WASH & Health Care Facilities

WASH & health care facilities are meant to be places where people go to seek treatment for illness, not where they are at risk of contracting one.

Yet, millions across the globe face an increased risk of infection if they seek treatment at health care facilities because of the lack of safe and improved WASH (water, sanitation, and hygiene). Many of these facilities are breeding grounds for infectious diseases and thus pose a major barrier to the overall health of individuals and positive healthcare treatment outcomes.

These problems have become even more evident over the past year as developing nations continue to battle the COVID-19 pandemic. WASH services are needed more than ever to protect patients and health care workers.

Recently, UNICEF, the World Health Organization, large development organizations, and national governments have made it a top priority to improve WASH in health care settings by doing a global assessment and making a plan of action to fix this atrocity.

The Water Problem

A severe lack of safe water, sanitation, hygiene, waste management, and environmental cleaning in health care facilities across most low- and middle-income countries poses a huge threat to the health of patients, visitors, health care workers, and especially newborns and their mothers. According to recent reports from UNICEF and the WHO, an estimated 896 million people use health facilities with no water service, and another 1.5 billion use facilities with no sanitation service.

There are major issues worldwide with WASH & health care facilities in low- and middle-income countries, and in the Rorya District, Tanzania, where Maji Safi Group is already working to tackle WASH issues in many different sectors, the problem is huge.

Access to Clean Water

Access to consistent, clean, and improved water sources remains an issue throughout Tanzania for many WASH & health care facilities. Though most facilities in this study (81%) have access to an improved water source, others are still relying on water from rivers and shallow wells, which can cause major health issues. Only 51% reported that they have access to water most days, with other facilities receiving water only some days of the week or even only seasonally. Only 23% of the facilities receive water that is treated at the source, and hardly any have a system in place to regularly monitor the quality of the water they are using. The lack of clean water places these facilities at a much higher risk of contamination and the spread of water-borne and infectious diseases.


Lack of Sanitation

In these health care facilities, it is also very common to find significant plumbing issues with drain systems in sinks, showers, and toilets. Cleaning is often very infrequent, and some facilities have floors that are not cleanable. It was reported that only half of the toilets/latrines observed were free from foul odors and sufficiently clean for use.


Hand Washing and Hygiene

Another major barrier to hygiene in these WASH & health care facilities is the poor quality of hand-washing stations and a lack of sufficient materials to use. One in four health care rooms did not offer hand washing at the point of care at all, and the stations found were some of the most unclean and poorly maintained parts of the facility. Only 56% of hand-washing stations in consultation rooms had water available, and only 51% had soap. This is a major hindrance to clean, safe health care. If workers are not able to clean their hands properly, there is always an increased risk for bacteria and viruses to spread.

Unsafe Waste Management

In many WASH & health care facilities, there were major gaps and deficiencies related to sorting, collecting, storing, and disposing of health care waste products. This can be extremely harmful to patients, visitors, and health care workers. The lack of proper management of waste is often the result of poor training and supervision.

Lack of Environmental Cleaning

In many facilities, the overall environment was not clean and kept to a proper standard to ensure safety. Cleaning systems and practices were not in place to make sure that surfaces were cleaned, sanitized, and sterilized properly. Tanzanian HCFs lack specific standards for cleanliness, leaving those in charge with no guidelines or minimum standards to abide by. Latrines are often blocked, bathtubs are clogged and/or not regularly cleaned, and water systems often leak or are broken. Standards must be put in place to regulate cleanliness in these facilities.

Maternal and Neonatal Care

One of the primary areas where WASH issues are rampant is in maternal and newborn care. Each year, more than one million deaths are related to unclean births, including 26% of neonatal deaths and 11% of maternal mortality.

The overall cleanliness of labor and delivery rooms and the availability of proper hand-washing stations and sanitation practices are essential to the health and well-being of newborn babies and their mothers. Without them, there is a much higher risk for infant mortality and/or illness in the mother or baby.

Education & Health Care Workers

Much of the problem with WASH in health care facilities stems from a major lack of education and training for health care workers. There are no education requirements in Tanzania for health care attendants, and many do not receive proper training on the importance of WASH.

Patients are not educated about proper hygiene either. The study found that only 33.5% of the respondents were informed of essential hygiene behaviors upon arrival at the health care facility.

While there is a huge gap in education, many health care workers are aware that they are at great risk for infection because of unsafe WASH practices – 86% of auxiliary workers reported their concern about common infections, such as HIV and tuberculosis, being passed at their facilities, and 41% of workers said they often lacked proper personal protective equipment (PPE).

The Maji Safi Mission


One of Maji Safi Group’s primary goals this year is to join the global movement towards improving WASH in health care facilities to complement our community-based education model.

Practical potential ways for improvement:

  • Perform a baseline assessment in more than 20 health care facilities (HCFs) in the Rorya District.
  • Partner with the District Medical Office and the Shirati KMT District Designated Hospital to create a 5-year plan for improving WASH in HCFs.
  • Implement a WASH Facility Improvement Team (FIT) model with partnering HCFs and provide capacity building and infrastructural improvements.
  • Advocate for the improvement of WASH in HCFs in the Rorya District and recruit partners from the private and public sectors.
  • Monitor and evaluate the effectiveness of our interventions and share our learnings with other district and regional governments.

Over the past decade, Maji Safi Group has proven the tremendous power of interactive, community-driven education in combatting diseases and promoting healthy lifestyles. In 2021 and beyond, we hope to be on the frontline of educating communities about WASH through the HCFs we partner with.

The UN Secretary General, Antonio Guterres, said this: “Water, sanitation and hygiene services in health facilities are the most basic requirements of infection prevention and control, and of quality care. They are fundamental to respecting the dignity and human rights of every person who seeks health care and of health workers themselves. I call on people everywhere to support action for WASH in all health care facilities.” 


Typhoid in Tanzania

Like cholera and leptospirosis, typhoid fever is a neglected tropical disease (NTD) caused by the bacterium Salmonella Typhi. In the United States, typhoid fever is rare, with under 400 cases annually, mostly acquired in endemic regions of the world like Asia, Africa, and South America. In fact, people are not routinely vaccinated for typhoid in the United States, except before traveling abroad. Typhoid is extremely transmissible via the fecal-oral route through contaminated water or food, and people living in areas without access to clean water and sanitation facilities are most at risk. Children are at the highest risk of infection and experience the highest rates of morbidity and mortality from typhoid. Typhoid can cause high fever, headaches, abdominal pain, weakness, loss of appetite, and enlarged spleen and liver. Untreated, typhoid can become life threatening.

With 40% of Tanzanian households lacking access to safe drinking water and 60% lacking access to improved sanitation, many Tanzanians in both rural and urban communities are at high risk of infection from typhoid. Tanzania has an incidence of typhoid of over 79 thousand cases a year. The majority of cases occur in children under 15 years old. Typhoid fever is treated with antibiotics, including ciprofloxacin and ceftriaxone. Unfortunately, Salmonella Typhi is increasingly drug resistant. In 2016, multi-drug resistance of 89% was demonstrated in blood-culture studies in Moshi, Tanzania. Blood cultures are necessary to diagnose typhoid, and a full course of antibiotics is needed to treat, making the disease difficult to address in low-resource environments. Prevention through access to clean water, improved sanitation, and proper hygiene practices, especially handwashing, is critical to decreasing the risk of infection, morbidity, and mortality.

Maji Safi Group’s Community Efforts to Prevent Typhoid

Maji Safi Group incorporates typhoid prevention into all its sanitation and hygiene education programs in schools, homes, health care centers, and community venues, such as restaurants, stores, salons, etc. Since typhoid can be transmitted readily through food preparation, Maji Safi Group’s outreach to restaurants with hygiene education is a particularly important component in prevention. In 2022 alone, MSG visited and taught WASH lessons at 16 salons, 29 shops, and 25 restaurants for two days each. WASH lessons included hand washing, water filtering, treatment and storage, food preparation, and toilet facilities. In 2022, Maji Safi Group also distributed 477 handouts related to typhoid prevention.

