Published on and written by Cyril Jarnias
Moving to Tanzania is a dream for many: safaris, Zanzibar beaches, a warm atmosphere, and a relatively low cost of living. But beyond this postcard image, healthcare is a crucial issue for any expatriate. In a country ranked among the poorest in the world, with a developing healthcare system and stark inequalities between cities and rural areas, moving without solid medical preparation is a real gamble.
This article details the Tanzanian healthcare system for expatriates, including how hospitals work, the role of insurance, access to medication, health risks, emergency and medical evacuation procedures, as well as dental, vision, and mental healthcare. It provides benchmark figures for realistic preparation without alarmism.
A Developing Healthcare System with Significant Regional Disparities
The starting point is unequivocal: Tanzania remains one of the poorest countries on the planet, with a poverty rate around 28% and a GDP per capita below $3,000. Logically, the healthcare system reflects this context.
The health authorities—primarily the Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC)—oversee a network mixing public, private, and faith-based facilities. Over 60% of facilities are public, but they are chronically underfunded, poorly equipped, and face a severe shortage of qualified personnel.
The healthcare system in Tanzania is structured according to a strict hierarchy, ranging from village dispensaries to the national hospital. This organization reveals major disparities: infrastructure is generally insufficient outside major urban centers, with a marked gap between cities like Dar es Salaam, Arusha, Moshi, Mwanza, and the rest of the country.
The best hospitals—both public and private—are concentrated in Dar es Salaam and Arusha. Elsewhere, it is not uncommon for residents to travel long distances to access specialized care, or even adequate emergency services.
Public vs. Private: What Expatriates Actually Experience
For the poorest Tanzanians, reliance on the public sector is often the only option. For expatriates, the reality is very different: the vast majority avoid the public sector as much as possible and turn to the private sector, considered more reliable and comfortable, even if it remains below Western standards.
The Public Sector: Essential for the Population, Not Suited to Expatriate Expectations
In theory, basic public care is free for the most vulnerable locals (very poor individuals, children under 5, pregnant women, people over 60). In practice, the picture is darker: overcrowded hospitals, endless waiting lines, shortages of equipment, medication, and staff.
Major public reference hospitals in Tanzania, such as Muhimbili National Hospital in Dar es Salaam, Mount Meru Regional Referral Hospital in Arusha, or the Kilimanjaro Christian Medical Centre (KCMC) in Moshi, play a central role for Tanzanians but remain “significantly below” Western standards. Expatriates rarely use them, except in cases of absolute emergency for rapid stabilization before evacuation.
Diplomatic sources
The National Health Insurance Fund (NHIF), the main public insurance scheme, primarily covers civil servants and, increasingly, some private or informal sector workers. It reimburses basic care (consultations, hospitalization, essential medicines, tests). But it is primarily designed for citizens, faces chronic administrative delays, and is considered largely insufficient for expatriate needs. Even when they can join, expatriates do not make it their primary safety net.
The Private Sector: The Natural Entry Point for Expatriates
Conversely, the private sector is the reference for most foreigners. Private clinics and hospitals offer more modern facilities, shorter wait times, streamlined administrative procedures, and generally English-speaking doctors. Expatriates notably mention:
This is the number of reference medical facilities identified for expatriates and travelers in Tanzania’s major cities.
These facilities have much more advanced equipment than average (CT scans, MRI, modern operating rooms, cardiology, oncology, nephrology, specialized maternity services…). Some clinics also focus on a “fast” service for expatriates, like the “Personalized Fast Track Service” at Regency Medical Centre.
The flip side is twofold: costs are high relative to local income, and even these establishments acknowledge their limitations for the most complex cases. For prolonged resuscitation, major surgeries, or specialized pathologies, evacuation to Nairobi (Kenya) or Johannesburg (South Africa) is often the only acceptable solution.
Medical Emergencies: A Fragile Chain, Unreliable Numbers
One of the most sensitive points for an expatriate is emergency management. In Tanzania, there is no true structured national public ambulance system. The official emergency numbers, 112 and 114, are far from offering reliability comparable to Europe or North America.
Outside Dar es Salaam, dialing 112 can prove ineffective: the call doesn’t go through, remains on hold indefinitely, or is hampered by the language barrier, as operators primarily speak Swahili. Consequently, in many regions, victims of serious injuries are often transported to the hospital by improvised means: taxi, private car, motorcycle, or with the help of ‘good Samaritans’ or law enforcement. Data indicates that less than 10% of seriously injured people benefit from an ambulance transfer.
