative fails to address the complicity of Northern states in such human rights violations. A critical approach to climate inequality must explicitly address the historic and current causes of climate change, disrupt the savior-savage narrative, and ensure that the discourse appropriately addresses the deeper structural inequities that produce environmental injustice (Gonzalez, 2015).

How is climate inequality being tackled in Tanzania?

In Tanzania, a number of climate adaptation techniques have been developed by rural communities to mitigate the impact of climate inequality. Crop switching is the process whereby farmers plant rice or maize in years with adequate rains and switch to millet in dry years. The use of forest resources for generating cash income (making timber, charcoal, or bricks) in particularly dry seasons can help to mitigate the impact of potential crop failure.

However, adaptation plans, and measures must also alleviate the vulnerability of the most susceptible groups to climate change. Reactive measures, such as those above, are needed to respond to the immediate stresses and hazards of climate change. However, reducing immediate vulnerability is not enough. More systemic changes in governments and institutions are needed to bring about permanent reductions in vulnerabilities.

Effective environmental and social governance is needed for an effective adaptation to the changing climate in Tanzania. Certainly, if literacy rates and educational enrolment continue to decrease, the effectiveness of educational campaigns on climate change and health promotion may decrease. A broad commitment to public programs and spending on health and education is therefore paramount to tackling climate inequality.

To conclude, climate change is having a disastrous impact on communities in the global south, particularly those in eastern Africa. This is a matter of injustice as these communities are contributing the least to carbon emissions. As we have explored, efforts to redress this climate inequality must (a) explicitly address the particularly vulnerable groups to climate change as well as (b) provide a systemic and long-term adaptability framework that appropriately addresses the historic and current causes of climate change. This may come in the form of local schemes of adaptability, national financing mechanisms and better environmental and social governance.


By Mazhar Shahen – Art in Tanzania internship

Africa is a heavily affected region by HIV and AIDS disease, with majority of cases being localized in the eastern and southern sides of Africa. In 2018 there were 1.1 million new cases in Africa of HIV according to World Health Organization (WHO). In 2018 there were 37.9 million cases of HIV patients with 1,7 million of these cases being newly infected in 2018 globally. Out of the 1.7 million new cases globally 1.1 million were majorly located in the sub-Saharan Africa region. 770,000 patients lost their lives to HIV-related illnesses in 2018, 470,000 out of them were people died due to AIDS related diseases in 2018 and 25.7 million people are living with HIV disease.


Human immunodeficiency virus (HIV) is an immune system compromising virus. Acquired immunodeficiency syndrome (AIDS) can be developed if HIV infected patients are not treated. Currently we do not have a cure for HIV, once contracted the person is going to have HIV for the rest of their life. HIV positive patients that do not go under treatment usually go under three stages of progression.

Stage 1 is acute HIV infection; acute condition means severe and sudden. Patients are very contagious with a very large amount of HIV in their blood. Bodies natural response to the virus is flu like symptoms, however this is not all cases as some people do not get sick after the infection, or ever. In the case that a patient is suspecting being HIV positive, an antigen/antibody tests or nucleic acid tests (NATs) only can help confirm the infection.

Stage 2 is chronic HIV infection; chronic condition means long-lasting persisting effects. HIV reproduces at very low levels; however, it is still active. It could be also called asymptomatic HIV infection stage as patients may not have any symptoms during this phase. Without treatment this stage can last a decade or even longer, however some patients might progress at a faster rate. In this stage HIV can be transmitted to others without proper medical treatment. Signs of this stage ending is an increase the HIV in the blood, the viral load, and a decrease in CD4 cell count. People who have access to proper medication may never reach stage 3.

Stage 3 is acquired immunodeficiency syndrome (AIDS). This is the most severed immune system phase, the most critical part of the HIV infection. When the patients develop opportunistic infections (OIs) or have CD4 cell count below 200 cells/mm they are diagnosed with AIDS. AIDS patients have a very badly damages immune system that increases the risk of severe illnesses, OIs. Without treatment AIDS patients usually survive three years.

hiv TReatment

Although there is no cure for HIV with proper treatment with antiretroviral therapy (ART) medicine the HIV virus can be controlled. Majority of patients are able to control the virus within six-month period. This treatment with ART helps prevent the transmission of the HIV disease to others. The viral load, the amount of HIV in the blood, can be reduced using antiretroviral therapy. ART can reduce the viral load to very low levels, to viral suppression levels. Viral suppression is achieved by having less than 200 copies of HIV per milliliter of blood. If HIV patients skip their medications, they will give room for the disease to multiply in a more rapid form, which could lead to compromising the immune system and getting sick. If an HIV positive individual is inconsistently receiving ART medication drug resistance might develop. The HIV can mutate, change, and will develop resistance to responding to certain HIV medication. This will limit the patient’s options for successful HIV treatment. If the HIV is developed into a drug resistant form it will be able to transmit to others. Taking medication consistently as prescribed helps prevent drug resistance.

hiv and babies

HIV-positive mother with an undetectable viral load will help prevent transmission of HIV to her offspring. If a mother with HIV is taking her ART medicine as prescribed consistently throughout the pregnancy, labor, and delivery and supplies the baby with ART medicine for 4-6 weeks after birth, there is less than 1% chance of the baby transmitting HIV disease.

Currently the United States do not recommend mothers which are HIV positive to breastfeed even if they were on their medication. Being on HIV medication does help reduce the risk of transmission to the baby through offspring, however it does not eliminate the risk.

HIv prevention success in Eswatini

Governments and people have the ability to turn around the prevalence of the HIV infection in the region. Eswatini is the first African country to have 95% of people living with HIV know their status, with 95% of them on life-saving ART. The country managed to achieve this 10 year ahead of its 2030 goal. This was done by the government providing counselling, educating the public and mainly providing free ART drugs for HIV patients. This was a very strategic and well thought out plan that could be adapted in several others high risk countries in Africa.

HIv Status in tanzania

As of 2019, 1.7 million people in Tanzania are living with HIV. Currently reports reveal show that 5% of adults are living with HIV in Tanzania, with 40% being unaware of being positive for HIV disease. That is much lower than the UNAIDS target of 90% awareness of people living with positive HIV.

Tanzania is currently undergoing the fourth Health Sector HIV and AIDS Strategic Plan (HSHSP IV) which started in 2017 and ends in 2022. The plan goal is to help increase the access to prevention services to the general public in order to reduce the transmission of HIV. Currently 93.6% of the adults in Tanzania that are aware of their infection are on ART medication, and 87% of those adults on medication are in the viral load suppression stage. There is a significant progress, but there is more work that need to be done in order to meet the UNAIDS criteria in Tanzania. Being aware of the disease and suppressing the viral load is the key to prevent transmission to other individuals. Most common ways to prevent HIV/ADIS transmission: avoiding drug use, sharing needles, having unprotected sex, be monogamous, and vaccination if available.


Cloete, A., Strebel, A., Simbayi, L. C., Wyk, B. v., Henda, N., & Nqeketo, A. (2010). Challenges Faced by People Living with HIV/AIDS in Cape Town, South Africa: Issues for Group Risk Reduction Interventions. Aids Research and Treatment, 2010, 420270-420270. Retrieved 2 25, 2021.

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Gayle, H. D., & Hill, G. L. (2001). Global Impact of Human Immunodeficiency Virus and AIDS. Clinical Microbiology Reviews, 14(2), 327-335. Retrieved 2 25, 2021.

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