The Future

The WHO has recommended mass vaccination with the newly developed Typbar-typhoid conjugate vaccine in endemic countries with a high burden of typhoid and high antimicrobial resistance. This new vaccine is more effective than previous typhoid vaccines. It requires only a single dose and can be used safely in children over six months of age, making it appropriate for use in conjunction with regular childhood vaccination programs.

Through education and community programs on the importance of using clean water, improving sanitation, and practicing proper hygiene education, Maji Safi Group is already instrumental in reducing the burden of typhoid in Shirati. If the Typbar-typhoid conjugate vaccine becomes a viable option in the medical landscape of the Mara Region, Maji Safi Group would be able to expand its programmatic impact by working closely with our partners at the District Medical Office (DMO), the Shirati KMT District Hospital, and the health centers and dispensaries we work with to explore ways to make this new option as effective and accessible as possible. When the medical community in the Rorya District conducts mass drug administration (MDA) campaigns, Maji Safi Group typically helps staff the outreach and provides onsite WASH and disease prevention education.

Maji Safi Group also has the capacity to react quickly to disease outbreaks through print media, village visits, radio broadcasts, social media, and a telephone hotline. After having helped government health authorities fight three cholera outbreaks in the Rorya District, an emergency response plan was developed by MSG and the DMO with funding from the LUSH Charity Pot program.

During COVID-19, Maji Safi Group reached millions of people in East Africa through a social media campaign with factual information about preventing the disease and was one of the top 10 public health influencers on social media within East Africa.

Click HERE for more information about our ICT program.

Symptoms and Treatment of Typhoid

Typhoid fever, a significant health concern in regions like Tanzania, manifests through a range of symptoms that can often be confused with other febrile illnesses. Recognizing these symptoms is crucial for timely intervention and treatment, significantly since the disease can be life-threatening if left untreated.

Identifying Typhoid Symptoms

Typhoid fever doesn’t manifest immediately after the infection; it has an incubation period of 6-30 days. The symptoms often develop gradually and can be non-specific initially. Common symptoms include:

  1. High Fever: One of the first signs, typically rising over several days up to 104 degrees Fahrenheit.
  2. Weakness and Fatigue: Patients often experience a feeling of tiredness and weakness.
  3. Stomach Pain: This can be particularly acute in the lower abdomen, with possible bloating.
  4. Headache: A persistent, dull headache can be a common experience.
  5. Loss of Appetite: Individuals may exhibit a significant reduction in appetite or disinterest in food.
  6. Rash: Some patients develop a flat, rose-colored rash known as “rose spots.”
  7. Enlarged Spleen and Liver: In some cases, an enlarged spleen or liver is detectable upon physical examination.

Seeking Timely Medical Attention

Given these symptoms, especially when persistent or severe, it’s imperative to seek medical attention promptly. Early diagnosis often involves blood cultures to detect the presence of S. Typhi bacteria, the causative agent of typhoid.

Modern Treatment Approaches

Once diagnosed, treatment should commence immediately to prevent the illness from advancing to a more severe stage. The cornerstone of typhoid treatment is antibiotic therapy. While drugs like ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole were previously effective, resistance to these has grown significantly.

Today, ciprofloxacin and ceftriaxone are frontline treatments. However, an emerging global challenge is the increase in Salmonella Typhi strains resistant to these antibiotics. In Tanzania, a disturbing rate of multi-drug resistance has been observed, underscoring the urgent need for vigilant antibiotic stewardship.

To combat drug resistance, there’s a growing emphasis on vaccination as a preventive measure, particularly in high-endemic areas. The World Health Organization (WHO) recommends the typhoid conjugate vaccine (TCV) for children over six months of age in these regions. New-generation vaccines like Typbar-TCV are more potent and long-lasting than their predecessors, requiring only one dose, thereby offering a practical preventive health measure.

The Role of Hygiene and Clean Water

Treatment aside, prevention is always better than cure. It’s crucial to highlight the role of hygiene and access to clean water in preventing typhoid. Regular handwashing, safe food preparation practices, and consuming treated water are simple yet effective ways individuals and communities can reduce their risk of typhoid.

Impact of Clean Water Initiatives in Tanzania

In Tanzania, a nation where 40% of households grapple with the scarcity of safe drinking water, the impact of clean water initiatives extends far beyond just quenching thirst. These initiatives are pivotal in reshaping communities, reducing disease prevalence, nurturing the economy, and ultimately, fostering a healthier, more prosperous society. Here, we delve into the multifaceted benefits that clean water programs, such as those implemented by Maji Safi Group, have brought to Tanzanian communities.

Health: Curtailing Disease and Saving Lives

The most immediate and evident impact of clean water is the reduction of water-borne diseases, including typhoid fever, cholera, and leptospirosis. By providing access to clean, uncontaminated water, these initiatives dramatically decrease the incidence of these illnesses, particularly among vulnerable populations such as children under 15, who bear the brunt of morbidity and mortality from conditions like typhoid.

Moreover, clean water enhances general well-being. It means healthier children who can attend school regularly and adults who are fit to work. For instance, by integrating typhoid prevention into its sanitation and hygiene programs, Maji Safi Group has played a crucial role in illness prevention, further underscoring the health benefits of accessible clean water.

Economic Benefits: Fueling Community Development

The economic upliftment stemming from clean water initiatives is profound yet less discussed. When communities are healthy, adults can pursue their livelihoods uninterrupted by illness, and children can attain education without frequent health-related absences. This stability is foundational for economic development, as it fosters a robust workforce and cultivates future generations of skilled professionals.

Furthermore, water projects often create job opportunities within communities, from construction to maintenance roles, facilitating a direct infusion of economic resources into local households.

Women and Children: Changing Lives

In many Tanzanian communities, the task of water collection falls primarily to women and children, often involving long, perilous journeys that consume time which could be used for educational or economic activities. Clean water access within communities liberates them from this duty, empowering women to engage in more productive endeavors and allowing children more time to focus on their education.

Sustainability and Environment: Promoting Harmony with Nature

Clean water projects, when designed mindfully, also contribute to environmental sustainability. They prevent the depletion of local water sources, protect ecosystems, and promote harmony between communities and their environments. Educating communities on sustainable water use ensures that these resources are available for future generations.

Community Empowerment: The Foundation of Self-Sufficiency

Clean water initiatives are often coupled with educational programs that empower communities to maintain and manage these water resources independently. Knowledge of water safety, hygiene practices, and basic maintenance are invaluable for the sustainability of these projects, fostering a sense of ownership and pride within the community.

Tanzania SWASH Guidelines

Tanzania’s SWASH Guidelines play a crucial role in addressing the pressing challenge of water, sanitation, and hygiene (WASH) in schools across the country. These guidelines, introduced by the Ministry of Education, Science, and Technology in 2016, provide a comprehensive framework for improving WASH facilities in primary and secondary schools.

In this article, we explore the key elements of the Tanzania SWASH Guidelines and their significance in overcoming barriers to educational success. We delve into the importance of conducting assessments to identify areas for improvement, the role of hygiene education in promoting healthy behaviors, and the need for community involvement in sustaining WASH initiatives. By adhering to these guidelines and implementing sustainable WASH practices, we can create safe and conducive learning environments that contribute to the overall well-being and academic achievements of Tanzanian students. Join us as we delve into the transformative impact of the Tanzania SWASH Guidelines in promoting a healthier and more successful educational system.

