In the densely populated wards of Kigamboni, Kurasini, and Mchafukoge, a quiet but powerful transformation is reshaping how residents think about hygiene, health, and responsibility.
At the centre of this change are Community Health Workers (CHWs), whose door-to-door efforts are helping bridge long-standing gaps in water, sanitation, and hygiene in Tanzania’s commercial capital.
For years, rapid urbanisation has strained Dar es Salaam’s WASH infrastructure, leaving many communities vulnerable to preventable diseases. While facilities have gradually improved, changing everyday behaviour has remained a challenge.
That is where CHWs, supported by WaterAid Tanzania’s project on strengthening WASH in communities and healthcare facilities funded by DP World, have become the critical link.
“Access to infrastructure alone is not enough. What sustains health is behaviour,” said Richard Shabani, Dar es Salaam Regional Health Officer. “Community health workers are trusted voices, and they are helping transform hygiene from a temporary response during outbreaks into a daily habit.”
Formative studies conducted under the project showed that while hygiene practices improved during outbreaks such as cholera or COVID-19, those gains often faded once the crisis passed.
CHWs are now working to embed hygiene into daily life through household visits, school sessions, and community meetings.
Using local forums and familiar language, they address sensitive but persistent challenges, including open urination and the perception that sanitation is solely a government responsibility.
With refresher training and improved tools, CHWs deliver age-appropriate and gender-sensitive messages that resonate across generations.
“People listen to us because we live here with them,” said one CHW in Kurasini. “When they see us practising what we teach, they start to believe change is possible.”
Beyond households, the project is also reshaping hygiene standards in key public health facilities, including Mnazi Mmoja Hospital, Kigamboni Health Centre, and Kurasini Dispensary, where reliable water and sanitation are essential for safe care.
At Kigamboni Health Centre, damaged infrastructure had previously forced staff to fetch water in buckets to serve reproductive and child health units.
At Mnazi Mmoja Hospital, water shortages risked disrupting surgical services and compromising the dignity of mothers in labour. Meanwhile, Kurasini Dispensary, despite strong sanitation standards, faced challenges in managing medical waste sustainably.
“These challenges affect patient safety directly,” said Shabani. “The interventions we are seeing now ensure that staff can work safely, patients receive dignified care, and preventable infections are reduced.”
A key focus of the initiative is the integration of WASH into Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH) services.
Ensuring continuous access to clean water, soap, and personal protective equipment is significantly reducing the risk of infections, particularly among mothers and newborns.
The project also places strong emphasis on gender and social inclusion, with newly built or rehabilitated facilities designed to be accessible to persons with disabilities and resilient to climate stress.
Special attention has been given to menstrual hygiene management, providing privacy and safe disposal options for women and adolescent girls — an often-overlooked but critical need.
As community health workers continue their house-to-house visits and healthcare facilities become cleaner and safer, the initiative is expected to reach more than 65,000 residents across the targeted wards.
“What we are seeing is not just better infrastructure, but a shift in mindset,” said Shabani. “This is about dignity, prevention, and long-term resilience.”
Through its dual focus on community empowerment and institutional strengthening, Dar es Salaam is moving beyond temporary fixes. The city is laying the foundations for a culture of hygiene that could safeguard public health for generations to come.