Creating Health Futures: Maternal Health Policy, Planning, and the Making of Postcolonial Tanzania, 1961–1980

This thesis examines the development of maternal health policy planning in Tanzania between 1961 and 1980 within the broader context of postcolonial nation-building. The period from 1961 to 1980 marked Tanzania’s transition from colonial rule to self-governance. Future-making and planning dominated the making of the newly independent state of Tanzania under the leadership of President Julius Kambarage Nyerere and his party, the Tanganyika African National Union (TANU). After independence, Nyerere underscored the urgent need to combat ignorance, poverty, and disease. According to Nyerere, these three enemies were detrimental not just to the health of the people but also to Tanzania’s national development and future. Yet, the legacy of colonialism continued to shape the health sector, where welfare and medical services had historically been marginal to colonial agendas and often delegated to Christian missionaries. The rural areas were conspicuously neglected in the national health plans and provisions. The new post-independence government faced the dual challenge of inheriting an underdeveloped colonial health infrastructure while seeking to fulfil the nationalist aspirations of equitable service provision. Focusing on maternal health, this study examines how the Tanzanian state envisioned, planned, and implemented health policies during the first two decades of independence. It explores the impact of Ujamaa and broader socio-economic strategies on healthcare delivery, as well as the roles of TANU members, experts, and missionaries. The study also focuses on the instrumental role of transnational actors, specifically Switzerland and China, in health-policy planning in Tanzania. The analysis is grounded in three theoretical frameworks: the travelling theory, which highlights the transnational movement and adaptation of ideas—in this case, concepts of health; political economy, which foregrounds the state’s role in structuring health systems; and the postcolonial theory of hybridity, which critiques the imposition of external models without adequate integration of local knowledge and practices. Methodologically, the study draws on archival research, oral histories, and secondary sources. The collected data enabled an investigation into how national-level policies, primarily formulated in urban areas, were reflected in and implemented at the local level in the rural Kilombero Valley. Ultimately, the study revealed how health-policy planning in postcolonial Tanzania followed colonial patterns. The challenges faced by health workers and facilities necessitated the mobilisation of resources to build health structures through Ujamaa, as well as assistance from international cooperation. The study also shows the struggle of women in navigating maternal health concepts and national policies, as shown in aspects such as maternity leave and family planning. Despite the notable efforts that Tanzania demonstrated in improving health, this study shows how health plans often failed, worsened by problematic infrastructure, and an ambivalent rural-urban divide that influenced the health system, even during periods of relative economic success and gradual service expansion in the 1960s and early 1970s, and the ultimate decline in the 1980s.