Tanzania SWASH Guidelines

The Importance of Tanzania SWASH Guidelines

In order to understand the significance of the Tanzania SWASH Guidelines, it is essential to recognize the impact of inadequate water, sanitation, and hygiene facilities on student health and educational outcomes. Here are key points highlighting the importance of these guidelines:

  • Health and Well-being: Insufficient access to clean water, proper sanitation, and hygiene facilities can contribute to the spread of diseases and negatively impact the overall health and well-being of students. The Tanzania SWASH Guidelines aim to address these issues by providing a framework for the provision of safe and hygienic environments in schools.
  • Academic Performance: Poor WASH facilities in schools can have a detrimental effect on academic performance. Lack of access to clean water, functional toilets, and proper handwashing facilities can lead to increased absenteeism, reduced concentration, and lower cognitive abilities. By implementing the Tanzania SWASH Guidelines, schools can create an environment that promotes better learning outcomes.
  • Gender Equality: Inadequate menstrual hygiene management facilities can disproportionately affect girls’ education. The guidelines emphasize the importance of separate and appropriate facilities for girls, ensuring they have equal opportunities to attend school and succeed academically.
  • Disease Prevention: Proper sanitation and hygiene practices are crucial for preventing the spread of infectious diseases, such as diarrheal diseases and respiratory infections. The Tanzania SWASH Guidelines provide guidelines for waste management, handwashing facilities, and cleanliness maintenance, promoting a healthier school environment and reducing the risk of disease transmission.
  • Sustainable Development Goals: The Tanzania SWASH Guidelines align with the United Nations’ Sustainable Development Goals (SDGs), particularly Goal 6, which aims to ensure access to water and sanitation for all. By adhering to these guidelines, Tanzania is making significant progress towards achieving SDG targets and improving the overall quality of education and life for its students.

By recognizing and implementing the Tanzania SWASH Guidelines, schools in Tanzania can make significant strides in improving student health, enhancing educational outcomes, promoting gender equality, and contributing to sustainable development goals. These guidelines provide a comprehensive framework for creating a safe, healthy, and conducive learning environment for all students.

The Problem

School is meant to help children and youths succeed and thrive. However, many Tanzanian students are fighting to stay healthy because it is difficult for their schools to provide acceptable levels of water, sanitation, and hygiene. In 2010, UNICEF, SNV, and WaterAid conducted a SWASH (School Water Sanitation and Hygiene) mapping survey in 2,697 schools located in 16 districts in Tanzania. As the statistics below indicate, the survey showed that the provision of water, sanitation and hygiene in pre-, primary and secondary schools was lamentable. The situation especially results in reduced cognitive function and learning and a high number of absences due to WASH-related diseases and poor menstrual hygiene management. Issues, such as poor sanitation, a lack of doors on latrines, and a lack of access to menstrual products, lead to girls being denied an equal opportunity to succeed academically compared to their male peers.

Guidelines for Successful School Water, Sanitation and Hygiene (SWASH)

To address these barriers to educational success, the Ministry of Education, Science and Technology created a National Guideline for Water, Sanitation and Hygiene for Tanzania Schools in 2016 to implement improvements that would lead to efficient and adequate provision of water, sanitation, and hygiene in primary and secondary schools. Ensuring that students and teachers are educated about WASH and provided with proper WASH facilities that meet the defined guidelines leads to increased learning, attendance, and overall success of students.

Intervention and Assessment

A crucial first step towards changing SWASH is planning the appropriate interventions after conducting an assessment of the improvements needed at a school to provide adequate water, sanitation, and hygiene facilities and thus guarantee a safe environment for learning. Assessments and intervention steps enable administrators, government partners, and other stakeholders to see a detailed outline of what the successful development of the facilities could look like. The development of such a SWASH plan involves analyzing the current challenges and creating a timeline for targeting the areas that specifically need improvement.

Education around Hygiene and Sanitation 

Constructive and sustainable interventions need to include a strong commitment to effective hygiene education to promote healthy behaviors and proper use of WASH facilities. This helps ensure that facilities are used correctly to maintain cleanliness and promote longevity. Just having a WASH facility has little impact on health outcomes unless the students, faculty, and surrounding community are educated about proper hygiene and sanitation. For younger children, it is helpful to educate them with games and stories, while keeping the information simple for them to understand. Older children will be able to have more complex and in-depth discussions about the importance of good hygiene practices. It is also important that teachers and community members help demonstrate the correct way to use facilities and encourage regular cleaning and maintenance to ensure the longevity and safety of facilities. If WASH facilities are not used properly, they can become a breeding ground for disease and pose severe safety hazards.

One way Maji Safi Group ensures sustainability in our SWASH programs is through organizing teachers and students to launch a School Health Club to lead their school towards healthier environments and habits. Members of the club maintain and clean the WASH equipment, replenish WASH supplies, and continue to teach future students about important health education. Through such peer-to-peer teaching, students become empowered as young leaders in their schools and community.

Hygiene Practices at Home are Equally Important as at School

Encouraging proper sanitary and hygienic behaviors for students at school is a big step for improving student health, but an enabling environment for practicing healthy habits at home must be established as well. This helps ensure that the positive effects on student health are protected in both their school and home life. Effective SWASH projects make sure that the schools, teachers, and students engage with the community to ensure that a ripple of change makes it into the homes. It has been found that parents are likely to embrace proper WASH practices that children bring home from school, and thus adopt them in their homes.

Community Involvement

An important aspect of holistic WASH intervention is getting the community involved in positive changes. This encourages the long-term use and support of SWASH facilities and also maximizes the overall health benefits realized by the community. It is always easier to make lifestyle changes when those surrounding you are also making those changes; therefore, community involvement catalyzes the interventions being made at schools. Getting the community actively involved can be accomplished in many ways, including meetings and events that give students the voice to lead their community in a healthier direction.

Requirements for a proper SWASH facilities include:

  • Adequate water supply from a protected water source that provides safe drinking water and water for personal and environmental cleaning.
  • Latrines and urinals that have washable floors and pits (or septic tanks) that ensure safely stored waste. Schools must have separate latrine blocks for boys and girls to ensure privacy and the necessities for girls to continue to attend schools during menstruation.
  • One hand-washing facility for every 100 pupils with clean water and soap in an accessible location for all (including at latrines).
  • Proper disposal of waste on a daily basis in a safe trash pit or incinerator and proper drainage for wastewater.
  • Proper maintenance of facilities and a high level of cleanliness at the school and in the surrounding areas. There should be a regular checklist that ensures that facilities are maintained, restocked, and repaired as needed.

Our mission

Maji Safi Group will continue to develop programs that provide WASH education and instill proper WASH practices in schools and communities. By preventing common and preventable diseases, we can help transform rural Tanzania. We walk alongside communities as they make behavioral changes and obtain WASH infrastructure, and we provide factual health education that catalyzes healthy habits among our participants.

MSG has always put extra focus on engaging with youths, so that they can bring change for generations to come. Through our School Health Clubs, we are committed to improving SWASH conditions and breaking the silence surrounding menstruation, so girls are not denied the necessities they need to safely stay in school during their cycle.

If we commit to assessing, educating, and implementing sustainable SWASH programs, we can positively impact the future of Tanzanians!

Public Health Practicum Experience In Tanzania

The Maji Safi Group (MSG) is a non-profit organization that promotes public health and prevents waterborne diseases through WASH (Water, Sanitation, and Hygiene) education in Tanzania. Since its inception in 2013, MSG has championed a participatory development model that places local community members at the forefront of driving transformative changes in public health.

This article explores the invaluable Public Health Practicum Experience in Tanzania offered by MSG. This immersive program allows students and professionals in the field of public health to engage with communities and gain hands-on experience in tackling critical health challenges. Participants work closely with local community members, learning about their unique needs and co-designing sustainable interventions.

From conducting health assessments and implementing WASH education initiatives to monitoring progress and evaluating outcomes, this practicum experience equips individuals with practical skills and an in-depth understanding of the complex dynamics of public health in Tanzania. By placing communities at the heart of their approach, MSG and its Public Health Practicum Experience in Tanzania are fostering sustainable change and empowering communities to lead healthier lives.

Public Health Practicum Experience In Tanzania

The Participatory Development Model of MSG

Explanation of MSG’s participatory development approach

At the heart of Maji Safi Group’s (MSG) work in Tanzania lies a powerful approach known as participatory development. This model recognizes the inherent knowledge, resources, and strengths within local communities and empowers them to drive changes in public health. MSG firmly believes that sustainable solutions can only be achieved when community members are actively involved in the decision-making process.

Involvement of local community members in driving changes in public health

Unlike traditional top-down approaches, MSG prioritizes the inclusion and participation of local community members. Through ongoing dialogue and collaboration, MSG fosters a sense of ownership among the communities it serves. This involvement empowers individuals to take charge of their own health and well-being, leading to long-lasting changes that extend far beyond the duration of MSG’s programs.

