Health in the urban environment: experience from Dar es Salaam/Tanzania

Dar es Salaam is a typical example of the rapid urbanization process in sub-Saharan Africa. Health problems in the city are tremendous and reflect the epidemiologic transition, with the emergence of chronic diseases, as well as the prevailing problems related to infectious diseases. Not surprisingly, HIV/AIDS has become a major determinant of health. Public health services have been strengthened in the past 12 years through the support of a bilateral program called the Dar es Salaam Urban Health Project (DUHP). The program was jointly funded by the Government of Tanzania and the Swiss Agency for Development and Cooperation. The focus of the program shifted from the initial rehabilitation of the health infrastructure to a strengthening of the management capacities of the public health care delivery system. The basis for the collaboration and complementarity between public and private health care providers has been created. Partly thanks to the success of the DUHP, the health system has become the spearhead and testing ground for core health sector reforms and has had a substantial influence on the introduction of a donor-supported sectorwide approach in the health sector in Tanzania. Perhaps most importantly, the foundations have been laid for a more democratic health system in which both the staff and the population are involved.