C07: Creating Health Futures: Welfare-policy planning in Tanzania from the 1960s to the 1980s

The sub-project C07 will address the history of health policy as a central planning and infrastructuring feature of welfare policy in Tanzania and will investigate how health-policy planning became an important tool for future-making in the newly independent country from 1961 onwards. Currently, the dynamics around the current COVID-19 crisis powerfully show the horrendous impact of a new infectious disease. They make the value of functioning health systems very clear, and shed light on the inequalities between rich and poor countries and their respective health systems as well as on the highly unequal access to resources during a global pandemic. Unsurprisingly, health is currently at the centre of interest in global policy and policy planning and will also be a major topic of the Future Africa CRC in the second phase. The sub-project will concentrate on health-policy planning and the creating of health infrastructures in Tanzania after independence from 1961 to the 1980s, as other costly aspects of welfare policy such as pro-poor or pro-old-age policies were not yet considered feasible in the newly independent state of Tanzania.
Many of the new African governments were confronted with considerable challenges in the field of health. When the colonial authorities left there were too few trained African doctors – in Tanganjika only 18 – not enough hospitals and a very limited number of African people with experience in health policy. The period from the 1960s to the 1980s became a phase of intensive planning and future-making. Tanzania used various Western welfare models, but also socialist/communist forms of health policy, drawing on experiences from the Soviet Union and the People’s Republic of China. However, Tanzanian politicians also had to rely on the infrastructures that had been implemented by the colonial administrations. Experts from the British administration remained rather powerful in the independent state, even if a strong nationalization policy was introduced (Eckert 2007). Additionally, in Tanzania, the development of health services was strongly connected with the land-use change and the collectivization approach of the Ujamaa programme which was initiated by the country’s first president Julius Nyerere and enforced in the 1970s (Lal 2015). The introduction of health centres was seen as an important tool to accompany the broad land-use change, to help the rural population and likewise to make the Ujamaa programme more attractive for peasants.
The sub-project will examine public-health-policy planning as a means to create a better future for the rural population and investigate the impact of various international models and the influence of transnational actors. It will also study how these new approaches were further developed by Tanzanian health politicians and doctors on the ground. A geographical focus will be the regional development in the Kilombero District, and particularly its health centre in Ifakara. Ifakara lies in the SAGCOT corridor, and the sub-project will thus contribute to the understanding of the history of rural and agricultural planning in one of the key areas of the CRC. The project generally highlights the connection between future planning, (changing) concepts of social welfare, and political legitimation. As a possible ongoing project for the third phase of the CRC, the research of the sub-project will address Tanzania as an important centre for the further development of South African and Namibian health-reform plans and will focus on the transnational development of health planning in Eastern and Southern Africa until 1990/94.

Keywords: Health-policy planning, Health-reform plans, Modern and current history
Research region: Tanzania

1. How was the Tanzanian health system being planned; how did government and TANU argue?

2. In what ways were the plans bound back to the Ujamaa model? Were the two first 5-year plans implemented?

3. What problems and challenges arose, including in connection with the relocations through the Ujamaa programme?

4. How did the country’s postcolonial elites and representatives of development agencies from abroad collaborate in efforts to control specific diseases?

5. Did the fight against certain diseases bring together otherwise antagonistic actors?

The project will use methods of historical research: it will be based on an analysis of archival documents from archives in Tanzania, the UK, and Switzerland and on the examination of printed/published sources from the 1950s to the 1980s, e.g. health reports from the government of Tanzania. With an oral-history approach, it will also make use of additional interviews the PhD student will conduct during his field trips to Tanzania. Additionally, the project can build upon the research of the historical project A02 of the first phase of the CRC, which dealt with the past planning of rural and communal development in Tanzania. Furthermore, the project will refer to approaches of “travelling concepts” and thus building a bridge to project C02 which addresses political actors and experts in infrastructure planning in Kenya.