Importance of community empowerment in sustainable health interventions

By placing communities at the center of its work, MSG recognizes the transformative power of community empowerment. It acknowledges that individuals living within a community possess deep insights into the challenges they face and the most effective strategies to overcome them. Through the participatory development model, MSG empowers communities to identify their own needs, co-design interventions, and take ownership of their implementation.

Through this approach, MSG ensures that its efforts align with the cultural norms, values, and aspirations of the communities it serves. By actively involving community members in decision-making processes, MSG ensures that interventions are not only effective but also sustainable, as they are designed and implemented with a deep understanding of the local context.

In summary, MSG’s participatory development model fosters collaboration, empowerment, and sustainability. By harnessing the knowledge and agency of local community members, MSG paves the way for transformative changes in public health in Tanzania.

The Participatory Development Model of MSG

Overview of the Public Health Practicum Experience

The Public Health Practicum Experience offered by Maji Safi Group (MSG) in Tanzania is a unique opportunity for students and professionals in the field of public health to gain practical skills and firsthand experience in tackling critical health challenges. This section provides an overview of the program, including its purpose, target audience, and structure.

Description of the program and its purpose

The Public Health Practicum Experience is designed to immerse participants in the realities of public health in Tanzania. It offers a comprehensive and hands-on learning experience that goes beyond theoretical knowledge. Participants have the chance to work directly with MSG and local communities, contributing to impactful interventions and gaining a deep understanding of the challenges and opportunities in public health.

Target audience: students and professionals in the field of public health

The program is open to both students pursuing degrees in public health and professionals seeking to enhance their practical skills and broaden their global health perspectives. It provides an ideal opportunity for individuals who are passionate about public health and eager to make a tangible difference in underserved communities.

Duration and structure of the practicum experience

  1. Duration: The Public Health Practicum Experience typically ranges from a few weeks to a few months, allowing participants to engage in meaningful and impactful work while accommodating different schedules and commitments.
  2. Structured learning: Participants are exposed to a structured learning environment that combines classroom instruction, fieldwork, and mentorship from experienced public health professionals. This multifaceted approach ensures a well-rounded and immersive experience.
  3. Fieldwork and community engagement: The program emphasizes hands-on fieldwork, giving participants the opportunity to collaborate with local communities, conduct health assessments, implement WASH education initiatives, and monitor progress.
  4. Reflective practice and evaluation: Participants engage in reflective practice, critically analyzing their experiences and evaluating the outcomes of their interventions. This process encourages continuous learning and improvement.

The Public Health Practicum Experience offered by MSG provides a transformative experience for participants, equipping them with valuable skills, a deeper understanding of public health challenges, and the ability to contribute to sustainable change in Tanzania.

Impact and Benefits

Practical skills gained through hands-on experience

The Public Health Practicum Experience offered by Maji Safi Group (MSG) in Tanzania provides participants with invaluable practical skills. By engaging in hands-on fieldwork, participants develop competencies in areas such as community engagement, needs assessment, program implementation, monitoring and evaluation, and intercultural communication. These skills equip participants with real-world experience and enhance their ability to address public health challenges effectively.

In-depth understanding of public health challenges in Tanzania

The practicum experience offers participants a unique opportunity to gain an in-depth understanding of the complex public health challenges faced by communities in Tanzania. By working closely with local community members, participants witness firsthand the impact of waterborne diseases and other health disparities. This immersive experience fosters a deeper appreciation for the social, cultural, and environmental factors that influence public health outcomes in the region.

Empowering communities to lead healthier lives

One of the most significant benefits of the Public Health Practicum Experience is the empowerment of communities. By adopting a participatory development model, MSG and its participants actively involve community members in designing and implementing interventions. This collaborative approach builds trust, fosters community ownership, and empowers individuals to take charge of their own health. The experience instills a sense of agency and resilience among community members, enabling them to continue driving positive change long after the practicum concludes.

Through their contributions, participants in the Public Health Practicum Experience become catalysts for sustainable improvements in public health. Their efforts not only directly benefit the communities they work with but also have a ripple effect, inspiring others to embrace healthier behaviors and leading to systemic changes in public health practices.

In summary, the Public Health Practicum Experience offered by MSG in Tanzania yields multiple impacts and benefits. Participants acquire practical skills, develop a comprehensive understanding of public health challenges, and contribute to empowering communities for long-term health improvements. This transformative experience shapes participants into advocates for equity and drives positive change in public health both locally and globally.

Impact and Benefits


The Public Health Practicum Experience offered by Maji Safi Group (MSG) in Tanzania is a transformative journey that combines hands-on learning, community engagement, and the empowerment of individuals and communities. This section provides a concluding reflection on the importance and impact of the program, reaffirming MSG’s commitment to community empowerment and encouraging future participants to engage in this meaningful experience.

Recap of the importance of the Public Health Practicum Experience in Tanzania

The Public Health Practicum Experience in Tanzania, facilitated by MSG, stands as a powerful platform for individuals passionate about public health to make a tangible difference. Through this program, participants engage with local communities, co-design interventions, and contribute to the prevention of waterborne diseases and the improvement of public health outcomes. The participatory development model adopted by MSG ensures that interventions are sustainable, community-driven, and culturally relevant, resulting in long-lasting impact.

Affirmation of MSG’s commitment to community empowerment

MSG’s commitment to community empowerment is at the core of its work. By involving local community members in all aspects of public health interventions, MSG acknowledges their expertise, values, and aspirations. This participatory approach not only amplifies the voices of the community but also ensures that interventions are contextually appropriate and sustainable. MSG remains steadfast in its dedication to empowering communities to lead healthier lives and fostering enduring changes in public health.

Encouragement for future participants to engage in the program

To all individuals passionate about public health and seeking to make a meaningful impact, the Public Health Practicum Experience in Tanzania offered by MSG beckons as an incredible opportunity. By participating in this program, individuals gain practical skills, broaden their understanding of global health challenges, and contribute to sustainable change at the grassroots level. The experience shapes participants into advocates for equity, resilience, and community-driven interventions. By joining forces with MSG, participants can be part of a collective effort to improve public health outcomes and empower communities in Tanzania and beyond.

In conclusion, the Public Health Practicum Experience in Tanzania provided by MSG embodies the power of community engagement, participatory development, and hands-on learning. By embracing this experience, individuals have the potential to become change agents who positively impact public health and inspire others to join the journey towards healthier and more empowered communities.

Menstrual Hygiene Products in Tanzania

Menstrual hygiene is a critical aspect of women’s health and well-being. Yet, it is often overlooked or stigmatized in many parts of the world. In Tanzania, menstrual hygiene remains a taboo subject often met with silence and shame. In addition, the lack of access to affordable and reliable menstrual hygiene products is a significant barrier to women’s education, employment, and social mobility.

Maji Safi, a non-governmental organization (NGO) based in Tanzania, is working to change this narrative by providing access to menstrual hygiene products and education to girls and women in rural communities. This article explores the challenges women face in Tanzania with regard to menstrual hygiene and the impact of Maji Safi’s interventions on these women’s lives. It highlights the need for more investment in menstrual hygiene education and infrastructure in Tanzania and other low-income countries to ensure that all women have access to the essential resources to manage their periods with dignity and without shame.

Menstrual Hygiene Products

In many places, menstruation is a taboo subject. It is shrouded in silence and stigma, so people are not properly educated about menstrual hygiene health (MHH), reproductive rights, and respect for the other sex. In addition, a lack of access to feminine hygiene products keeps women and girls away from work and school, and the use of makeshift materials, such as old rags, hay, and mattress fillings, leads to serious health issues.

Maji Safi Group has built an innovative and much respected Male and Female Hygiene Program in the Mara Region of Tanzania. Through interactive school classes, community events, and radio shows, we have helped break the silence and educated thousands of people about menstruation and reproductive rights and given the girls in our school programs free access to different kinds of feminine hygiene products: disposable pads, reusable pads, tampons, and menstrual cups.

Fortunately, menstrual hygiene products are becoming increasingly accessible and affordable to females in Tanzania.

Below is a list of companies that are targeting this need, including a brief description of their products.

