Primary Health Care in Tanzania through a Health Systems Lens: A History of the Struggle for Universal Health Coverage

Robust health care systems are paramount for the health, security, and prosperity of people and countries as a whole. This book provides for the first time a chronicle of the struggle for, and eventual success of, universal health coverage (UHC) in Tanzania. Beginning with an introduction to primary health care in the country, from its historical foundations to the major milestones of implementation, this book then considers stewardship of this important aspect of health systems over time. Written in a way to allow the application of lessons learned to other countries' contexts, this book covers:- Policy and governance issues such as leadership, human resources, and financing of health systems;- Practical aspects of health system delivery, including supply chains, community care, new technologies, and the integration of services for particular population groups;- The impact and mitigation of global events on health systems, such as resilience and preparedness in the light of disease outbreaks or climate change, and social, commercial, and political influences.Concluding with a look to the future, forecasting the changes and new solutions needed to adapt to a changing world, this book is a valuable reference for policy makers, global health practitioners, health system managers, researchers, students, and all those with an interest in primary health care and reforms - both in Tanzania and beyond.

Ntuli Angyelile Kapologwe graduated as a Medical Doctor (MD) from the University of Dar Es Salaam before attending Tumaini University, Tanzania, where he obtained a Master's degree in public health (MPH). From 2013 to 2017, Dr Kapologwe attended executive training at the Swiss Tropical and Public Health Institute (Swiss TPH) in Basel, Switzerland, where he earned an MBA in International Health Management (MBA-IHM). From 2019 to 2020 he studied for a Post Graduate Diploma in Strategic Leadership that was jointly hosted by Aalto University (Finland) and Uongozi Institute (Tanzania) where he earned a Post Graduate Diploma in Strategic Leadership. In 2020, he earned a Doctor of Philosophy Degree (PhD) at the University of Dodoma (UDOM) where he conducted implementation research that was embedded with process and outcome evaluation studies on the effects of Direct Health Facility Financing (DHFF) initiative on health system performance in the public primary health facilities in Tanzania.From 2010 to 2014, he served as District Medical Officer (DMO) for Bahi, near the capital Dodoma. From February 2014 to December 2016, he held the position of Regional Medical officer (RMO) in Shinyanga, Tanzania. Since January 2017 he has held the position of Director of Health, Social Welfare and Nutrition Services (DHSWNS) at the President's Office - Regional Administration and Local Government Authorities (PORALG). Dr Kapologwe has exercised leadership in many institutions, associations, alumni and organisation bodies, also he works on several committees at both National and International levels. He has more than 50 articles published in international peer-reviewed journals and is a journal board member of the East African Journal of Applied Health Monitoring and Evaluation.

Dr. James Tumaini Kengia works at the President's Office-Regional Administration and Local Government (Po-RALG) as a Coordinator for Regional Health Management Teams (RHMTs), Research and Publication. Dr. Kengia is also a focal person for Data.FI (Data for Improvement Project) jointly implemented with USAID (Through Palladium) & UNICEF and also participate in the management of a CDC-funded HIV/AIDS project developed to accelerate the implementation of Health Policy and Strategies for HIV/AIDS Treatment Services through the President's Office - Regional Administration and Local Government (PORALG).He is an experienced Public Health Specialist with a demonstrated history of working in hospitals and the healthcare industry in general. Dr Kengia is a Principal Dental Surgeon with also a Postgraduate Diploma in Hospital Management that was part of an International Leadership Training (ILT) in Hospital Management supported by the Government of Germany. He also holds an MBA for Medical Doctors from the University of Applied Science Neu-Ulm, Germany, and a PhD in Public Health Leadership from Tokyo Medical and Dental University, Japan. He has worked as a member of Regional Referral Hospital Management Team (RRHMT), Regional Health Management Team (RHMT), Ag. Regional Medical Officer for Mwanza region and Principal Investigator/Director for Mwanza HIV/AIDS services improvement project (MHASI). While working in RRHMT, RHMT and Po-RALG, he has been involved in planning, coordination, supportive supervision, and monitoring and evaluation of health and social welfare services. Since the academic year 2017/2018 he has been involved in teaching and supervising students of the MSc. Public Health at the University of Dodoma, Tanzania where he teaches Health System Management, Leadership, Management and Administration courses.

Dr Van Praag is currently retired, but still active as a Health Systems and Community Care advisor to various government bodies, research projects and NGOs in Tanzania. Recent consultancies include UNICEF and the Joep Lange Institute of the University of Amsterdam, supporting innovative adolescent care and operational research in various regions. Previously, he held the position of technical specialist of FHI360 and Country Director for FHI for 12 years in Tanzania. He has over 30 years of clinical, epidemiological and public health leadership in countries in Asia and Africa as well as at the Geneva headquarters of WHO, where for 10 years he was the coordinator for HIV Care.

Japhet Killewo is a professor emeritus at the Muhimbili University of Health and Allied Sciences (MUHAS) in Tanzania where he has been teaching epidemiology. He researches communicable and non-communicable diseases, having designed and carried out the largest field study for monitoring HIV infection trends and evaluating the impact of HIV interventions in Tanzania (1989-2009). He also worked for 4 years with the International Centre for Diarrhoeal Disease Research (ICDDRB) in Bangladesh monitoring and evaluating reproductive health interventions in a health and demographic surveillance system. In 2010, Killewo initiated an urban based health and demographic surveillance platform in Dar es Salaam, Tanzania where more than 100,000 residents of all ages are being researched and followed up for in- and out-migration, vital events, socio-economic status, NCDs, food insecurity and HIV Drug Resistance. He is currently the Country Manager for the Africa One Health University Network (AFROHUN). In this position Killewo carries out One Health activities in collaboration with human and animal health institutions in the country. Killewo has critically reviewed a considerable number of research proposals and manuscripts for various peer reviewed international journals and has published widely in local as well as international journals, having written chapters in books and edited a section in the International Encyclopaedia of Public Health. He is also the Editor-in-Chief of the derivative volume on Epidemiology and Demography in Public Health and has more than 125 published articles in journals to his credit as of November 2022.

Dr Albino Kalolo is a Senior Lecturer and Researcher in Public Health at St Francis University College of Health and Allied Sciences in Ifakara, Tanzania. He is currently involved in training medical students and other trainees in Epidemiology, Community Medicine and Research Methodology. His research work broadly encompasses developing people-centred social health protection initiatives, applying ecological approaches in health promotion, decolonizing global health partnerships, translating research evidence to policy and practice, use of digital solutions to improve the quality of health care providers and developing and evaluating health system strengthening interventions in the context of poor resource settings. In his research work, he applies implementation science research methodologies embracing participatory (mixed) methods. In the course of training and work, he has received several awards that strengthened his capacity in research and enhanced scientific productivity. Before joining the university, he served for six years in the Tanzanian district health system at the capacity of medical officer in charge of a district hospital and a District Medical Officer. He holds a Doctor of Medicine (MD) degree from the University of Dar es Salaam, a Master of Science (MSc) in Public Health from Maastricht University in the Netherlands and a PhD in Public Health at the University of Heidelberg in Germany. Between 2019 to 2021, he joined the Global Health Equity Scholars (GHES) Program with the Health for a Prosperous Nation (HPON) and the University of California Berkeley.