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Tanzania's First Line of Defense against Pandemics

By The Global Fund

August 8^th, 2022

Clutching a bag with medical supplies, Nasra Salimu glances at a goat tethered in her compound as if to bid it goodbye. Satisfied with the goat’s food ration for the day, Nasra sets off, walking up a dirt path towards the village center.

As a community health worker from Bereko Village in Dodoma Province, Tanzania, Nasra’s job is to knock on doors and call on people to stop diseases from occurring and spreading. When she is not seeing patients, she is a farmer – raising animals and working the land.

As she saunters up a hill, she calls greetings to people running small businesses in her hamlet. She crosses a road, then turns a tight corner to enter a neighborhood – a line of low-roofed, single-story units where several families live squeezed in together. Nasra is here to find people who may be ill with tuberculosis (TB).

“I am here for people who have TB symptoms like weight loss, night sweats, or those who have a cough lingering for more than two weeks,” says Nasra.

In countries with a large rural population, community health workers like Nasra serve as the first line of defense in the fight against infectious diseases.

They are leading the charge in the global effort to fight HIV, TB and malaria in villages across Tanzania and beyond. These health workers – most of them women – are also trained to spot unusual happenings that could lead to outbreaks and report them. They comb the last mile in search of people who are at a greater risk of diseases, or who may be already exposed and need treatment.

Tanzania's First Line of Defense against Pandemics

Tanzania's First Line of Defense against Pandemics

About 1,000 kilometers west of Bereko in Kigoma, we have come to meet Ezekiel Msumyi, another community health worker, but one who has a sharper focus on data collection. Besides helping the community fight malaria and other challenges such as maternal and child health, Ezekiel collects data from each of the 193 households in his caseload, doing surveillance of any unusual happenings or outbreaks within the community.

Community health worker Ezekiel Msumyi collects data from his caseload of 193 households which is used to identify any potential disease outbreaks and rapidly respond.

We arrive to find Ezekiel and his flipchart, which opens with the map of the village and then lays out rolls of data – from numbers of pregnant women in the village to numbers of mosquito nets distributed. Under swaying banana trees in his garden, Ezekiel explains how he collects data from different hamlets under his care.

“I do this job from my heart; if I hear news of a problem in the community, I rush to the affected area to investigate,” Ezekiel says.

“If I find that the reporting was factual, and that there is a health problem, like an outbreak, I document it. Following that, I send the information straight to the clinic."

Tanzania's First Line of Defense against Pandemics

Tanzania's First Line of Defense against Pandemics

Athmani Mwinyihaji runs the management of health information in Kasulu District. He says that community health workers like Ezekiel are not only helping fight today’s infectious diseases, but they are also crucial in helping Tanzania stay vigilant for the next pandemic.

Athmani shares a recent story of a time when one of the community health workers noticed an incident where dozens of people in one village suddenly started to vomit and have diarrhea. The community health worker sent urgent word up the formal health system, prompting the district to quickly dispatch a team of experts to investigate the matter and help the villagers. It soon emerged that all those affected had attended a religious event where they had consumed contaminated drinks. The sick were promptly linked with a health facility and treated.

Athmani can share more examples of success in surveillance, including another recent one when community health workers noted an incident of dead fish floating down a river. Reporting by community health workers prompted the Ministry of Health to quickly send word to the public to avoid eating the fish while the Ministry investigated the matter further. These speedy actions saved lives in these communities, Athmani says.

“We look at how the system communicates data from community health workers to the national level," Athmani adds.

"If community health workers see anything unusual, any health matter that is of public importance, they report that on the spot and that goes all the way to the national level so we can take quick action.”

The strength of any health and community system is reflected in its people. There are more than two million community health workers in the countries where the Global Fund invests. In these countries, the health of hundreds of millions of people is supported by the social capital and trust built by people like Nasra and Ezekiel. If the next big pathogen emerges here, the training and experience of these health workers will be vital in the effort to stop it at the nick of time and save lives.

Footnotes

Story by Ernest Waititu. Photography by Vincent Becker. With many thanks to Global Fund implementing partners in Tanzania for their support.

FootNotes

Story by Ernest Waititu. Photography by Vincent Becker. With many thanks to Global Fund implementing partners in Tanzania for their support.

© 2026 The Global Fund

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