Anuflo Industries – Introduced affordable, safe, and eco-friendly menstrual cups to rural Tanzania and created an app and a website in Swahili to educate their users and provide a convenient way for girls and women to track their menstrual cycle.


AFRIpads – Started as a 3-person social enterprise and now delivers reusable menstrual pads to 37 countries. They are committed to providing cost-effective and eco-friendly MHH solutions that support local manufacturing and rural development. Their standard kit includes 2 Super Maxi pads, 3 Maxi pads, and a carrying pouch.


ReliefPad – Makes eco-friendly, reusable pads with a focus on chemical- and fragrance-free products with anti-microbial properties that kill off germs to protect from infections. They empower 10 million girls across the globe by breaking taboos, providing MHH education, and offering pads.

Luna Cups – Makes eco-friendly menstrual cups from soft, durable, and hypoallergenic medical grade silicone that eliminates the risk of toxic shock syndrome. The cups can be left in place for up to 12 hours, where after they should be emptied, rinsed with water, and reinserted. After each period, they must be sterilized and then stored.

Always – Is an American product manufactured in Canada and sold globally. Their menstrual hygiene products include disposable maxi pads, ultra-thin pads, panty liners, disposable underwear for nighttime wear, and vaginal wipes. They have run several campaigns, such as ‘Always Keeping Girls in School’ and ‘End Period Poverty’ where a pad was donated for each package sold.


Be Girl – Is a social enterprise committed to meeting the menstrual hygiene needs of 250 million girls with high-performance products, addressing gender equality, and giving girls choice, confidence, and courage. Be Girl also provides age-appropriate menstrual education for girls and boys. They are well-known for their period panties.


WomenChoice Industries– Is a social enterprise that manufactures and distributes low-cost reusable breast pads, diapers, and menstrual pads called ‘Salama Pads’. Their mission is to ensure that every woman and girl in Africa stops using unhygienic materials to manage her menstruation. Salama pads can withstand 100 washes and are manufactured in Tanzania.

Fahari Pads – Fahari reusable sanitary pads are fabricated in Dar es Salaam. They are eco-friendly, ultra-absorbent, natural, long-lasting, and made of high-performance textiles designed to keep the user safe, dry, and comfortable during menstruation. Each kit contains 4 reusable sanitary pads (1 maxi and 3 regular size pads) and costs approximately $5.


Elea Ambassadors – Produces affordable, eco-friendly sanitary pads made from high-performance textiles. The reusable pads provide protection for 12+ menstrual cycles. Elea Pads are distributed and sold by a woman-to-woman, micro-entrepreneurial sales force, whose members receive start-up kits, training, and marketing support. Elea Pads has a network that reaches more than 50,000 girls and women in rural areas.

Lunette Cups – This Finnish company’s mission is to change the attitude towards menstruation and provide education and period care solutions, so daily lives are not interrupted by lack of MHH. The design of reusable Lunette cups is rooted in safety, ease, and comfort and accommodates bodies of all ages, shapes, and sizes. Lunette cups are ecological, convenient, and economical.

PrincessD Menstrual Cups – Made from medical-grade silicone, this South African menstrual cup brand is reusable for 10 years and offers leak-free protection for up to 12 hours. One menstrual cup is equivalent to approximately 3,000-5,000 sanitary pads/tampons over a 10-year cycle and therefore ideal for girls in impoverished areas and environments with without proper waste management.

O.B Tampons – The idea for a tampon that could be inserted without a separate applicator was initiated in Germany in 1947 as the cardboard used for the applicator in the American product Tampax was unavailable in post-war Germany. The young gynecologist Judith Esser designed it, and by 2010, O.B. tampons were exported to over 30 countries. Although not reusable, tampons are preferable to disposable pads, as they are more affordable and create less waste.

U By Kotex® – U By Kotex® believes that nothing should get in the way of a woman’s life, especially not her period, nor the negative perceptions around menstruation. Kotex produces disposable tampons, pads, and liners. The company is a founding sponsor and supports the mission of the nonprofit Alliance for Period Supplies, which collects, warehouses, and distributes menstrual hygiene product in local communities.

Lavy Pads – Tanzanian entrepreneur, model, and beauty contest winner Flaviana Matata has launched these high-quality feminine sanitary pads that are safe, comfortable, and affordable. Her goal is to break the silence and stigma surrounding menstruation and help vulnerable girls get pads for free while in school in low-income areas. Ten percent of her profits go directly towards this goal.

Mother Nature Products – This South African company has launched Glory Pads. They are plastic- and chemical-free, 100% natural and fully biodegradable within six months. They are highly absorbent, super soft and light, odor-free, and equipped with a unique bamboo charcoal center for maximum absorption and antibacterial properties. Revenue from Glory Pads supports MHH campaigns and educational programs in schools and communities.



T-Marc Tanzania – This organization is an independent, locally managed, non-governmental organization committed to improving the well-being of Tanzanians through programs that provide accessible, affordable health services and products in both Zanzibar and mainland Tanzania. In January 2020, they launched Flowless sanitary pads. They are a high-quality, ultra-thin, and cost-effective product. They offer an ultra-soft cotton top layer, a breathable back sheet, super-absorbent core, side leakage protection, and aloe vera extract for freshness and smoothness.

Maji Safi Group

Maji Safi Group is committed to helping girls and women in Tanzania grain access to affordable menstrual hygiene products, so they can stay in school and be successful in the workforce. We are delighted to see that so many options are available. So far, our strongest partners are Anuflo Industries, AFRIpads, and Be Girl.



WASH and Child Mortality

In 2015, the UN set the Sustainable Development Goal of having safely managed water, sanitation, and hygiene (WASH) worldwide by 2030.

This hope has brought the direct need for these improvements to the forefront. Some two billion people have gained access to improved water and sanitation sources. But the work to eliminate WASH issues is far from over – 700 hundred million people still do not have access to improved water sources, 2.5 billion do not use improved sanitation facilities, and 1 billion still practice open defecation.

Poor WASH impacts children in unique ways and specifically affects child mortality rates. Children are especially susceptible to health issues from unimproved water sources because of their developing body systems – digestive, respiratory, lymphatic, etc. Their survival rates from the disease are also much lower when basic sanitation and hygiene resources are compromised. Worldwide, 6,000 children die of water-related diseases every day.

Evidence supporting a connection between child health outcomes and WASH conditions has often been limited and inconsistent. Still, recently, the development world has pushed to reexamine this relationship. The findings indicate that people with access to safe water and proper sanitation facilities have much lower child mortality risks and diarrhea. Historically, the most profound data has been linked to how poor WASH impacts diarrhea-based diseases among children.

WASH and Child Mortality

Importance of WASH in Developing Countries

Access to safe water, sanitation, and hygiene (WASH) are critical for improving health and well-being in developing countries.
Poor WASH conditions can spread waterborne diseases and increase the risk of death, particularly among children.

In addition to its impact on health, access to WASH is also essential for economic development. This is because it allows for improved productivity and reduces healthcare costs. However, the lack of WASH facilities can also lead to increased gender inequality, as women and girls are often tasked with collecting water and dealing with the lack of proper sanitation facilities.

Investing in WASH initiatives in developing countries is a crucial step toward improving health outcomes, promoting economic growth, and reducing inequality.

The Connection Between WASH and Child Mortality Rates

There is a strong connection between access to safe water, sanitation, and hygiene (WASH) and child mortality rates. Children are particularly vulnerable to the health consequences of poor WASH conditions due to their developing immune systems and higher exposure to pathogens in their environment.

The lack of access to clean water sources and proper sanitation facilities can increase the risk of waterborne diseases, such as diarrhea, which is one of the leading causes of child mortality worldwide. Poor hygiene practices in healthcare facilities can also contribute to infections and increase child mortality rates. Therefore, improving WASH conditions has a significant impact on reducing child mortality and improving health outcomes for children.

Importance of WASH in Developing Countries

WASH and Diarrheal Episodes

Children living in rural places plagued by WASH issues experience an average of four to eight diarrheal episodes per year between birth and age two. This suggests that they are exposed to many pathogens during their first two years of life. Diarrhea globally accounts for 1.4 million child deaths per year. The World Health Organization suggests that 58% of these deaths are linked to unsafe water supply, sanitation, and hygiene.

