In 2025, Tanzania’s Ministry of Health completed a comprehensive evaluation of the Afya Call Center, the nation’s 24/7 health hotline. Afya is a critical public health platform for providing real-time medical advice, referrals and a safe space for community feedback. With support from VillageReach and funding from the Endless Foundation, the evaluation used the Community Insights to Action (CITA) framework to examine whether Afya was serving under-reached communities, how well it was capturing and acting on feedback, and what lessons could drive future health system improvements.
I spoke with Dr. Ona Machangu, Assistant Director for Health Promotion Services at the Tanzania Ministry of Health (MoH); Simon Nzilibili, Coordinator for Health Promotion Partnerships and Stakeholder Engagement, MoH; and Saidi Mtengule, Supervisor at the Afya Call Center. Together, they shared reflections on Afya’s successes, challenges and the bold vision they hold for the future of community-centered health engagement in Tanzania.
What is Afya and why is it an important resource?
Dr. Ona Machangu:
The Afya Call Center is a national health hotline that provides immediate, trusted health information and referrals to Tanzanians 24 hours a day, seven days a week. When we launched it in 2019, our initial focus was on responding to an Ebola outbreak. But it was during the COVID-19 pandemic that Afya truly took off and became an essential resource for the public.
After COVID-19, we expanded Afya beyond just emergency response. Now, it serves as a comprehensive health communication tool supporting day-to-day health promotion, chronic disease management and community engagement. We are proud that it has made health care more accessible and inclusive in Tanzania.
Anyone can call the hotline free of charge on 199 to receive information and guidance from our health professionals, including doctors, nurses and environmental health officers. Beyond real-time calls, we also use an interactive voice response (IVR) system to deliver information across nine health areas, including sexual and reproductive health, mental health and many more.
Saidi Mtengule:
As of now, we have 37 staff serving at the call center, working in shifts to handle an average of 3,000 calls per day. The system is designed to ensure that each agent answers no fewer than 100 calls per shift, often up to 150. Many additional calls are managed through IVR.
What has your role been in evaluating Afya? How are CITA principles involved?
OM:
My role, as Assistant Director in Health Promotion Services at the MoH, has been to provide strategic oversight and operational leadership to the call center. The recent evaluation, guided by the CITA framework, focused on amplifying community voices and ensuring feedback was not only collected but systematically acted upon.
We use a client relationship management platform that allows us to track call volumes, topics and types of feedback. Monthly analyses help us identify trends and areas requiring urgent attention, for example disease outbreaks or facility-level service complaints. Through this evaluation, we also examined how well we are closing the feedback loop and ensuring that callers feel heard and see action being taken.
Simon Nzilibili:
My role has focused on coordinating partnerships and ensuring that insights from the community are channeled effectively to MoH and other stakeholders. By aligning with CITA principles, we have emphasized inclusivity, transparency and responsiveness. The evaluation set out to understand how well the call center was reaching all communities, to assess how efficiently and quickly complaints were being handled, to uncover any system-wide barriers or opportunities for improvement, and to work with communities and partners through human-centered design to develop practical solutions to take forward.
What are the most pressing challenges you found?
OM:
One key challenge is infrastructural investment. We still face power outages and do not have a backup generator, which affects continuity. Our servers and computers are aging, and there’s limited capacity to handle high volumes or expand new functionalities like SMS and WhatsApp integrations.
Awareness is another major issue. Many people, especially in under-reached rural areas, still do not know about 199. Our surveys showed that a significant number of respondents in those areas had never even heard of the service, despite our mass media efforts. This underscores the need for more targeted community-level sensitization.
SN:
Another challenge is related to the feedback system itself. Currently, Afya cannot make outbound calls to follow up with users. So, if a call drops or if a user wants an update on their complaint, they must call back themselves. This limits trust and satisfaction because they don’t see the outcome of their feedback.
There’s also a challenge in system integration. Right now, feedback often stops at the MoH level. Many complaints actually involve local facilities overseen by the President’s Office – Regional Administration and Local Government (PO-RALG), and there is no consistent, functional structure to ensure these issues are resolved locally and communicated back to the caller.
SM:
From an operational standpoint, we also need more advanced training for agents — both in data handling and in soft skills like active listening. Additionally, technical issues like poor network connectivity, especially in rural areas, can hinder smooth operations.
What are some quick wins and longer-term ambitions?
SN:
In the short term, we can improve service through better advocacy and awareness campaigns targeted at under-reached communities. This includes working with community leaders, schools, religious gatherings and using culturally resonant methods to build trust and recognition for 199. Of course, increase demand should be met with technological innovation, like expanding the service to social media, using chatbots, and messaging services, so not every interaction is via voice-calling.
We can also introduce simpler technological upgrades, like a dedicated IVR option for complaints and suggestions, making the feedback mechanism easier to use. The journey doesn’t stop at the call center. We need strong linkages between the call center and health facilities to ensure good customer care. Currently, we face challenges following up once clients are referred to facilities. We need to improve our escalation capabilities, so when an issue cannot be resolved at the call center level, it is efficiently referred to the appropriate service point or facility. After the issue is addressed, feedback should be communicated back to the call center agent, who can then update the client. This creates a more robust and responsive feedback loop to ensure that clients feel heard and supported.
OM:
Longer term, we have big ambitions to activate outbound call capabilities, and integrate SMS and WhatsApp channels so we can provide updates directly to callers in a way they can access. We also plan to decentralize the complaints resolution process. Instead of relying only on national-level agents, we envision empowering district and regional health teams to resolve issues at the source, while the national center retains oversight. By linking local government data systems with our national health information system, we can create a more robust loop where community insights directly inform policy and service improvements at all levels. In the future, we also hope to develop public dashboards to share real-time data on complaints and resolutions to strengthen transparency.
We could learn from inter-governmental groups like the Global Telehealth Community of Practice how best to improve the system to where, after each call, users can rate their experience and provide quick feedback via SMS or their chosen method. This would support agent accountability and help us identify areas for immediate improvement.
How do you think success can be measured and best achieved?
OM:
Success for Afya is measured by more than just call volume. Because this is a free service, we currently achieve equitable reach to people in rural and marginalized communities. It is important that we can sustain it as such.
Equally important are resolution rates and user satisfaction. We plan to introduce a star-rating system and routinely analyze data on complaints and service improvements to ensure that every individual feels supported. Beyond individual cases, the insights gathered through Afya will also be used to identify broader trends and systemic challenges. By bringing these insights into national decision-making forums, we can drive larger health system reforms and improve services for communities across Tanzania.
SM:
Improving response times and maintaining high service quality are critical. We also aim to build capacity among our staff to handle complex cases and ensure that every user feels heard and respected. However, we are constrained by not having energy and data storage backups.
OM:
Ultimately, our goal is to strengthen trust and improve health services. Tanzanians should know that when they reach out to 199, their concerns will lead to action and the health care they need.
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The Afya Call Center represents a new era of health engagement in Tanzania — one that values community voices and transforms them into actionable insights. While funding and logistical challenges remain, the commitment of its leaders to learn and adapt signals a promising future. By continuing to build trust, expand access and close the feedback loop, Afya aims to become the backbone of a responsive, people-centered health system.