Nyerere’s healthcare vision endures amid service expansion

DAR ES SALAAM: WHEN Tanzania gained independence in 1961, access to healthcare remained a major challenge, particularly for rural communities where medical facilities were scarce and distances to essential services were often considerable.

For Mwalimu Julius Nyerere, the country’s founding President, the fight against disease was not merely a health priority but an integral part of the broader struggle to build a nation free from poverty and ignorance.

Twenty-seven years after his death on October 14, 1999, the vision he championed continues to resonate in Tanzania’s healthcare development.

From expanding dispensaries and hospitals to investing in specialised treatment, strengthening community health services and improving affordability and access, the country has made significant strides in bringing healthcare closer to its people.

Today, Tanzania’s health system has expanded considerably from the limited infrastructure available at independence.

The Ministry of Health’s Health Facility Registry lists 14,398 health facilities, including dispensaries, health centres and hospitals, reflecting the scale of infrastructure development aimed at bringing essential services closer to communities.

These figures illustrate the growth of the country’s health system over more than six decades.

They also underscore the enduring importance of primary healthcare, a key element of the rural development approach pursued under Nyerere’s leadership, when extending essential services to ordinary citizens was regarded as fundamental to national progress.

Expanding healthcare infrastructure is an important step towards addressing these challenges, but it must go hand in hand with ensuring that facilities are adequately staffed with qualified healthcare workers, stocked with essential medicines, equipped with functioning medical equipment and able to provide affordable services.

Mwalimu Nyerere declared war against three major enemies of development including poverty, ignorance and disease after independence.

His government sought to expand healthcare access, particularly in rural areas that had received limited investment during colonial rule.

Under the Ujamaa policy, the government pursued equitable access to social services, including healthcare, while development plans incorporated measures to establish health centres, dispensaries and hospitals and increase the number of trained medical professionals.

The First Five-Year Development Plan, covering 1964 to 1969, sought to establish regional hospitals and expand specialist and surgical services.

The Second Five-Year Development Plan, covering 1969 to 1974, placed greater emphasis on preventive healthcare and the control of communicable diseases.

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Subsequent development plans continued efforts to extend healthcare services to urban and rural populations.

These priorities were consistent with the broader primary healthcare principles promoted internationally through the Declaration of Alma-Ata in 1978, which called for urgent action to achieve health for all.

The foundation established during the early years of independence was carried forward by subsequent administrations, which invested in facilities, medical training, equipment and partnerships with religious institutions, private providers and development partners.

As of March 2026, total patient beds in public facilities in Tanzania reached 156,932 (an increase from 86,131 beds in 2021. Intensive Care Unit (ICU) Beds (Public Facilities) had 1,647 beds (up from 258 beds previously).

The figures demonstrate the scale of the infrastructure developed to support inpatient, maternity and critical care services.

However, the growing population and available beds also points to the need for continued investment in facilities and the resources required to make them operational. Other indicators show improvements in emergency and maternal healthcare.

Government statistics cited in health sector performance reports show that the number of hospitals with emergency medicine departments increased from seven in 2020 to 113 in 2024, while facilities providing Comprehensive Emergency Obstetric and Neonatal Care rose from 340 to 523 over the same period.

The availability of essential health commodities also improved from 73 per cent in 2020 to 86 per cent in 2024, reflecting efforts to strengthen the supply of medicines and other medical products.

On July 24, 2026, Chief Government Spokesperson and Permanent Secretary in the Ministry of Information, Culture, Arts and Sports, Mr Gerson Msigwa, said the number of health facilities had increased from 10,153 in the 2021/22 financial year to 13,683 by March 2026.

He said the government had invested 1.73tri/- through the Prime Minister’s Office–Regional Administration and Local Government (PMO-RALG) between the 2021/22 and 2025/26 financial years to expand healthcare infrastructure.

According to Mr Msigwa, the investment supported the construction of 25 new council hospitals, rehabilitation of 62 older hospitals and construction of 564 health centres. It also supported the completion of 1,586 dispensary buildings initiated by citizens.

The government also constructed 87 emergency medicine departments, 30 intensive care units and 21 oxygen generation plants to strengthen emergency and critical care services.

These developments reflect continuing efforts to expand access beyond major urban centres, an objective that echoes Nyerere’s emphasis on social services as part of national development.

The availability of medicines has also been a focus of investment. On March 11, 2026, government figures put the availability of medicines and medical supplies at 88.8 per cent in February 2026, compared with 73 per cent in the 2021/22 financial year.