Children are at high risk of being exposed to these dangerous pathogens in public play areas. Child play often occurs when soil and surface water have been infected with pathogens that cause serious health issues when ingested. Human feces is also a major contributor to soil-transmitted bacteria that cause diarrhea and other similar issues in young children. With the continual practice of open defecation in many communities, there are rich opportunities for children to ingest fecal bacteria, which leads to illness and possibly death. Data indicate that safer fecal disposal reduces childhood diarrhea occurrences by 37%. There is much-needed work to end open defecation and install proper latrines and toilets for people to use in these communities.

WASH and Diarrheal Episodes

WASH and Child Health Care 

Another focus area in WASH that would improve overall child health and reduce mortality rates is improved sanitation in healthcare facilities. Having clean water and proper sanitation in delivery rooms and during health services for mothers and babies would help reduce childhood mortality. Fundamental hygiene during labor and delivery, such as cleaning hands and surfaces, reduces the risk of infections and death up to 25%.

There is a great need in Tanzania’s healthcare facilities for more WASH education. Workers must be taught the importance of proper WASH practices, and we must work to ensure the proper equipment is available for them to use.

Improving and Saving Lives

For children to thrive physically and cognitively in their communities, there must be better WASH practices. Fundamental education on things like handwashing, food preparation, and proper waste disposal saves and improves lives. For example, handwashing with soap can reduce diarrheal diseases by 42 to 47%.

Every year, close to 11 million children die worldwide before their 5th birthday, primarily from preventable diseases, and another 300 million suffer from illnesses caused by WASH issues. Maji Safi Group’s mission is to help these numbers drastically decrease in rural Tanzania. Would you join us in saving and improving the lives of these children?

Empowering Voices in Shirati


Dr. Beth Osnes (left) and PhD canidate Chelsea Hackett (right) walking home from the Maji Safi Group office

When Dr. Beth Osnes and I began to think about taking our Vocal Empowerment program outside of Starfish: Her Infinite Impact (the organization in Guatemala where we co-developed it over the past three years), we realized that it would not be the best fit for just any organization. Consequently, we began to construct a list of “Key Requirements” that an organization must have in order for the program to flourish.

We came up with four traits:

1. The organization has a mission of long-term engagement in a community.

2. The organization is run with the guidance of local community members.

3. The organization shows an ongoing dedication to the concerns of girls and women.

4. The organization is operated with a sense of joy and play.


Community Health Workers supporting a local community clean-up group in Shirati

From reading many of Maji Safi Group’s blog posts and speaking with the leadership team, it became readily apparent that their organization meets the first two requirements immediately. While Maji Safi Group continues to be responsive to pressing health needs, such as two cholera outbreaks within the last year, it has a longer mission of improving health – something that is not done overnight. Maji Safi Group’s Community Health Worker (CHW) model ensures that the knowledge gained comes from within the community, and the majority of the employees will remain in the area to spread that knowledge throughout the region – unlike many aid organizations that primarily employ foreign workers.


Female Hygiene Program Page 2

Linda Arot (left) and Judith Mcbache (right) demonstrating how to use a sanitary pad at a Dining for Female Hygiene event put on by Maji Safi Group

The third requirement is more nuanced and not always easy to find in organizations. However, after speaking with Maji Safi Group’s Female Hygiene Coordinator, Linda Arot, we realized immediately that it was present. The Female Hygiene Program, headed by Linda and CHW Judith Mbache, is a living example of Maji Safi Group’s dedication to the girls and women of the Shirati community. Their knowledge of the unique challenges facing girls in their community and their larger goal of improving public health guide their weekly meetings. Linda and Judith are two women who are clearly concerned with the physical, emotional, and spiritual well-being of the girls they work with, and their program is a wonderful match for the Vocal Empowerment program.



Linda (left), Freddy (back) and Lilian (front) at Rorya FM doing a skit for listeners

This was demonstrated when we were in Shirati with a radio show that Linda, Judith, Freddy and Lilian presented to the community, telling the story of a young girl struggling with menstrual hygiene. They were able to engage various call-in listeners in a conversation around menstrual health – all to ensure that girls are informed and able to reach their goals without menstruation as a barrier.

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It was the fourth element that Beth and I were not sure of until we arrived in Shirati. Joy and play are intangible things in many ways. It is hard to quantify the amount of happiness, laughter, and energy employees bring to their work. Organizations do not often give data reports on the playfulness of their staff. This last element was something we would need to chance by trusting that Bruce’s assurances that the CHWs were true.

13304983_945024452261464_3328239341471304577_oTo our relief, surprise, and glee, Maji Safi Group not only runs with a sense of joy and play, but in my opinion, they could not succeed without it. From our first meeting with the Community Health Workers where they sang the songs they have created about various public health issues, it was clear that this intangible element was abundant in their incredible group of vibrant, excited, and eager individuals. We spent the next five days, from 8:30-4:30, learning just how much fun it was to work with Maji Safi Group.

13308568_945024428928133_8004299849846156216_o (1)Each day, we trained the Community Health Workers in the various theatre games and exercises that make up the Vocal Empowerment program. From the outside, these games may appear childish or silly, but each of them is selected and intended to open new spaces inside of individuals and groups in a way that being “well-behaved adults” never could. Luckily, the Community Health Workers saw the intention behind the games and understood their importance immediately. They gave 100% of their energy to anything that we threw at them, from keeping three balls thrown in a pattern around a group to running a slow speed race. Throughout the course of the week, the games and exercises became more public and gained higher exposure. This mimicked the same model we use in the Vocal Empowerment program. I like to think of it as slowly practiced embarrassment. The more comfortable you are with being silly or doing something surprising (to yourself and others), the better able you are to do serious things that surprise, that alter, that change the normal patterns of behavior. Maji Safi Group’s work is about changing the status quo, about altering the standard actions of a community to collectively improve health. And while they may not seem connected, the more comfortable you are getting outside of your comfort zone through a game, the more prepared you are to introduce a new concept to those around you.


The Community Health Workers’ expertise in “mastering embarrassment” was demonstrated when we journeyed to the main road in Shirati to do our daily vocal exercises. These are, by any measure, outside of normal street behavior. They involve various vocal and physical warm-ups that performers and those in vocal therapy use to better prepare their voices for speaking. In the Vocal Empowerment program, they serve the ongoing purpose of helping young women prepare their physical voices to advocate for themselves and their communities. When done in a public setting, as we did by the road, they also involve that element of exposure that ensures stepping out of your comfort zone. The group of Community Health Workers, while nervous, gave the exercises their all. They were able to handle the perplexed looks of community members and the gawking of small children. In the end, they even had fun!


By the end of the week when we were ready for a public sharing of short “dilemma scenes” they had created, it was clear that the CHWs were masters of public engagement, conquering embarrassment, and keeping the energy high. They performed four scenes as well as several public statements and songs we had rehearsed. No one showed any nerves or anxiety. They were eager, calm, and focused as they shared their work with the community. Beth and I were now 100% certain that we had found a perfect partner for the Vocal Empowerment program. In fact, the final moment of the show demonstrated that we had more to learn about joy from Maji Safi Group than we could ever have imagined.

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Community Health Worker Jared Ongati teaching students hand washing at a public school

After ending the rehearsed show, Jared Ongati gathered the entire audience into a circle. He asked everyone in attendance, from the children who had been lying in the grass to the older community members who had been resting in the shade, to join the Community Health Workers in one of the vocal exercises: the wave. In this exercise, one by one individuals go from touching their toes to bringing their arms into the air while traveling from the bottom to the top of their vocal range. Once the first person has hit the top, the next person can begin. Altogether, the result is a wave of sound and motion that moves around the circle. As Beth and I waited for our turn, we knew that Maji Safi Group thrives on infusing even the most somber of topics with joy, life, and energy. Their work will continue to touch the hearts of the community and make a widespread impact on the health and well-being of Shirati. I believe it is so because they are able to approach every challenge with wide smiles, laughter, and love.


