Zubeida* thought her child was being stubborn.
For years, her child wet the bed, long past the age when he should have stopped. She tried to correct it the only way she knew how, scolding him and sometimes even beating him, hoping it would force a change. But nothing changed.
Eventually, out of frustration and confusion, she did something different. She picked up her phone and dialed 115, having heard about the number in her community.
On the other end was Kausa Hamisi Mfaume, a call centre agent at the Zanzibar Afya Call Center. Kausa listened as the mother explained what had been happening, how long it had gone on and what she had tried.
“I told her not to beat the child,” Kausa recalls. “Bedwetting is not something a child does intentionally.”
Instead, she encouraged her to take the child to a health facility for proper assessment and care. The mother followed that advice. A month later, she called again. This time, her voice carried relief. The child had been treated and the bedwetting had stopped.
Since this call centre was established, more people are choosing to seek care at health facilities, instead of relying only on home remedies or informal advice.
The cost of not knowing
Kausa Hamisi Mfaume a call centre agent at the Zanzibar Call Centre, Tanzania. Photo credit: Ronald Ngeno
Across Zanzibar, this kind of uncertainty is more common than we might assume. People fall sick, or notice something unusual, or struggle to navigate services that feel distant. Yet, they are left to interpret symptoms on their own, rely on friends/neighbors, or delay action altogether. In some cases, as Zubeida’s story shows, misunderstanding can lead to harm within the home itself.
But now, for the past two years, Kausa has been part of the team that answers those calls, working in shifts to ensure someone is always on the other end of the line. Some days are calm, with only a handful of calls. Other days, especially during outbreaks of diseases like cholera or mpox, the phones do not stop ringing.
“When there is an outbreak or even a suspicion of one, people want to understand what is happening,” she explains. “The calls greatly increase.”
And the questions come in many forms. Some callers simply want clarity; to find out what a symptom might mean, whether something is serious, or what they should do next. Others are already inside the health system but feel stuck; this usually happens after visiting a facility and not receiving the help they expected. They call looking for direction, for reassurance, or sometimes just for someone to explain things in a way that is easy to understand.
Kausa remembers another case, where a caller was trying to get a government health insurance card but did not know or where to begin. The deadline had already passed and they were unsure what options remained. Kausa guided them step-by-step—first back to their local leader and then, when that route proved unsuccessful, to the appropriate health facility where they could follow up. Without this conversation, the person might have given up.
Expanding to meet new needs
What Kausa is part of today has grown over time. The Zanzibar Afya Call Center was first launched under helpline 190 as part of the National Health Promotion Strategy 2022–2027. It was designed to provide health education, address rumors and misinformation, raise awareness of services and collect feedback from communities.
In 2025, the integration of M-Mama services brought everything under a single national helpline: 115 and expanded the center’s role to include maternal and infant health support. Today, call agents not only respond to health questions, but also help coordinate emergency maternal referrals through a GPS-enabled ambulance tracking system, linking pregnant women to health facilities.
While this integration has strengthened efficiency and emergency response, the system still requires continued investment in staff training, technology and clear operating procedures to meet growing demand.
GPS-enabled ambulance tracking helps call centre agents locate ambulances across Zanzibar and coordinate emergency maternal referrals in real time. Photo credit: Ronald Ngeno
Turning information into action
Behind each call is an expectation that the person answering will not only listen, but respond with accurate, practical information. Through support from partners, including VillageReach and CIHEB Tanzania, agents like Kausa have received training on epidemic response, vaccine-preventable diseases and how to recognize and communicate symptoms of conditions such as polio.
Still, the work is not without its challenges: call volumes can surge unexpectedly, placing pressure on a small team working across multiple shifts. Also, not all agents come from medical backgrounds, which makes ongoing training essential as new health issues emerge. At times, equipment does not work as it should, systems are slower than they need to be, and resources remain limited.
There is also, occasionally, a misunderstanding of the service itself. Because 115 is free to call, some people use it casually, phoning in for entertainment or to pass time. Each of those calls takes a few minutes that could have gone to someone else in need of real help.
Yet, despite these challenges, Zanzibar’s Afya call centre’s impact is felt in powerful ways: in the decisions people make after they hang up and in the care they seek sooner rather than later.
The foundation is already there. What remains is to strengthen it.
With more investment in training, better technology and additional support for the people behind the phones, the 115 call centre could reach even further, respond even faster and support even more people during those critical moments.
Because in those moments, what matters most is knowing what to do next.
And sometimes, all it takes is a call.
* Name changed for privacy
To learn more about VillageReach’s telehealth work in Africa, please contact Edwin Mulwa at: edwin.mulwa@villagereach.org