Turning left off the Nyere road, the main route between the Dar es Salaam city center and the airport, the ancient VW van--more rust than metal--bucks and weaves, slewing down 2-foot-deep craters that pockmark the dirt track. Within moments of leaving the tarmac road, you enter the slums of Dar es Salaam, home to 80 percent of the city's population of three million, where a one-room house of cement blocks, rotting wood, and rusting corrugated metal will house a family of eight. Shallow wells dug next to pit latrines are a source of contaminated water often used for washing, drinking, and cooking.
It is in the slums of Tanzania's largest city that the grim statistics linked to one of the planet's poorest countries are rooted. The happy snapshot of laughing African children posing for the camera has a grotesque twist here. Two out of every 10 children will die before they are five years old from preventable diseases such as cholera, malaria, and diarrhea.
There are few old people in the city slums, where life expectancy is 37, well below the national average of 45 calculated by the World Bank for 2000. AIDS is driving life expectancy down. According to U.N. figures for 1999, 8 percent of Tanzanians are HIV positive, but no one really knows the true grip the disease has on the country There are indications that the figure is far higher. Cervical cancer rates are on the rise, a sign of increasing infection, and in some urban areas up to 30 percent of pregnant women are diagnosed as HIV positive.
But it would be a mistake to think of Tanzania as an aid-dependent country devoid of hope. Behind the images of disease, poverty, and hopelessness so commonly associated with Africa lies a far more optimistic truth. Focusing on Tanzania's approach to public health and the development of the environmental health profession makes it clear that Tanzania is a country capable of solving its own problems.
Over the past four years, the Tanzanian government has undergone a series of radical reforms that some believe the U.K. government would do well to emulate. The ruling Chama Cha Mapinduzi party has taken bold steps to relinquish power to local authorities in a bid to give the people what they ask for, rather than what the government thinks they need.
"In the past, the way it worked was that central government would tell the districts, we want this issue dealt with,' and they would have to do it," explains Dr Gabriel Upunda, Tanzania's chief medical officer...