Another Successful Maji Safi Read-a-thon

“Parents approach me to tell me the Maji Safi Read-a-thon is a deeply meaningful way to talk with their child about giving back. I can feel the excitement of our students as they read to make a difference in our world.”

-Sarah Oswick, Principal

wildcat_on_whiteSome people hate Mondays; I loved Monday, May 23. Some people would consider visiting
17 classrooms in one day a chore; for me, the hours between 8:15 a.m. and 2:30 p.m. flew right by. The applause from their classmates and the smiles, the pride, and the sense of accomplishment that exuded from this year’s Maji Safi Read-a-thon participants gave those hours wings.

For the fourth year in a row, elementary students at Whittier International School in Boulder, CO, participated in this win-win project where children improve their reading skills, gain a sense of social responsibility, help others through personal effort, and raise money for Maji Safi Group’s work in the remote and impoverished area of Shirati, Tanzania.

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Backed by the Wildcat Student Council, the 2016 Maji Safi Read-a-thon got under way in January. In cooperation with Maji Safi Group and led by former Whittier teacher John LeClair, council members worked hard to promote the project with posters, classroom visits, and school-wide announcements. Their dedication payed off. Children turned page after page, families found personal sponsors, and Maji Safi Group once again relied on our much appreciated group sponsors to honor every book read, so students without personal sponsors could contribute as well.

Three months later, the children had accomplished these amazing results:

Participants: 65
Books read: 850

Most books read by individual students: 68
Most pages read by individual students: 9,664
Number of personal sponsors: 77
Number of group sponsors: 18
Money donated by personal sponsors: $3,600
Money donated by group sponsors: $1,075
Money donated by matching sponsor: $3,600

Grand total: $8,275

In every classroom, John LeClair and I (Erna Maj) spoke about the Wildcat Student Council’s commitment to service projects and honored each Read-a-thon participant with a certificate and a coupon for a free ice cream cone from Ben & Jerry’s Scoop Shop or Lindsay’s Boulder Deli, our loyal community partners in Boulder. This year, the certificates held a special surprise – through coloring, they connected children across cultures and the Atlantic Ocean. A child in Shirati had colored the left side of a picture drawn by Maji Safi Group’s artist, Jackie Lucas, leaving the right side for his or her Whittier friend to color.

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It is this connection that over the past four years has become a treasured part of the school year at Whittier. Our ‘Young Global Citizens’ know that due to their efforts, children in Maji Safi Group’s After School Program can learn about personal hygiene and disease prevention through coloring, singing, dancing, doing puzzles, and playing games. The Whittier students know that even kids their age can save lives on the other side of the globe!

“We’ve really enjoyed participating in this program which has turned our reluctant reader into a motivated, independent reader.”

– Deb C. Whittier parent


Thank You for Making a Difference!

A huge thank you to everybody who participated in and supported the 2016 Maji Safi Read-a-thon: students, parents, sponsors, teachers, volunteers, etc. Thanks to your support, the children in the rural community of Shirati can continue to improve their public health situation and learn about disease prevention, so they can stay healthy and reach their full academic potential!

After School Program

After School Program awards

Community Health Worker Consolata Ladis giving out awards to the top WASH performers.

In the After School Program, Maji Safi Group’s Community Health Workers (CHWs) teach students how to prevent waterborne diseases, so they can stay healthy and succeed in school.

Since July 2012, 6000+ students from 10 schools have attended, and in 2015, the District Education Office approved Maji Safi Group to teach water, sanitation and hygiene (WASH) education in all 125 primary schools in the Rorya District. Now, more kids than ever will receive the benefits of this education.


After School Program Page 2CHWs teach in a fun and nurturing environment. Art, games, puzzles, and other activities encourage students to develop their creative and cognitive skills. This way, the things the children need to learn become things they want to learn.

Over the academic year, students learn about

  • sanitation,
  • personal hygiene practices,
  • waterborne and water-related diseases,
  • water treatment,
  • the fecal-oral disease cycle,
  • bilharzia, and
  • the benefits of preventing diseases.

To enable proper WASH techniques, Maji Safi Group provides schools with demonstration ceramic drinking water filters and handwashing stations. At the end of the program, our staff artist paints a WASH-related mural to serve as a reminder of lessons learned and as an inspiration to future students.

My Maji Safi Story Part I


Mambo from Merikani! My name is Samantha Nelson, and I studied abroad in East Africa during the fall of 2015. Coincidentally, I spent most of my time in northern Tanzania with World Learning SIT, the same program Maji Safi Group co-founders Bruce Pelz and Max Perel-Slater studied with in 2009. Believe it or not, I have also returned to Bruce’s hometown of Boulder, CO, where I plan to graduate in the spring from his alma mater, University of Colorado. Oh, and did I mention we have the same major? Let us rewind a little bit, so I can tell you how and why I started working with Maji Safi Group (MSG) in the first place.

As a double major in the natural sciences, I thought studying abroad in Tanzania would provide me with the quintessential experience and subsequent skill set I needed to develop my very own natural science study. This opportunity would manifest itself through the Independent Study Project (ISP) that serves as the pinnacle field study section of SIT’s programs. The ISP gives students an entire month to conduct independent research in an international setting. During this time, I envisioned myself romping around the rainforest, posted up on the coast of the Indian Ocean researching coral reef ecology, species conservation, or something of the like. But here comes the plot twist – I didn’t want my ISP to be yet another nicely bound packet of paper that sits on the shelves of the SIT office in Arusha with no real application other than as a reference point for other SIT students. Upon further contemplation and a little self-reflection, I realized that I wanted to use my ISP as a chance to provide a service that would directly benefit Tanzanians based on their needs and wants.

So, almost surely, you now all understand the logical sequence of events that followed and culminated with me studying the menstrual health and personal hygiene practices of girls ages 12-25, right?

Oh, not quite yet? Labda (maybe) I am still missing some important details. I told my program director, Baba Jack, how I felt, and he asked what I would be interested in studying. I responded with ‘water-related issues’, and he said, “I have the perfect guy for you.”

Once in contact with Max Perel-Slater, MSG’s co-founder and Tanzania Executive Director, we went back and forth for a couple weeks, contemplating ISP topic ideas that would amalgamate the needs of the organization with my own interests and niche experience. While doing so, Max briefly mentioned MSG’s Female Hygiene Program (FHP), and the ‘budding feminist’ within me instantly perked up. Intrigued, I asked what work I could do to help this program, and he explained how the group had been meaning to collect some data that would help the organization update and expand the FHP. “Hey, I could totally do that!” I thought, and we decided to get the ball rolling.

To do so, Max put me in contact with MSG’s dynamic and upbeat Tanzania Director of Operations, Emily Bull – who, funny story, is yet another SIT Study abroad alumnae. With the help of Ms. Bull, I developed a survey for adolescent girls and young women in the District of Shirati, a rapidly growing area on the shores of Lake Victoria. The survey targeted girls in both primary and secondary schools, in the FHP, and around the village. The purpose was to learn more about these females’ knowledge of and practices concerning personal and menstrual hygiene and to explore related social implications, such as school attendance and access to family planning resources.


Pictured left to right: Emily Bull, Bena Migenda and Samantha.

The groundwork for this project was laid during a weeklong period in October where I took Max’s advice to make the 12-hour trek to Shirati to check out the site and familiarize myself with MSG employees and members of the community. During this time, I finally met Max and Emily as well as MSG’s charismatic and devoted team of Community Health Workers (CHWs), whom I would be working closely with in the coming month. I also met Bena, my extremely overqualified and wonderfully charming translator, who became my study collaborator, travel buddy, and best friend in Shirati. Bena accompanied me on all of my outings, and we worked closely with FHP teachers Linda, Mama Judith, and Lillian. The five of us went to the FHP’s triweekly meetings at local primary schools and the MSG office in Shirati.

Picture5This ‘jump-right-in approach’, as opposed to slowly reintroducing myself to the world of pre-pubescent and adolescent girls, was one of the main motivators for the incorporation of many of my survey questions. During these meetings, I was able to hear first-hand what kind of questions the girls typically asked the FHP teachers and subsequently gauge what they wanted to know. These inquires included questions such as, “What if you don’t get your period?” and “Can you really not get pregnant a week after your period ends?” Other survey questions were developed by collaborating with the FHP teachers to see what kind of queries they felt would provide them with helpful data that could be used in the future – for example, “Do you feel comfortable at home and/or at school when you menstruate?”

