On average half a million tourists visit the semi-independent Tanzanian region and Archipelago of Zanzibar each year. For those staying in one of its many luxurious resorts, the ‘other side’ remains invisible. Although Zanzibar profits from tourism, it is considered as a low/middle income country. Zanzibari’s may face challenges like limited access to quality health services and a weak referral system between clinics.

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Clinical Officer Abdulmalik Moh'd Hassan capturing data in Myuni Primary Health Care Unit
(© PharmAccess Foundation)

Since the Zanzibari semi-independent status, the Government has been committed to provide healthcare to all its 1,5 million citizens. Among those vigorously working to improve the situation for the Zanzibari’s is Mr. Abdula Ali (58), Coordinator Health at the President’s Office Regional Administration and Local Government (PO-RALG).

Mr. Ali’s interest in healthcare was triggered early. He remembers a government health official visiting his class while in high school. The class taught the pupils about communicable diseases that are spread from person to person like HIV, Ebola and Hepatitis A and B.  Soon after, he chose to dedicate his career to healthcare.  

Thanks to the support of the Wehubit programme of Enabel to PharmAccess’s Safecare project (which focusses on improving the quality and financial sustainability of the Zanzibari health system), people like Mr. Ali will be able to focus on improving community access to quality healthcare. The support of PharmAccess started by assessing the current levels of quality of 44 primary healthcare centers, that provide the basic health services for the community.

Mr. Ali is looking forward to the insights the continuing assessments provide. But there is one element that he is specifically interested in, which is to improve the referral system. Currently Zanzibar does not have a proper system in place to track patients; sending them from one health center to another can be unclear and complicated.

Mr. Ali: ‘’I came across a story of a mother who lost her life because she was referred too late. Her previous delivery required a caesarian section, and she should have been referred earlier to a more specialized center. This devastating example motivates me even more to help improving the system.

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Mr Abdula Ali (right) on a health summit in Dodoma, Tanzania
(© PharmAccess Foundation)

Thanks to the support of Enabel’s Wehubit programme, PharmAccess has trained staff from the Ministry of Health as assessors who are now evaluating the quality of the health centers throughout the country.

Mr. Ali: ‘’We need to track our progress and see where quality falls short. For example, where equipment is broken, where we need manpower or additional supplies. It is very important work. We work with limited budgets, so we better know where to invest first.

Mr. Ali also helps organizing the capacity training for the government and healthcare staff to fully adopt the quality methodology and digital technology.

Mr. Ali: ‘’earlier our improvement efforts were done on a more ad-hoc basis, now it is part of a solid, digitalized plan where we can track progress over time.

Although the project is in an early stage, Mr. Ali is enthusiastic about the support of PharmAccess to improve client safety:

During one of our first meetings we looked at some assessment results, noted that some of the identified quality gaps, for example, proper segregation of hospital waste did not need  much financial investment, rather a change in the way things were being done. We right away contacted those responsible for health at the district level to discuss the first steps to establish improvement. The fact that the support is so hands-on is a real asset of this project.


Wehubit supports the evaluation of capability of 44 primary healthcare facilities in Zanzibar. The project should lead to structural quality improvements in terms of safety and effectiveness of care. 

The project uses a digitally enabled quality methodology of SafeCare to evaluate the current levels of quality. Healthcare providers can access the data via their mobile phones.

The assessment of the 44 facilities revealed quality gaps. Each of them receive a tailored Quality Improvement plan which identifies which actions to prioritize to improve their services.

The facilities also receive the necessary resources to implement their improvement plans and the process is supported by health managers.