The absence of a structured pre-hospital system partly explains the very high road mortality rate – over 30 deaths per 100,000 inhabitants according to the WHO. For expatriates, this means that in case of a road accident, heart attack, or anaphylactic shock, the speed of care largely depends on their own preparation: knowing in advance which facilities to go to, having a vehicle, having the contacts for private ambulances.
Several private companies have positioned themselves in this niche, especially in major cities.
– TMHS Emergency Medical Services, with a fleet of equipped ambulances and training offerings (BLS, ACLS, etc.)
– Knight Support, present in Dar es Salaam and Arusha
– Ambulance networks attached to certain private hospitals
These services are paid and often expensive, but can make a real difference in some situations. They are frequently integrated into the contracts of large companies or international NGOs.
Medical Evacuation: A Non-Negotiable Element for Expatriates
The structural limit of the Tanzanian system is such that expatriates must consider medical evacuation (medevac) as a probable scenario, not a theoretical hypothesis. For major surgery, advanced oncological care, certain resuscitation cases, or even cutting-edge diagnostics, the standard is to be transferred by plane to Nairobi or Johannesburg.
Several operators specialize in these evacuations:
Main operators specializing in medical assistance and evacuation in Tanzania and the region, offering services adapted to remote areas.
Medically equipped aircraft based in Arusha, capable of taking off from bush airstrips and performing night flights.
Based in Nairobi with offices in Dar es Salaam and Arusha. Offers subscriptions covering evacuation from safari or mountain areas.
Specializes in helicopter evacuations around Kilimanjaro, Serengeti, and the Ngorongoro Crater.
Include Flying Medical Service, Mission Aviation Fellowship, and Global Air Ambulance for extended coverage.
Most of these flights can only operate during the day, due to a lack of lighting on many airstrips. For international evacuation, administrative constraints must be added: valid passport, sometimes vaccination certificate (notably for yellow fever), medical clearance for flying.
The gross costs, without insurance, are colossal. A simple example from real international insurance cases shows that repatriations can exceed 60,000 euros, while some hospital stays exceed 200,000 euros. Without appropriate coverage, an expatriate therefore exposes themselves to catastrophic financial risk.
Health Insurance: Why a Comprehensive International Contract is Essential
In this context, living in Tanzania without solid health insurance is simply unwise. Expatriates can choose between local insurance and international contracts dedicated to expatriates, with major differences.
Local Insurance: Limited Coverage, Focused on the Territory
Local insurers like Jubilee, UAP, or Resolution offer private coverage for the urban middle class and some companies. They may include access to the country’s best clinics (Aga Khan, IST Clinic, Premier Care, Regency, etc.) with sometimes benefit caps expressed in Tanzanian shillings. For example, some plans negotiated by brokers like Howden Puri include:
| Type of plan (example Howden Puri) | Annual limit (TZS) | Annual premium adult (TZS) | Annual premium child (TZS) |
|---|---|---|---|
| Inpatient only | 20 to 100 million | starting from 356,000 | starting from 275,000 |
| Comprehensive (in/outpatient) | Outpatient up to 2 million | starting from 960,000 | starting from 864,000 |
These amounts may seem modest for an expatriate employed by a multinational, but they remain high relative to the local minimum wage (approx. 50 USD per month). Above all, these local products remain focused on Tanzania, with almost no portability abroad and often non-existent or very limited medical evacuation coverage.
International Insurance: Designed for Expatriation, Including Evacuation
International health insurance contracts for expatriates constitute the safest option for those settling long-term. Players like Cigna Global, Allianz Care, William Russell, VUMI, IMG Global, NOW Health International, GeoBlue, DavidShield, AXA, or Indigo Expat offer customizable plans with:
– Coverage for care in Tanzania and abroad
– Coverage for medical evacuations and repatriations
– Networks of partner clinics with direct billing
– 24/7 multilingual assistance
– Dental, optical, maternity, mental health options, etc.