The highlight of my first enthusing week in Shirati was helping out with MSG’s Global Handwashing Day festival on Oct. 15th – a day relished across the globe for its ability to spread awareness about proper, yet often overlooked, basic hygienic practices. To celebrate this joyous day, MSG made appearances at village schools across Shirati. I accompanied one of the many teams of CHWs in the field that day to Obwere Primary School. Once we arrived, two hand washing stations were assembled; subsequently, a captivated audience of some 400 pupils and teachers watched Shalua, a delightful CHW, model the eight steps of hand washing. Students then had the opportunity to try the steps out for themselves, and they were encouraged to teach them to their family members at home. Following this informative morning, an after-party took place at the MSG office, complete with singing, face painting, and a dancing session that led to the infamous vumbi (dust) disco.

Needless to say, the entire experience left me stoked to be returning to Shirati a couple of weeks later.

Right now, I need to get back to working on Buffs for Maji Safi, a campus group that two other CU students and I started last month. Please tune in next week to see how my return to Shirati went.

My Maji Safi Story Part II


Hey everyone, it is me, Sam, again! Sorry for ending my last post with such a cliffhanger! I am back now and ready to finish telling you how my experience with Maji Safi Group ended, and how my journey with Buffs for Maji Safi began!


For a quick refresher: I had just finished my Independent Study Project (ISP) prep week and celebrated Global Handwashing Day in Shirati where I laid the groundwork for my final project with SIT Tanzania. I then returned to Arusha where I developed my study design and finalized my survey.

After going back and forth with Max, Emily, and my SIT professors, we decided I would survey female students from seven schools (six primary, one secondary) as well as girls in the Female Hygiene Program (FHP) at their tri-weekly meetings and young women in the village who had presumably not been exposed to MSG’s FHP. I would also attend FHP events to gather what I called ‘metadata’. I would use these observations to help contextualize my study and better understand what it means to be a maturing girl or young woman in rural areas in northern Tanzania.

Female Hygiene dance performance

Upon my much anticipated return to Shirati, I could hardly wait to get the study going; however, formalities and logistics took precedence. I had to obtain permission from the headmasters of the schools I would be working in and visit the Shirati immigration office to get permission to work in Shirati.

Then, on a glorious, not-so-sunny Wednesday morning, the study commenced. Speaking in a colloquial manner, Bena floated through the survey questions with our first participant, a village girl who worked at a little duka (store) in the town center – with me waiting nervously in the corner. Admittedly, the first interview was not perfect, but with each new interview, things went a little more smoothly, and I started to understand more and more. That first day, we managed to complete eight interviews. It turned out that finding girls in the village who had the time to talk to us and fit our criteria (either over 18 or having had a baby) was hard. However, on days when we ventured out to one, two or all seven schools, we managed to talk to as many as 20 girls in two hours.

Female Hygiene being community leaders with skit

Female Hygiene Program participants perform a skit about menstrual hygiene management and preventing early pregnancy during an event for the Day of the African Child.

When probed to respond, some girls were clearly more comfortable than others. Some young, and often pre-menstrual, girls gave little more than a nod and uttered a couple of sentences under their breath, but many others, notably village women and MSG’s Female Hygiene Program participants, radiated confidence and were elated by the opportunity to share how much they knew.

By the end of the three weeks, 202 girls from 23 different schools and 21 different villages had completed the survey! Little did I know that the easier part was now behind me. The 25-question survey was awesome in that it provided us with tons of data, but the data now needed to be entered and analyzed. This task was easier for the “ndiyo” (yes) or “hapana” (no) questions. For the open-ended questions, assessing the responses proved to be much more difficult than anticipated. Perhaps the best example was the question, “Je, unajua maana ya ‘hedhi’?” (Do you know what ‘menstruation’ is?) If they answered yes, the girls were asked to explain what it was as well as why they thought women menstruate. Needless to say, these questions yielded a wide array of answers, which also warranted additional consideration to determine their most accurate translation.


Consequently, I am still working on expanding and refining my analysis of the data; however, I will provide you with some general demographics as well as some key findings and their interpretations from my preliminary analysis. The average participant age was 14.5 years, and the average education level they had achieved or were currently enrolled in was C6. In the US, this is roughly equivalent to 6th grade. The average age at which participants began menstruating was 14.3 years, and 78.8% of them reported they did not know about menstruation until their first period. For those that did know about menstruation, the most common place they learned about it was at school. However, interviews with public school health teachers provided little to no explanation as to why a considerable number of participants lacked knowledge about menstruation as one teacher reported that female students begin learning about the topic when they enter C4.

Furthermore, although it may not be initially concerning, nor surprising, that girls reported ‘school’ as their primary source of information about menstruation, it should garner some alarm. Females face many unique challenges when it comes to attending, excelling in, and completing school. Obstacles include safety concerns while traveling to and from school and while at school; social stigmas that favor educating males; and the need for private and sanitary restrooms, so girls can maintain their menstrual hygiene while getting an education. Sadly, these obstacles have manifested themselves as barriers for girls living in Shirati where more than two thirds of female students fail their primary school exams and are therefore unable to continue pursuing an education. Additionally, this somber finding conceals the countless number of girls who drop out of school before they are even eligible to take the exam.


More private and sanitary toilets need to be built to enable girls to stay in secondary school after starting menstruation and reach their full potential.

The reality is that adolescent girls and young women’s needs are not being met. Too easily, girls are allowed, and even encouraged, to slip through the cracks in an antiquated (public) school system and a patriarchal society. However, during my time in Shirati, I was able to see how Maji Safi Group combats these tribulations. The organization acts as a much-needed safety net for the community’s females. MSG is able to provide them with educational opportunities and subsequently help restore their lost or negated potential.


Female Hygiene Program facilitator Judith Mbache (front) speaking at a female hygiene event with fellow facilitator Linda Arot (back).

While there, I observed a sense of purpose and a strong desire to teach and learn, exuded by MSG employees and program participants alike. One of my favorite examples occurred during my final interview with Mama Judith – truly a one of a kind FHP facilitator. When I asked if there was anything else she wanted me to know, she simply responded, “No!” and instead asked me (the student) for new information or articles that she could use to teach her FHP girls. Another fantastic instance was on a Saturday afternoon when the FHP girls came together to host a “Dining for Female Hygiene” event. The purpose of this affair was to allow the girls the opportunity to speak as topical experts and teach the guests of honor, i.e. their own mothers, about puberty, menstrual hygiene, and even teen pregnancy.



Female Hygiene Program participants and their female guardians at the “Dining for Female Hygiene” event that I attended.

During my brief stay in Shirati, it became clear that not only has MSG developed a way to improve the lives of its female community members, it has also created an environment in which teachers are not afraid to be students, and students gain the confidence to become teachers and community leaders.

Although I feel the time for me to say goodbye to my new friends and Maji Safi family came all too quickly, I am so grateful for the experiences they facilitated and the opportunity I was given to become a member of their community. All I can say is asante sana (thank you very much) to all of my friends and family back in Tanzania. I could not have done it without you, so thank you for making it possible!

Since returning home, I have been fortunate enough to keep in contact and work with my Maji Safi Group family, as they have helped me and two other CU students, Alex Posen and Ryan Messinger, start a campus group called “Buffs for Maji Safi”. The three of us are working with Bruce Pelz to organize events on campus and work with the Boulder community to increase awareness and support for Maji Safi Group’s work in Shirati. We are also excited to help host Dr. Chirangi, MSG’s Senior Mentor and Medical Superintendent at the Shirati KMT District Hospital, at this week’s Conference on World Affairs (April 4-8) at the University of Colorado.


Dr. Bwire Chirangi at the Shirati KMT Hospital.

If you live in the Boulder area and find yourself free on Wednesday evening and want to learn more about MSG, please email [email protected] for info about opportunities to meet Dr. Chirangi.  We hope to see you around, and for now, tutaonana baadaye (see you later)!