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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.
by Gift Treighcy Banda-Mtaula, Ibrahim Simiyu, Sangwani Nkhana Salimu, Stephen A. Spencer, Nateiya M. Yongolo, Marlen Chawani, Hendry Sawe, Jamie Rylance, Ben Morton, Adamson S. Muula, Eve Worall, Felix Limbani, Miriam Taegtmeyer, Rhona Mijumbi, on behalf of the Multilink consortium
Multimorbidity, the presence of multiple chronic health conditions, is a leading cause of death globally. In Malawi, chronic noncommunicable and communicable diseases such as HIV frequently co-exist, putting pressure on an under-resourced system. However, the health system is primarily structured around disease-specific [vertical] programs, which hinders person-centred care approaches to multimorbidity. Our study focuses on multimorbidity care and explores the perceptions of healthcare workers on the patient pathways and service organisation throughout the patient’s interaction with the health facilities. This cross-sectional qualitative study took an interpretivist approach. We conducted 13 days of clinical observations at Queen Elizabeth Central Hospital and Chiradzulu District Hospital. We also conducted 13 days of clinical observations and semi-structured in-depth interviews with different cadres of purposively sampled healthcare workers (n = 22) at Queen Elizabeth Central Hospital and Chiradzulu District Hospital. Through thematic analysis, we identified an understanding of the organisation of care and healthcare workers’ perspectives on the delivery of services. Findings showed both hospitals provided services for inpatients and outpatients with multimorbidity, including screening, management, prevention of secondary conditions and rehabilitation. Patient diagnosis and management for multimorbidity were often delayed due to frequent stockouts of medication and consumables necessary for diagnostic testing for NCDs at the hospital level. Some healthcare workers were not equipped with the knowledge, skills, or guidelines to manage multimorbidity. As HIV care is currently better resourced than other chronic conditions, healthcare facilities may strengthen the supply chain, healthcare workers’ training sessions and monitoring and evaluation tools to ensure NCDs are well managed, learning from HIV programmes.This study aimed to investigate factors influencing the acceptance of smartphone applications among high-risk pregnant women in the Lao People's Democratic Republic to support continuous care.
An explanatory sequential mixed-methods design.
The quantitative phase included 167 high-risk pregnant women recruited from four tertiary hospitals in Vientiane, Lao PDR. Validated questionnaires were used to measure demographics, digital technology usage, eHealth literacy and anxiety. Data were analysed using descriptive statistics and multiple regression analysis. In the qualitative phase, in-depth interviews with 20 women were conducted to further explore experiences, perceptions and barriers related to smartphone application usage. Interviews were analysed via direct content analysis.
Quantitative findings indicated that smartphone application acceptance was significantly predicted by eHealth literacy (B = 1.53, 95% CI 1.22–1.84, p < 0.001) and pre-existing non-communicable diseases (B = 4.39, 95% CI 1.05–7.73, p = 0.010). Anxiety negatively impacted acceptance (B = −0.28, 95% CI −0.51 to −0.05, p = 0.019). The model explained 53.9% of the variance in smartphone application acceptance (R 2 = 0.539). Qualitative findings highlighted four key themes: awareness of pregnancy risks, unclear health information, perceived benefits of smartphone applications including accessibility and emotional reassurance and practical barriers such as internet costs and limited digital literacy.
Positive perceptions of smartphone applications regarding accessibility and reassurance were observed, alongside significant barriers, such as limited digital literacy and internet costs. Addressing these factors may enhance the adoption and effective utilisation of digital health technologies among high-risk pregnant populations.
No patient or public contribution.
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.
FreshRSS 