The differences between these products and local plans are notable on several key points:
| Criterion | Typical local insurance | International expatriate insurance |
|---|---|---|
| Geographic area | Primarily Tanzania | Regional or worldwide (with/without USA) |
| Renewal with age | Often limited around 65–70 years | Often renewable for life |
| Medical evacuation | Rarely included, sometimes optional | Generally included and well-funded |
| Portability when moving | Very limited | Designed to follow the expatriate across countries |
| Premium calculation basis | Individual claims experience | Global pooling by age bracket |
Costs are logically higher, but they must be compared to the covered risks. Examples of monthly premiums for a 30-year-old on a product like William Russell (reference data) show a range:
| International plan (30 years old, Zone 2, $250 deductible) | Monthly premium (USD) |
|---|---|
| Bronze | ~98 |
| SilverLite | ~140 |
| Silver | ~180 |
| Gold | ~324 |
For a fifty-year-old, these amounts can exceed 500 USD per month for the most generous coverages. At the scale of an expatriate budget, health often represents 7 to 20% of total expenses. This financial effort must be weighed against the high probability of using care: some statistics indicate that 50% of insured individuals use the system at least once a year, while 10% of patients account for 80% of costs.
How to Choose Your Contract When Moving to Tanzania
Beyond price, several elements should be closely examined before signing:
Details of coverage, medical network, and practical modalities of health insurance for expatriates and residents in Tanzania.
Annual and per-procedure limits for specialized care (resuscitation, oncology, maternity). Coverage for pre-existing conditions under terms and waiting periods.
Medical evacuation included to Kenya or South Africa. Access to a broad network of partners in Tanzania (Aga Khan, IST Clinic, Premier Care, Regency, ALMC, Tasakhtaa, etc.).
Direct billing available at network hospitals. Reimbursement for out-of-network consultations and pharmacy expenses per insurer policy.
Partial or full coverage for mental health, dental care, and optical equipment, depending on the chosen coverage level.
Specific conditions for risky activities like climbing Kilimanjaro, scuba diving, or safaris. Verify inclusions/exclusions in the contract.
Many expatriates use specialized brokers to compare over 300 existing plans, benefit from neutral advice, and get assistance in case of disputes or claims.
Medication and Pharmacies: Abundance in Cities, Structural Weaknesses
In major cities, pharmacies are easily accessible and visible. In Dar es Salaam, there are over 1,100 pharmacies – nearly half of the country’s pharmacies – and a growing number of accredited pharmacies and Accredited Drug Dispensing Outlets (ADDOs) in rural areas.
Nevertheless, several limitations quickly appear for an expatriate:
– Stockouts are frequent, especially for chronic disease treatments (diabetes, hypertension…).
– The pharmaceutical system relies heavily on imports: about 70% of national needs are imported, with local industry covering only about 30%.
– Local production is concentrated in a few generic drug factories, only a handful of which are recognized as compliant with good practices by the regulatory authority.
The pharmaceutical market is regulated by the Tanzania Medicines and Medical Devices Authority (TMDA), successor to the TFDA, reputed to be one of the most serious regulators in Africa. Medicines are classified into five risk categories (schedules). Pharmacies can sell prescription, over-the-counter (OTC), and general sales list (GSL) medicines, while rural outlets (ADDOs) have a more restricted sales scope.
In theory, selling prescription medication without a prescription is punishable (fine up to one million shillings or six months in prison). In practice, the absence of a precise legal list of prescription-only medicines and gaps in enforcement still favor “flexible” sales. It is therefore not uncommon for foreigners to take advantage of this flexibility to buy antibiotics at a pharmacy without medical documentation, at the risk of contributing to antibiotic resistance.
For these reasons, recommendations for expatriates are clear: it is essential to prepare well for departure, research local legislation, secure health coverage, and plan appropriate management of finances and taxes in the host country.
– Arrive with a sufficient reserve of chronic medications, in their original packaging, accompanied by a prescription or medical certificate.
– If possible, plan for a backup stock or a solution for supply from your home country in case of prolonged shortage.
– Do not count on the “guaranteed” availability of specific or recent drugs.
A concrete example illustrates the burden of medication even in the public sector: a diabetic patient followed at Mwananyamala Hospital indicated paying about 10,000 TZS (approx. 5 USD) every two weeks for insulin, while the monthly minimum wage is around 50 USD.
Major Health Risks: Malaria, Water, Altitude, Emerging Diseases
Living or traveling in Tanzania exposes you to specific health risks, sometimes underestimated by new arrivals.
