Zanzibar introduces performance-based health assessments

Unguja. The Zanzibar Ministry of Health will begin assessing health workers on the quality of services they provide, shifting its focus from infrastructure development to healthcare outcomes.

The move follows substantial government investment in health facilities, medical equipment, and financing aimed at strengthening service delivery across the Isles.

The announcement was made on Monday, June 29, 2026, by the Permanent Secretary in the Zanzibar Ministry of Health, Dr Mngereza Mzee Miraji, during a meeting to review progress and set priorities for improving healthcare services. The forum, jointly organised by the ministry and PharmAccess, brought together health sector leaders and stakeholders from across Zanzibar.

"From now on, we will no longer be judged by the number of hospitals we have built, but by the quality of services delivered within those facilities," said Dr Miraji.

"The next step is to stop blaming one another. If we want change, we cannot continue doing the same things and expect different results. We must all agree that quality is now our priority and commit ourselves to enforcing it," he added.

Dr Miraji said that from July 1, the ministry would no longer tolerate poor performance by health workers, with the new approach applying across the healthcare system, from dispensaries and health centres to district, regional, and referral hospitals.

As Zanzibar works towards its 2030 health targets, he said every department and directorate must align its plans with five strategic priorities, led by improving healthcare quality and strengthening patient safety.

He also called for a stronger referral system linking primary healthcare facilities with district, regional, and referral hospitals, stressing that quality healthcare begins at the community level.

"We will no longer accept explanations for maternal health complications because no information was available. We already have a community health system through which referrals can be made, and community health workers are performing their responsibilities. We therefore do not expect pregnant women to develop complications because information failed to reach the appropriate level," he said.

Dr Miraji identified accountability and performance management as another priority, urging health workers and managers to focus on measurable results.

"Whether you are a nurse, a midwife, or any other healthcare professional, your duty is to report to work every morning and serve the people, not spend your time engaging in idle talk," he said.

He revealed that attendance reports submitted to the ministry showed some health workers reported for duty on only 14 days in a 30-day month, describing the trend as unacceptable.

The Permanent Secretary also urged officials to base decisions on reliable data rather than assumptions, warning that poor decision-making could undermine service delivery and overall performance.

PharmAccess Project Manager, Dr Faiza Abasi, said the organisation has partnered with the Zanzibar Ministry of Health since 2020 to improve healthcare quality at every level, from dispensaries and health centres to district, regional, and referral hospitals.

"Through this partnership, our goal is to ensure that healthcare services provided in all facilities meet recognised quality standards," she said.

Dr Abasi said the partnership had developed a framework for assessing healthcare quality across the sector.

"We measure quality using a five-level rating system, similar to hotel classifications. Health facilities are assessed against these standards. However, no facility in Zanzibar has yet attained Level Five, with most currently rated between Levels One and Three," she said.