The expansion of services has included greater investment in specialised treatment, helping patients access procedures within the country instead of travelling abroad for some forms of care.

Maternal health offers another measure of the changes taking place. In August 2026, the Ministry of Health reported that maternal deaths had declined from 556 to 104 per 100,000 live births over the period covered by its reported figures.

The ministry attributed the improvement to government investment and cooperation with private healthcare providers, civil society organisations and development partners.

However, sustaining progress requires continued investment in skilled birth attendance, emergency obstetric care, reliable referral systems and services for women in remote communities.

Under President Samia Suluhu Hassan, the government has also pursued wider healthcare coverage through the Universal Health Insurance Act, which was signed into law on December 5, 2023.

The first phase of the Universal Health Insurance scheme began in January 2026, targeting vulnerable households whose insurance premiums are fully financed by the government.

By June 2026, a total of 997,015 beneficiaries had been registered out of 1,206,319 targeted, representing approximately 83 per cent of the intended coverage, according to the Ministry of Health.

Of those registered, 495,034 had collected their insurance membership cards, while 501,981 had yet to collect them. The government is also verifying the details of another 209,304 potential beneficiaries to establish their eligibility.

The programme targets vulnerable groups, including older people, children, pregnant women and persons with disabilities, with the aim of reducing financial barriers to healthcare and improving access to essential services.

The registration figures indicate progress towards the programme’s initial target, although the difference between enrolment and card collection shows that further work is needed to ensure beneficiaries can access services under the scheme.

Working with local government authorities and community health workers to reach registered beneficiaries and facilitate card collection is therefore important in translating enrolment into effective healthcare coverage.

The phased implementation of universal health insurance forms part of broader efforts to protect households from healthcare costs and ensure that access to treatment is not determined solely by a person’s ability to pay.

The Ministry of Health’s budget increased from approximately 1.618tri/- in the 2025/26 financial year to 1.8tri/- in 2026/27, reflecting continued public investment in the health sector.

Of the 2026/27 allocation, 1.148tri/- is earmarked for development projects, while 652.236bn/- is allocated to recurrent expenditure, supporting the expansion of healthcare infrastructure and the delivery of health services.

At community level, a government programme targeting approximately 137,294 community health workers across Mainland Tanzania aims to extend health education, disease prevention and basic services to households.

The Samia Health Super-Specialisation Programme also seeks to strengthen specialist skills and improve access to advanced medical care.

These efforts build on the principle that healthcare should be accessible not only in major cities but also in communities where distance, cost and shortages of professionals can delay treatment.

Specialised services have expanded at national, zonal and referral hospitals, enabling more Tanzanians to receive treatment within the country.

Muhimbili National Hospital (MNH) provides advanced services, including kidney transplantation, cochlear implantation, bone marrow transplantation and interventional radiology.

The Jakaya Kikwete Cardiac (JKCI) Institute has expanded its capacity to manage complicated cardiovascular conditions, receiving patients from across Tanzania and neighbouring countries.

The Ocean Road Cancer Institute (ORCI) has invested in modern diagnostic and treatment equipment, while the Muhimbili Orthopaedic Institute provides specialised procedures, including complex spine and brain surgery.

The expansion of these services has strengthened the country’s capacity to manage conditions that previously required some patients to seek treatment abroad. It has also created opportunities to attract patients from other countries through medical tourism.

Beyond Tanzania, Nyerere’s contribution to African liberation struggles and unity continues to be recognised through institutions bearing his name, linking his historical vision of African solidarity to current efforts to improve healthcare across the continent.

On August 1, 2026, Angola inaugurated the President Julius Nyerere National Referral Hospital for Burn Treatment in Kilamba, Luanda, in recognition of the former Tanzanian leader’s contribution to African liberation struggles and unity.

The inauguration also drew attention to the need for African countries to develop specialised medical services and reduce dependence on overseas treatment. During the inauguration, President Samia called on African countries to invest in specialised healthcare so patients could receive advanced treatment within their own countries rather than travel abroad.

Angolan President João Manuel Gonçalves Lourenço said naming the hospital after Nyerere recognised his contribution to African unity and support for liberation movements.

He said Tanzania had provided support to Angolan freedom fighters, soldiers and civilians during Angola’s struggle for independence.

As the country marks the 27th anniversary of Nyerere’s death, his declaration of war against disease remains relevant to a health system still working to close gaps in access, improve service delivery and ensure that the benefits of development reach every household.

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