August 2026
When members of Tanzania’s Ministry of Health joined the Data to Policy (D2P) program in 2022, they wanted to address the prevalence of tuberculosis (TB) among people living with HIV (PLHIV). TB accounts for nearly a third of AIDS-related deaths in the world, and Tanzania’s 2018 mortality data shows that 160,000 HIV-positive people who died also had TB infections.
To prevent TB among PLHIV, the World Health Organization recommends isoniazid preventive therapy (IPT) for 36 months. IPT is an antibiotic regimen in pill form. It can prevent latent TB from becoming an active, contagious TB infection.
Together with his D2P teammates, Edwin Chalia Oliver, Principal Economist and Head of Evaluation and Research at the Unit of Monitoring and Evaluation in the Ministry of Health, analyzed civil registration and vital statistics (CRVS) data to identify and quantify the magnitude and patterns of TB mortality among PLHIV. They studied trends in deaths, causes of death and differences across population groups and geographic areas. Through their research into root causes, they learned that many PLHIV were not completing doses of IPT. They decided to propose interventions to improve the uptake of IPT to prevent TB among PLHIV.
At the time, the Ministry of Health was designing a community health worker training program to build and strengthen a workforce to support numerous health programs at the village level. Oliver and teammates identified an opportunity to improve uptake of and adherence to IPT through the engagement of community health workers (CHWs). In the brief they developed through D2P, they proposed teaching community health workers about the importance and provision of IPV in the new training program.
“We want people who know their culture, their people, their traditions,” says Oliver. “Through engaging community health workers, we are able to reach areas which can't be reached by healthcare workers.”
The team presented the brief to policymakers in 2023. The Minister of Health took the proposal to the Directorate of Preventive Services and requested the inclusion of TB education and IPT provision training in the CHW training program. To make the CHW training program a reality, the government mobilized funds and formed a taskforce to develop training modules for CHWs, as well as a payment scheme to ensure that CHWs were paid on a regular schedule.
In 2024, with support from the Susan Thompson Buffett Foundation, the Ministry of Health launched a new six-month college certificate program for CHWs. As part of the program, CHWs learn about the importance of IPT and are trained to provide medication to community members living with HIV. The six-month training addresses many other topics, including malaria screening; patient referral processes; and emergency response and outbreak detection for cholera, Ebola and other diseases. CHWs are also trained to conduct general health screenings so that they can refer people to a health facility for care.
In addition to supporting community members in accessing health care, the CHWs are also trained in data collection, analysis and translation. Now, CHWs can report community-level data from the village health facilities to the government, support data analyses and then translate findings back to their communities. Through this approach, CHWs play a critical role in the translation of data to practice, and communities gain access to the information they need to improve their health.
“They train their communities to understand the data so that they can be a part of improving health issues and healthcare delivery,” says Oliver.
To date, 11,000 CHWs from 12 mainland regions have completed the six-month training program and returned to their villages to support community health initiatives, including IPT for PLHIV. There are now two CHWs —one man and one woman—in each village across the 12 districts providing public health resources and information to their neighbors. The government of Tanzania aims to train 170,000 CHWs by 2029, ultimately reaching all 26 mainland regions.
