Dar es Salaam. Health has always been a defining pillar of Tanzania’s social and economic development. Yet for decades, the system has struggled to meet the growing needs of its citizens.
Long queues at public hospitals, a chronic shortage of doctors, and the high cost of private services remain a daily reality for millions of Tanzanians.
Now, the United People’s Democratic Party (UPDP), through its 2025–2030 election manifesto, is promising nothing short of a revolution: free health services for all, thousands of new doctors and nurses, and routine health checks for school children.
But can the promise of universal care truly be delivered in a nation where health financing remains fragile?
Tanzania has made progress in expanding access to healthcare, particularly through the Primary Health Care Development Programme, which has seen more dispensaries and health centres built across the country.
Life expectancy has improved from 50 years in 2000 to 66 years in 2022, according to World Bank data. Yet challenges persist. The doctor-to-patient ratio remains alarmingly low.
The World Health Organisation (WHO) recommends at least 100 doctors per 100,000 people, but Tanzania has fewer than 20 doctors per 100,000. The result is overcrowded wards, long waiting times, and limited access to specialists.
Equally pressing is the issue of affordability. A report by the Ministry of Health shows that out-of-pocket expenditure accounts for nearly one-third of total health spending, pushing vulnerable households into poverty.
Health insurance penetration remains low, with less than 20 percent of Tanzanians covered under schemes like NHIF.
UPDP’s health pledges
UPDP’s manifesto makes ambitious promises including universal free healthcare. “From rural dispensaries to referral hospitals, all services would be free,” the manifesto declares.
It also promises massive recruitment of doctors and nurses, noting it will reach a target of 150 doctors for every 100,000 citizens by 2030, a near eightfold increase from the current ratio.
The party plans to coordinate school health checks to all pupils. The group both from primary and secondary schools would undergo health screenings at the start of each academic year.
Those diagnosed with illnesses would receive government-funded treatment and the families of patients who die in government hospitals would receive bodies without being charged mortuary or administrative fees.
Bold but costly
Health specialists welcome the ambition but question feasibility.
“Every Tanzanian deserves quality healthcare without worrying about the cost,” says a public health specialist based in Arusha, Dr Stella Magesa. “But moving from partial subsidies to fully free care across all levels is extremely expensive. We are talking about billions of shillings annually in additional spending.”
According to the World Bank, Tanzania currently allocates around seven percent of its national budget to health, below the Abuja Declaration target of 15 percent. To meet UPDP’s universal care pledge, that figure would need to at least double, experts argue.
Recruiting doctors is another hurdle. The government has indeed increased hiring in recent years, but the supply of graduates remains limited.
“Our universities produce around 1,000 doctors annually. To reach 150 doctors per 100,000 people, Tanzania would need more than 250,000 doctors by 2030. That is almost impossible without massive investment in training institutions,” notes Dr Magesa.
Other countries provide useful lessons.
Rwanda, for instance, has built one of Africa’s most inclusive health systems, with over 90 percent of the population covered under community-based health insurance.
Citizens pay small premiums, and the government subsidies the poorest. The result has been improved maternal health, reduced child mortality, and better access to care.
Cuba offers another striking example. With one of the highest doctor-to-patient ratios in the world, the island nation guarantees free healthcare for all its citizens.
However, this is sustained by decades of prioritising health in national budgets and making medical training a cornerstone of its economy.
“The Cuban model shows it is possible, but it requires a national consensus that health is not just a service but a right worth heavy investment,” says a senior lecturer in health sciences Hussein Kihwele. “UPDP must explain whether Tanzania is ready to make such trade-offs.”
The social protection angle
UPDP’s pledges also touch on issues of dignity and fairness, particularly in death. For years, families have complained of the financial burden when collecting bodies of loved ones from hospitals. Mortuary fees, transport costs, and administrative charges often add to grief.
By promising to waive such costs, UPDP is tapping into a deeply emotional issue.
“The body of a deceased patient will be handed over to their relatives without any charges,” the manifesto states plainly.
“This is not just about money. It is about respecting the dignity of citizens even in death,” says sociologist Dr Salome Chacha. “It may appear symbolic, but such policies matter in showing that the government understands people’s pain.”
Prevention as policy
The plan to screen all schoolchildren at the start of the year is another notable feature. Tanzania continues to struggle with childhood illnesses such as anaemia, malnutrition, and respiratory infections.
“Early detection is critical. Many children in rural areas never see a doctor unless they fall seriously ill,” notes paediatrician Dr Emmanuel Nyoni. “Annual checks could save lives, but again, it requires thousands of doctors, nurses, and equipment.”
Such a move would align with global best practice. For example, South Korea has a mandatory school health programme that screens for vision, dental, and chronic conditions, enabling early intervention.
Perhaps the greatest question is money. How would UPDP finance a free healthcare system, recruit doctors on a massive scale, and expand school screenings?
The manifesto suggests raising revenue through improved tax collection and cutting government wastage. But analysts argue that broader reforms may be needed.
“Free health care is not free — someone pays for it. Without raising the health budget closer to 15 percent of GDP, these pledges will remain aspirational,” says Dr Magesa. She adds that partnerships with the private sector and international donors could also play a role, but sustainability must come from domestic resources.
Hope and scepticism
On the streets, ordinary Tanzanians welcome the promises but remain wary.
“I spend nearly Sh50,000 every month on medicines for my diabetes,” says 58-year-old shopkeeper Juma Rashid from Dar es Salaam’s Kisemvule suburb. “If the government can provide free care, it will be a blessing. But politicians have promised before.”
For many, the pledges represent hope in the face of daily struggles. Yet they are also conscious of the gap between political ambition and practical delivery.
UPDP’s health manifesto is bold, touching both the emotional and practical dimensions of healthcare. By pledging universal free services, mass recruitment of doctors, routine health checks for pupils, and dignity in death, it presents a vision of fairness and inclusivity.
But the challenges are immense. Financing, training, and implementation remain the stumbling blocks. Experts caution that unless backed by a detailed roadmap, the promises risk being dismissed as political rhetoric.
Still, by placing health at the centre of its campaign, UPDP has elevated the debate. As Dr Magesa observes: “Tanzanians are tired of paying for poor services. Whoever can deliver affordable, quality health care will win the trust of the people.”
For voters, the question now is whether UPDP’s promises are realistic, or whether they are simply another election-season dream.
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