Voices From The Capacity Project: Improving Health Care In Zanzibar—Strengthening the Mnazi Mmoja Hospital

Zanzibar’s population of nearly one million needs better access to quality health care. Preventable, communicable diseases including malaria and tuberculosis are widespread, and health facilities suffer from a crippling shortage of doctors, nurses and supplies.

As part of the United Republic of Tanzania, Zanzibar maintains its own government and an independent Ministry of Health and Social Welfare. To improve the quality of health care, the Ministry created a Human Resources for Health 5-Year Development Plan. A key strategy is the development of Mnazi Mmoja Hospital (MMH) into a semi-autonomous organization.

MMH is the main referral hospital for Zanzibar. Service provision is limited due to a severe shortage of clinicians and a scarcity of supplies from basic equipment to essential drugs. Becoming semi-autonomous would allow MMH greater flexibility to address local needs and to develop creative solutions—such as remuneration arrangements to attract and retain skilled health workers—that may not fit within the Ministry’s structure. With this initiative, the Ministry is taking a step toward decentralizing Zanzibar’s public health care system to improve efficiency and better respond to local conditions and needs.

The Capacity Project is assisting the Ministry to strengthen human resources for health. As one aspect of this work, the Project engaged a Pfizer Global Health Fellow, Patrick Herzog, to support the transformation of MMH. Over six months, Herzog contributed to the development of a five-year strategic plan for MMH. The main objective is to establish the hospital as an independent arm of the Ministry by creating a management framework that improves revenue generation and financial stability, resulting in increased provision of medical supplies and equipment and enhanced infrastructure.

Following an orientation with Project staff, Herzog began work in Zanzibar in July 2006 and completed his assignment in December. "My background is industrial engineering," Herzog says. "But prior to working at Pfizer I worked in the health care industry, mainly in hospital administration dealing with finances, productivity improvement and cost savings, so I was very familiar with hospital environments." In Pfizer’s Global Health Fellows program, employees like Herzog team up with organizations that are involved in health care in developing countries. The Capacity Project’s partnership with Pfizer is one of several links the Project has formed to bolster its efforts.

The strategic plan for MMH is the result of a combined effort from the Capacity Project (especially Herzog and another consultant, Deborah Parsons of Rush University Medical Center), the Ministry and MMH. Herzog worked closely with Dr. Abdulla Saadalla, Director of MMH, Dr. Maryam Hemed, Medical Superintendent at the Ministry and Khamis Khamis, Head of the Ministry’s Human Resource Division, getting to know each of them well. His efforts were aided by becoming "a person behind the words," Herzog believes, which "carried a lot more weight into my strategic documents."

To get to know the local culture, Herzog spent his evenings interacting with community members. His interest in photography "opened the door to helping me integrate into the community," he recalls. After work, "I’d spend the last hour of daylight taking pictures of kids, then the next hour or two I’d be delivering the pictures I took the day before—hanging out with the kids, being invited to their homes and meeting their parents." He also taught a weekly English class in a rural district "to help in other ways besides working at the hospital."

This involvement helped him learn about the workings of MMH from the perspectives of actual patients. "I got to understand some of the dynamics of the hospital from the real stories of people who [told me about] their experience," Herzog remarks.

In December 2006, the executive committee formally voted to accept the plan. Herzog explains, "That made it an official document that will go into the Ministry of Health’s ongoing strategic planning efforts and their plan of action." He is optimistic that the plan will help to strengthen the quality of care for the people of Zanzibar. "The main goal was for the hospital to become semi-autonomous and they will do that," he says. "They understand the need and there is support to move forward."


The Capacity Project, funded by the United States Agency for International Development (USAID) and implemented by IntraHealth International and partners, helps developing countries strengthen human resources for health to better respond to the challenges of implementing and sustaining quality health programs.

The Voices from the Capacity Project series is made possible by the support of the American people through USAID. The contents are the responsibility of IntraHealth International and do not necessarily reflect the views of USAID or the United States Government.