Tanzania carries a dual burden of communicable and non-communicable diseases while remaining vulnerable to emerging pandemics of public health concern. Since its independence in 1961, Tanzania has implemented successive health reforms aimed at expanding access and moving towards universal health coverage (UHC). Despite notable progress, inequities in access, quality and financial protection persist. This review examined how policy evolution (1961–2025) addressed or reinforced inequities and the lessons for building resilience and equity in UHC.

We conducted a scoping review of national health policies, strategies, legislation and the related literature (1961–2025), following Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Eligible sources included government reports, strategic plans, evaluation reports and peer-reviewed or grey literature. Data were analysed using the Walt and Gilson Policy Triangle and mapped against the WHO Health Systems Building Blocks.

Out of 10 435 records identified, 60 documents met the inclusion criteria. Policy evolution reflected five broad reform episodes, ranging from postindependence centralisation to primary healthcare, structural adjustment and cost-sharing, sector-wide reforms and recent UHC-focused financing strategies. Reforms shifted from politically driven, top-down policies to participatory and evidence-informed approaches. Mapping showed progressive but uneven gains across service delivery, workforce, financing, governance, medicines and information systems. Six thematic shifts towards UHC were identified: fragmented to pooled financing, routine delivery to resilient systems, paper to digital systems, workforce numbers to distribution and skills-mix, state-only to mixed providers and expansion to effective coverage.

Tanzania’s reform trajectory illustrates adaptive progress, but persistent inequities in financing, workforce distribution and service access remain. Achieving equitable and resilient UHC will require stronger domestic financing, governance and primary care, with transferable lessons for other low- and middle-income countries.

To describe the lessons learnt during the promotion of a new approach to the care of critically ill patients in TanzaniaEssential Emergency and Critical Care (EECC).

A descriptive qualitative study using thematic analysis of structured interviews.

The study was conducted in Tanzania, involving 11 policymakers, researchers and senior clinicians who participated in the promotion of EECC in the country.

Five inter-related themes emerged from the promotion of EECC in Tanzania: (1) early and close collaboration with the government and stakeholders; (2) conduct research and use evidence; (3) prioritise advocacy and address misconceptions about EECC; (4) leverage events and embed activities in other health system interventions; and (5) employ a multifaceted implementation strategy. The themes map to the normalisation process theory domains of coherence, cognitive participation, collective action and reflexive monitoring.

The integration of EECC into Tanzania’s health policy is a result of a multidisciplinary collaboration including government and partners that has used evidence, advocacy and context and included multifaceted implementation strategies. The lessons from Tanzania’s experience provide guidance for adoption in similar settings to improve critical care systems, foster access to care and optimal outcomes for all critically ill patients.