*2.2.1 Health services post-independence (1961–1995)*

When Tanganyika became independent in 1961, the government expanded accessibility to modern health services aiming to improve the health and wellbeing of all her citizens. The health system was intended to be more responsive to the needs of the people focusing on those most at risk. The general goal was to facilitate provision of equitable, quality, and affordable basic health services.

Over the years, since independence in 1961 and soon afterwards, the government of Tanganyika and later the United Republic of Tanzania placed emphasis on the health sector and especially the key targets of eliminating diseases, eradicating poverty and illiteracy with the objective of achieving a universal health to all Tanzanians. In 1967, the country adopted a party declaration "Arusha declaration of 1967" which marked the start of a series of health sector reforms with the intention of increasing universal access to social services to the poor and those living in marginalized rural areas.

The implementation of the Arusha declaration entailed countrywide banning of private-for-profit medical practice in 1977 upon which the government took on the ambitious task of providing health services to all citizens free of charge. Further deliberate restructuring of the health sector included making health services more effective, accessible, and affordable with specific attention to most underprivileged groups of population including women, children under five-year age group and those living in abject poverty. Naturally, this policy necessitated prioritization of healthcare services due to the reality of limited resources. Considerable, deliberate, and focused efforts were directed towards combating communicable diseases which were seen to have high mortality rates.

Additionally, the country established and adopted an extensive network of health facilities throughout the country, which follows a pyramidal structure, from village dispensaries and community-based activities at the base followed by health centers, district hospitals, regional level hospitals, zonal hospitals and referral and national hospitals at the summit. This pyramidal structure of health services persists up to this very day and forms the backbone of healthcare facilities' distribution countrywide.

#### *2.2.2 Financing system for "Free health services"*

Free health services were enjoyed by Tanzanians until early 1990s. At this time, it became apparent that provision of free healthcare for all was neither tenable nor possible. The main explanation to this situation was the rising healthcare costs along with low economic growth. This sobering situation led to the government's adoption of health sector reforms in early 1990s. The reforms changed the financing system from free services to cost sharing policies in the form of user fees which was introduced in four phases from July 1993 to January 1995. The cost sharing policy put in place exemption and waiver for special groups.