Malaria remains endemic across most of the territory below 1,800 meters. Prevention rests on several complementary pillars: chemoprophylaxis prescribed by a doctor, long and light-colored clothing in the evening, repellents based on DEET or Picaridin, impregnated mosquito nets. Prompt treatment at the onset of fever is also fundamental.
Waterborne diseases like cholera and typhoid are regularly reported. Tap water is not potable: it is imperative to consume sealed bottled or treated water. Caution is also advised with raw foods or street food, especially during the first months of stay.
Among other identified threats: cyberattacks, environmental degradation, pandemics, terrorism, economic disparities.
– Dengue, Zika, chikungunya (arboviruses transmitted by mosquitoes)
– Sleeping sickness (trypanosomiasis) in some areas
– Rarer viruses but monitored like Marburg or Ebola (outbreaks have been documented, even if some have been officially declared over)
For expatriates attracted to climbing Kilimanjaro or Meru, there is a serious risk of acute mountain sickness. A prior medical consultation is strongly advised, as is registering with a specialized helicopter evacuation service for these peaks.
Health authorities and international organizations recommend a full panel of vaccinations for long-term stays:
| Vaccines generally recommended for a stay in Tanzania | General comment |
|---|---|
| Diphtheria – Tetanus – Pertussis | Up-to-date booster |
| Measles – Mumps – Rubella (MMR) | Strongly recommended, outbreaks possible |
| Polio | Booster often advised |
| Hepatitis A and B | Highly recommended |
| Typhoid | Recommended depending on living/travel conditions |
| Rabies | For long stays, rural areas, or contact with animals |
| Meningitis | Depending on risk profile |
| Yellow fever | Required only if transiting/arriving from a risk country |
| COVID-19, seasonal flu | Recommended per current guidelines |
A visit to a travel medicine clinic 4 to 6 weeks before departure allows adjusting this schedule to each person’s situation (age, medical history, exact destination, type of activities).
Cost of Care and Payment: The Era of Cash and Advance Payment
Even when insured, expatriates quickly discover a constant trait of the Tanzanian system: advance payment. In most establishments, public and private alike, the patient must pay in cash before receiving care, unless they benefit from a direct billing agreement between the hospital and their insurer.
This is the average cost in Tanzanian shillings for a 15-minute consultation with a private doctor in Dar es Salaam.
National policy provides that certain groups (children under 5, the elderly, very poor populations) are entitled to free care or co-financing schemes. In reality, stockouts at public hospitals frequently force patients—including the poorest—to buy their medicines at private pharmacies, which are more expensive.
For an expatriate, the key is twofold: having robust insurance and finding out precisely about the payment methods of the chosen facility (possibility of card payment, use of local mobile money, existence of agreements with international insurers…).
Dental and Eye Health: Progress, But Persistent Gaps
Tanzania has undertaken an ambitious oral health reform in recent years. The starting figures were alarming: more than three-quarters of adults and nearly one-third of children suffer from caries, with very high rates of periodontal disease. The dentist-to-population ratio is extremely low, on the order of 1 for 360,000 inhabitants.
Since 2022, the government launched a reform including the modernization of over 300 dental chairs and hundreds of digital imaging systems, the introduction of a dental scorecard in the health information system, and the promotion of alternative materials to amalgam like glass ionomer cement (GIC) and composites. Although extraction remains the most frequent intervention, the ratio between extractions and restorations is gradually improving.
For expatriates, this means that: the reality of living abroad can come with many challenges and opportunities. They must adapt to a new culture, a new language, and often a new work system. This experience can enrich their personal and professional development, but it can also generate feelings of loneliness and isolation. It is therefore essential for expatriates to build a support network and familiarize themselves with their new environment.
In major cities, you can find good-quality private dental practices, some clearly targeting foreign clientele (Dental Studio, Swedish Dental Clinic, Zam International Dental Clinic, International Dental Clinic…). In rural areas, the offering remains very limited and often attached to bush hospitals, with variable technical levels.
Regarding eye health, the situation is a bit better: the country has a national ophthalmology hospital, several zonal hospitals and regional centers, supported by a network of private and faith-based hospitals. But ophthalmologists are too few, concentrated in major cities, and cataract remains a major cause of preventable blindness. Again, an expatriate based in Dar es Salaam, Arusha, or Moshi will find a specialist relatively easily, while an isolated posting will make each trip for a simple eye exam more complex.
