Closing the women's health gap could inject $1 trillion annually into the global economy. Women reinvest up to 90% of their income into families and communities.
Interview with Dr Joseph Komwahingiro, Senior Country Director, Pathfinder Tanzania
How long has Pathfinder been working in Tanzania, and what are your main areas of focus?
Pathfinder has been a partner in Tanzania for decades, since 1957, working alongside the government and communities to strengthen health systems, improve maternal and child health, and advance women's rights and leadership.
We work alongside government and communities in five key areas:
Sexual and reproductive health: Access to contraception, family planning, safe delivery, and post-abortion care.
GBV prevention and response: Integrated care for survivors, particularly children. Kivule Hospital's One Stop Center is a model - survivors don't retell their trauma multiple times as they move between services.
Youth empowerment: Working with young people as leaders who already hold solutions, from peer education at Mtetema Primary School to youth-led climate adaptation.
Climate and health integration: Building climate-resilient health systems and supporting women with climate-smart approaches that protect health and economic security.
Women's economic empowerment: Through programs like Tuungane, connecting health with economic opportunities - because health services alone don't work if women can't afford to access them.
All of this is done in partnership with the Ministry of Health, Ministry of Community Development, Gender, Elderly, Children and Special Groups; Prime Minister’s Regional Administration and Local Government, regions like Morogoro, Arusha, and Zanzibar; and community-based organizations who are closest to the issues.
Why should Tanzania continue investing in women's health, what are the biggest challenges, and what gives you hope?
Women's health is infrastructure, not separate from economic development - it's foundational to it. When women are healthy, families and communities thrive. When women access contraception and plan families, they complete education and participate economically. When maternal mortality drops, you don't lose productive society members.
The data is clear: closing the women's health gap could inject $1 trillion annually into the global economy. Women reinvest up to 90 percent of their income into families and communities. Investing in women's health is one of the smartest economic decisions a country can make.
The challenges are real and interconnected:
Access gaps: Women in rural areas, women with disabilities, adolescent girls, and those in hard-to-reach regions face barriers - distance, cost, stigma, and lack of disability-inclusive facilities.
Health system strain: Health workers are under-resourced, understaffed, and under-supported. When facilities lack basic supplies, even skilled providers can't deliver quality care.
False separation of health from economic realities: Health services alone don't work if women can't afford access, lack economic power to make decisions about their bodies, or face climate shocks destroying livelihoods and health simultaneously. Climate change is amplifying these challenges - floods destroy health facilities, droughts drive child marriage, heat waves complicate pregnancies, and displacement increases gender-based violence.
But two things give me tremendous hope: Young people are leading peer education, demanding better services, holding systems accountable, building community solutions. We are also seeing integration in real-time.
These are signals that Tanzania is moving toward a different model where women's health is treated as infrastructure, communities lead, and sustainability is foundational. The challenges remain significant, but the pathway is becoming clearer, and Tanzania is demonstrating that pathway for the region.
Tomorrow is the International Day of Zero Tolerance for FGM. What does this day mean for Tanzania?
Tomorrow, the world commemorates this important day that has coincided with a major milestone for us as Pathfinder. We've just signed the HER Future partnership, which will reach over 380,000 young people in Morogoro and Arusha with integrated support: sexual and reproductive health services, GBV prevention, economic opportunities, and youth leadership development.
Tanzania has made real progress - FGM prevalence has dropped from 18% to 8% over three decades. But 2.7 million Tanzanian women and girls have still experienced FGM, and in Arusha, prevalence remains at 41%. The last 8% are often the hardest to reach.
HER Future treats FGM not as an isolated issue, but as part of a broader system linked to child marriage, maternal mortality, gender-based violence, and girls' education. You can't address one without addressing the others.
Why is FGM still happening in some communities despite the laws and awareness campaigns?
A: Because it's deeply connected to beliefs about marriageability, family honor, and economic security. In communities where FGM is practiced, families often believe their daughters won't be accepted for marriage without it - and marriage is seen as the only pathway to economic stability.
Awareness alone doesn't work. You need economic alternatives so families see other futures for their daughters. You need male engagement so young men pledge to marry girls who haven't been cut. You need religious and community leaders shifting norms from within. And you need health systems ready to support survivors with trauma-informed care.
This is why HER Future integrates health, economic empowerment, education, and community engagement. Communities have told us: you can't just tell us to stop FGM. You have to help us create different futures for our daughters.
What makes the HER Future project different from past FGM programs?
Three things:
Holistic approach: We address teenage pregnancy, maternal mortality, GBV, youth economic empowerment, and SRHR together - because in young people's lives, these issues are interconnected.
Disability-inclusive: Girls with disabilities face even higher rates of violence and are often excluded from services. HER Future ensures facilities are accessible, trains providers in disability-inclusive care, and engages families of children with disabilities.
Locally led: Tanzanian organizations - Pathfinder together with Amani Girls Organization, Femina Hip, Pastoral Women's Council - lead this work in collaboration with government and the Norwegian Embassy. This is a multi-year investment with government ownership from the start, not a short-term donor project.
How does FGM affect maternal and child health outcomes?
Severely. Women who have undergone FGM face 15% - 55% higher rates of perinatal death. They experience prolonged labor, increased cesarean sections, severe bleeding during childbirth, and higher maternal mortality risk. Survivors also experience chronic pain, infections, and psychological trauma.
These aren't just individual tragedies - they're health system burdens. When FGM complications lead to emergency cesareans or prolonged hospitalizations, our already-strained facilities bear those costs. Health workers in Arusha and Manyara deal with these complications regularly.
FGM elimination isn't just a rights issue. It's a health systems issue. Prevention reduces facility burden and saves lives.
What role do men and boys play in ending FGM?
Critical. In many communities, fathers, brothers, and potential husbands influence the decision. If marriageability is tied to FGM, young men need to publicly commit to marrying girls who haven't been cut. We've seen this work in Kenya, where Maasai warriors pledged not to marry girls who've undergone FGM. That shifted the calculation for families.
HER Future includes male engagement - working with fathers, religious leaders, traditional leaders, and young men to understand FGM's harms and model different masculinities where being a man isn't about controlling women's bodies. That's how we make change.
How can Tanzania reduce dependency on donor funding for women's health programs?
This is the critical question - and it requires multiple strategies:
Government ownership and domestic resource mobilization: The more Tanzania invests its own resources in women's health, the less vulnerable programs are to donor funding shifts. We're seeing this with m-mama - the government leads, and it scaled nationally.
Public-private partnerships: m-mama works because Vodafone Foundation partners meaningfully. There are opportunities for private sector to invest in women's health - not as corporate social responsibility, but as smart business. Healthy women are productive employees, consumers, entrepreneurs.
Sustainable financing mechanisms: Health insurance schemes that cover maternal care, community financing models, or social enterprises like Kenya's FemVive where women earn income distributing health products.
Integration across sectors: When health is connected to economic development, climate adaptation, and education - not treated as a standalone sector - you access different funding streams and justify investments differently.
The Women-Led Innovation Roundtable we convened thsi week explored these questions deeply. The consensus was clear: we need to move from "how do we get more donor funding?" to "how do we build models that don't require donor funding to sustain?"
That's the future Tanzania is building - and it's a pathway the entire region is watching.
