Pathfinder International works in Tanzania on a range of health issues—from HIV and AIDS to family planning advocacy—with a special focus on establishing integrated health care delivery systems at the community level.


With its rugged plains, snow-capped Mt. Kilimanjaro, and beautiful coastline, Tanzania is one of Africa's natural gems. Yet, the country has been faced with significant sexual and reproductive health challenges over the last few decades, including elevated rates of HIV and AIDS and a total fertility rate that has remained high. While major investments by the US Government and the Global Fund for HIV and AIDS, TB, and malaria have led to improved access to anti-retrovirals, increased condom-use, and demand for HIV testing, serious gaps in care remain. More than 5.7 percent of the population is HIV-positive, more than half of whom are women. At the same time, maternal mortality in Tanzania is unacceptably high, as the lifetime risk of maternal mortality is one in 24.

Since 1984, Pathfinder has had a strong presence in Tanzania, working closely with the government and with local partners to improve access to reproductive health and HIV and AIDS services, while also building the capacity of local NGOs. Based on our experience delivering community home?based care for people living with HIV and AIDS, Pathfinder is continuously working to integrate family planning services at the community level. Through trainings and the creation of a distribution system, Pathfinder has equipped community health workers with supplies to deliver information and non?clinical contraceptive commodities, such as condoms, to people in their homes.

For much of the past decade, Pathfinder has focused on a community approach to providing services to people infected with and affected by HIV and AIDS. What started as an effort to provide nursing care for the terminally ill has evolved into providing a range of services that improve the health and extend the lives of the families and clients we serve. Home-based care, in concert with a two-way referral system between communities and health facilities, ensures linkages to a range of quality social and health services such as family planning, prevention of mother-to-child transmission, and support for orphans and other vulnerable children. In particular, strengthening the ties between HIV and family planning services at the community level gives families the information and options they need to make the best choices for their reproductive health.

Pathfinder recently engaged in a new initiative specifically focusing on the elimination of pediatric AIDS through community-based efforts and involvement of local partners. Other innovative projects have included work to combat the high rates of maternal mortality in refugee camps by training health providers to use a new technology to treat postpartum hemorrhage, as well strengthening health systems in one of the poorest and most remote regions of Tanzania by highlighting connections between reproductive health and natural resource management.

Tanzania has more than 2.5 million orphans and over 50 percent of hospital beds are occupied by AIDS patients.

Evidence for Decision-Making

A key aspect of Pathfinder's approach to systems' strengthening is collecting evidence that enables public, private, and community partners to make informed health-related decisions. In Tanzania, examples of the kinds of evidence we collect to range from the "number of new or continuing patients, disaggregated by sex and age, who return for the results of an HIV test after counseling and testing." and the "number of women diagnosed with postpartum hemorrhaging who received treatment " to the "number of health facilities upgraded to provide family planning services." Some illustrative data from Pathfinder's work in Tanzania suggests that:

  • As of December 2011, 1258 active home-based care providers are operating in the field.
  • Between September 2009 and December 2011, 77,843 individuals were referred to HIV-related services, disaggregated by type of service.
  • Between April 2009 and December 2011, 90,643 couple-years of protection were provided through contraception, disaggregated by method.

Building Capacity, Strengthening Systems

While there has been tremendous progress in delivering health services in Tanzania, many gaps remain. The country has less than 40 percent of the health personnel it needs to deliver planned services. People in rural communities have difficulties in accessing health services. As the population of the country grows, the health care delivery system is unable to cope with increasing demand for services. Therefore, in Tanzania, Pathfinder is partnering with the national government, local governments, and local civil society organizations to improve access to quality reproductive health services at the community level. To do this, Pathfinder works with the local partners to deliver home-based care services to people living with HIV and AIDS; family planning counseling and services for all potential clients in the community; home-based counseling and testing services to address stigma and reduce opportunity costs incurred; and, the establishment of systems to address gender-based violence. Pathfinder enables local organizations, such as the Tanzania Red Cross Society, to establish community-based services, while at the same time strengthening local government capacity to provide technical support, oversight, and overall management support to ensure that community-based services link strongly with the established network of government health facilities.

To support the delivery of health services at the community level, Pathfinder is also working to:

  • Advocate for greater allocation of financial and human resources for health care at national and local government levels;
  • Increase community engagement in health service delivery; and,
  • Increase support for mechanisms to enable communities to hold their governments accountable for the delivery of reproductive health services.

