International trailblazer: Primary health care in Tanzania, 1920s-1990s

Abstract

The paper analyses the emergence of Tanzania’s primary health approach from the colonial to the postcolonial period. We argue that some British colonial health policies created favourable conditions for the postcolonial turn towards primary health. Based on official archival material, newspapers, interviews, and second- ary literature, the paper describes how rural health dispensaries and public health education campaigns provided continuity from the colonial to the postcolonial era. In both periods, governments aimed at increasing the rural population’s productivity by improving its health. However, much of this rural population was poor and settled across vast rural areas, bringing questions of cost and efficiency to the forefront. Even before the approaches’ definition in the 1970s, primary health elements promised the best results and met many popular expectations. This long experience with primary health care elements allowed Tanzania to act as a trailblazer setting examples for the emerging international norm of primary health care. However, liberalisation policies in the 1990s undermined this system while leaving the question of adequate health services for the rural poor largely unanswered. As a contribution to the emerging literature on global social policy, the paper shows that the primary health care norm diffusion has been a multi- directional process.