A Five-Year Journey of Impact: The Uhuru wa Afya (Health Freedom) Project (2020–2025)
From July 2020 to February 2025, Tanzania Health Promotion Support (THPS), with support from the United States Government (USG), implemented the Uhuru wa Afya (Health Freedom) Project, a bold, people-centred initiative that transformed Tuberculosis (TB), and Family Planning services across Katavi, Kigoma, Rukwa, and Songwe regions.
Over five years, Uhuru wa Afya did more than deliver services. It strengthened systems, built local capacity, expanded life-saving diagnostics, reduced catastrophic costs for patients, and restored hope to thousands of families.
At its heart, Uhuru wa Afya was about freedom:
- Freedom from TB through early detection and effective treatment
- Freedom to plan one’s family
- Freedom for communities to thrive through stronger health systems
Closing Critical Gaps
Although national TB indicators were improving, performance in the four supported regions lagged behind. Molecular diagnostics were limited, childhood TB detection was low, and many facilities lacked comprehensive family planning services, particularly in rural areas.
To close these gaps, Uhuru wa Afya directly supported 508 health facilities and expanded TB Directly Observed Treatment (DOT) services to 868 facilities overall. Working in close partnership with the Ministry of Health, National Tuberculosis and Leprosy Program (NTLP), the Prime Minister’s Office – Regional Administration and Local Government (PMORALG), and regional health and council management teams (R/CHMTs), the project focused on:
- Strengthening facility-based TB and TB/HIV services
- Expanding early detection and contact tracing
- Improving access to comprehensive modern family planning
Quarterly joint supportive supervision, on-site mentorship, and targeted capacity building activities ensured that facilities were not merely monitored but strengthened.
Over the life of the project, 3,645 health workers and community health volunteers were trained in TB diagnosis, pediatric TB, drug-resistant TB, molecular testing, data management, and family planning service delivery, building expertise that remains long after the project’s close.
Expanding Access to Timely Diagnosis and Strengthened Sample Referral System
Access to rapid TB diagnosis was a gamechanger. Uhuru wa Afya installed:
- 8 GeneXpert machines
- 2 TrueNat machines
- 31 i-LED microscopes
It also deployed 44 trained boda-boda riders to transport sputum samples from peripheral facilities to testing sites, integrated with existing HIV sample referral networks. This innovation dramatically reduced turnaround time for TB test results.
A Milestone in TB Diagnosis: TrueNat and GeneXpert Expansion
At the handover of TrueNat machines in Kigoma, Regional Administrative Secretary Mr. Hassan Rugwa noted: “These machines will save lives by ensuring faster diagnosis and earlier treatment. We commit to maintaining them for the benefit of our people.”
On her part, Dr. Benedicta Masanja, Chief of Party for Uhuru wa Afya at the time, said: “This investment strengthens local systems, not just today but for years to come. Our goal is sustainable health freedom.”
Impact: What Changed on the Ground?
- The results speak for themselves. TB case notifications increased from 3,521 to 4,739 annually, while childhood TB cases nearly doubled from 410 to 805 per year. Bacteriological confirmation improved from 38% to 70%, and treatment success consistently remained above 91%. 100% of TB patients had known HIV status.
- Through strengthened contact tracing, over 24,600 contacts were investigated, with nearly all eligible children under five placed on preventive therapy, stopping TB before it could take hold.
When Systems Work, Lives Change
Behind every statistic is a human story. In Kalambo District Council, Rukwa, 59-year-old OM had already completed six months of TB treatment when she was diagnosed with drug-resistant TB. The 18-month treatment journey seemed impossible. Weak and unable to farm, she feared she would not survive.
“I thought my days were numbered,” she recalls.
Through Uhuru wa Afya’s social protection support, covering transport, investigations, and nutritional assistance, OM completed treatment successfully.
“Today, I am strong again. TB is curable.”
She is now a TB ambassador in her village, encouraging others with symptoms to visit the health facility, living proof that support beyond medicine saves lives.
Expanding Choices for Women and Families
Family planning uptake rose significantly from 630,324 users at baseline to over 1,033,858 in the fourth project year. Youth accounted for 31% of users, and postpartum family planning coverage approached the national 40% benchmark.
But impact is best understood through women like Amina. In Fyengeleza Village, Sumbawanga, 43-year-old Amina Ndenje had seven children and carried deep fears about modern contraception, fuelled by community myths. When Uhuru wa Afya outreach team brought services to her village, she received respectful counselling and accurate information for the first time. She chose an implant.
“I don’t want another pregnancy. Now I can focus on raising my children well, without fear.”
Elsewhere, in Mpanda Municipal Council, Mariam Juma’s experience exposed another gap. Despite attending four antenatal visits, she had never received postpartum family planning counselling. Through Uhuru wa Afya referral, she received information, chose an implant, and regained control over her future.
Her case strengthened integration of postpartum family planning counselling across all 142 Uhuru wa Afya supported facilities, ensuring no woman leaves maternity care without the knowledge they need.
Innovation, Learning, and Local Leadership
Uhuru wa Afya supported operational research on TrueNat diagnostics and video-based TB education, while sharing best practices nationally and internationally, including presentations at the NTLP Annual Conference (Dar es Salaam), Tanzania Health Summit (Zanzibar) and the World Lung Conference (Indonesia).
The project was led by a strong local consortium—THPS as prime recipient, alongside Ifakara Health Institute, MKUTA, and Baylor Tanzania, demonstrating the strength of Tanzanian institutions in leading complex USG-funded programs.
A Lasting Legacy
As Uhuru wa Afya concludes, its impact endures through:
- Modern diagnostic infrastructure
- A skilled and confident health workforce
- Stronger regional health systems
- Sustained TB and family planning services
- Empowered communities taking charge of their health
From once underperforming regions to areas meeting national benchmarks, Uhuru wa Afya reshaped the health landscape of Western Tanzania.
Conclusion
The USG-funded Uhuru wa Afya Project clearly demonstrates what partnership, local leadership, and people-centred programming can achieve.
Through THPS leadership and USG support, thousands of lives were saved, millions were reached, and Tanzania moved closer to ending TB and ensuring reproductive health for all.
Health freedom is no longer just a vision. It is a lived reality.