In order to institutionalize capacity, Pathfinder works with the Ministry of Health and Social Welfare to establish in-service training materials for community-based health workers on the delivery of family planning services, the establishment of youth-friendly reproductive health services, home-based care for people living with HIV and AIDS, community-based integration of family planning and HIV services, and on improving health worker response to survivors of gender-based violence. Pathfinder is also collaborating with the Ministry to integrate and prioritize family planning in the local government budgeting process. Finally, Pathfinder is working with the Muhimbili University Health and Allied Sciences School of Public Health to establish a graduate degree program in behavior change, in order to enable Tanzanians to better understand and therefore better develop programs that support individuals, families, communities, and societies seeking to change key behaviors.

An Effective Response

Among the health and development priorities for Tanzania are maternal and newborn health and the HIV and AIDS epidemic. These two areas of concern contribute not only to high morbidities and mortalities, but also to an overall impediment in the socio-economic development of the country. Only 27 percent of married women use modern contraceptive methods and the unmet need for family planning has increased from 22 percent in 2004 to 25 percent in 2010. And while Tanzania has successfully scaled the provision of anti-retrovirals to HIV-positive people, the HIV prevalence rate is currently at 5.6 percent . It is for these reasons that national policies, frameworks, strategies, and plans have been developed and implemented to address both maternal and newborn health and the HIV epidemic. The country's target is to increase the current contraceptive prevalence rate to 60 percent by the year 2015.


In Tanzania, 50 percent of hospital beds are occupied by AIDS patients. With such high demand at health centers, Pathfinder strives to bring services into the communities to ensure all people have access. Your gift of $25 or $50 is critical to ensuring our work continues.

Our Projects

Gender-based violence in Tanzania

Preventing Sexual and Gender-Based Violence Against Children in Tanzania

Sexual and Reproductive Health and Rights Adolescent and Youth Sexual and Reproductive Health Gender

In Tanzania, Pathfinder works to prevent violence against children and adolescents at the household and community level.

Photo by Sarah Day

Community-Based Organization Capacity Building Project

Nigeria, Uganda
Maternal & Newborn Health

In Nigeria, Tanzania, and Uganda, Pathfinder aims to improve the capacity of community-based organizations to better prevent mother-to-child transmission of HIV.

Related Publications

April 2014

Reproductive Choice: Protecting Nature and Human Rights

Right now, communities face two interconnected crises—how to protect their health and the environment they depend on. The problems are complex. And Pathfinder is up to the challenge.

December 2013

The Way We Live: Advancing Health & Rights Through Integration

In a year of remarkable achievement, including Pathfinder’s landmark victory at the US Supreme Court and our return to Bangladesh with a $53.8 million project, what was most exciting? The answer—integration—is the theme of Pathfinder’s 2013 Annual Report.

November 2013

Sustainable Development in East Africa: Lessons from Four Population, Health, and Environment Projects

The integrated Population, Health, and Environment (PHE) approach is based on the premise that people’s health and the environments in which they live are inextricably linked.This publication features insights from four ongoing PHE projects in East Africa.

October 2013

Assessing Barriers and Opportunities in Integration of Family Planning into District-Level Planning

This technical update summarizes assessment findings from the Putting Reproductive Health Back on the Map in Tanzania project.

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See How Condoms Reach the Most Remote Villages in Africa

Condoms remain some of the most effective and affordable tools for combating unintended pregnancy. But how do condoms get to people who live in some of the hardest-to-reach corners of the world?

Tanzania-based photographer Sala Lewis traveled with global health organization Pathfinder International to document the Tuungane program in Tanzania, which brings condoms from the urban center of Kigoma to the small villages around the Mahale National Park. Project staff travel to the field at least once every two weeks, delivering what ever supplies are needed — contraception, anti-malaria drugs or even a new radio.

Tanzania Likely to Fall Short On Its Family Planning Targets

Tanzania will likely fall short of its 2015 reproductive health targets, which aim to reduce one million abortions, 2.9 million unintended births, and 18,000 maternal deaths that occur every year because of poor of access to family planning services.

Pasiens Mapunda, a reproductive health expert at Pathfinder International, told IRIN that while "women are beginning to take up family planning and facility births are increasing" challenges such as "inadequate health facilities, long distance[s] from homes to the nearest available hospital and even low staffing still remain and needs to be dealt with."

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