Mental Health: A Blind Spot That Also Affects Expatriates
As in many low- or middle-income countries, mental health in Tanzania remains largely under-resourced. WHO data shows a tiny number of psychiatrists and psychologists relative to the population (0.04 psychiatrists and 0.005 psychologists per 100,000 inhabitants), and a very limited network of psychiatric beds, mainly in urban areas.
Public hospitals, like Temeke Hospital in Dar es Salaam, are overwhelmed and under-resourced, with a single psychiatrist shared between facilities for hundreds of monthly consultations and no dedicated beds. Mental health is not a budget priority, stigma is strong, and attempted suicide is penalized by law.
For expatriates, these observations have several concrete consequences:
It is difficult to find an English-speaking psychologist or psychiatrist experienced in expatriate issues locally. Local organizations (Mental Health Tanzania, Serenity Path Tanzania, TAHMEF) offer services but primarily target the local population. Many expatriates therefore opt for teletherapy with practitioners from their home country, via specialized platforms.
International health contracts increasingly include coverage for therapy (in-person or remote) and psychiatric visits. It is still necessary to check that mental health is indeed included in the policy and understand the limits, deductibles, and prior authorizations.
Some Benchmark Figures for Context
Even if statistics sometimes remain incomplete, a few figures give a sense of the environment expatriates operate in:
| Indicator (general context) | Indicative value |
|---|---|
| Population with health insurance (2019) | ~32 % |
| Approximate minimum wage (month) | ~50 USD |
| Share of imported medicines | ~70 % |
| Number of registered pharmacies | > 2,560 |
| Share of these pharmacies in Dar es Salaam | ~44 % |
| Number of ADDO points (rural) | > 14,000 |
| Pharmacist-to-population ratio | 1 per 50,000 |
| Limited aging, still high infant mortality | ~38 deaths / 1,000 live births |
This data illustrates the Tanzanian paradox: a country in transition, with pockets of medical modernity in a few major cities, but also healthcare deserts and extreme financial constraints for the majority of the population.
In Practice: How an Expatriate Can Prepare Intelligently
The good news is that with methodical preparation, it is possible to live and work in Tanzania while significantly limiting risks related to the healthcare system.
Before departure, several steps are essential:
Before your trip, consult a doctor specialized in travel medicine to discuss vaccines, malaria prevention, altitude, and management of chronic diseases. Prepare a digital medical file containing your allergies, medical history, prescriptions, and reports. Take out a European or international insurance valid in Tanzania, covering medical evacuation to Kenya or South Africa, and ideally temporary returns to your home country. Identify recommended hospitals in major cities (Dar es Salaam, Arusha, Moshi, Zanzibar) in advance according to your itinerary. Also identify reliable pharmacies nearby and plan a sufficient reserve of your regular treatments.
Upon arrival, it is prudent to:
– Register with your embassy or consulate, which often provides a list of known doctors and clinics.
– Have an introductory visit with an English-speaking general practitioner at a private clinic, to “anchor” your file locally.
– Get the numbers for private ambulances and medevac services, as well as your insurer’s emergency contact details.
On a daily basis, it is essential to be cautious regarding water, food, mosquitoes, sun, and road safety. However, even with these precautions, a serious accident or illness can occur. The choice of host country must therefore be complemented by appropriate insurance, including evacuation options and medical relays in the region.
Tanzania offers expatriates a rich and unique life experience. In terms of health, however, it forces one to break with the illusion of a healthcare system that “just works” and to become an active participant in one’s own medical security, from the first-aid kit to the insurance contract, including knowledge of hospitals and local limits. The better one understands these constraints, the more one can serenely enjoy life on the ground.
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Cyril Jarnias is an independent expert in international wealth management with over 20 years of experience. As an expatriate himself, he is dedicated to helping individuals and business leaders build, protect, and pass on their wealth with complete peace of mind.
On his website, cyriljarnias.com, he shares his expertise on international real estate, offshore company formation, and expatriation.
Thanks to his expertise, he offers sound advice to optimize his clients' wealth management. Cyril Jarnias is also recognized for his appearances in many prestigious media outlets such as BFM Business, les Français de l’étranger, Le Figaro, Les Echos, and Mieux vivre votre argent, where he shares his knowledge and know-how in wealth management.
