Our partnership in Zanzibar

Our impact in Zanzibar

Since 2011, we have been working with the Zanzibar Ministry of Health (MoH) to support the delivery of treatment for parasitic diseases, schistosomiasis (SCH) and soil-transmitted helminthiasis (STH).

In 2025, we supported the MoH to treat over 1.46 million people for SCH, STH or lymphatic filariasis (LF). Most received treatment for both SCH and STH, with more than 3 million treatments delivered in total. 

We also partner on mapping the disease endemicity to guide decisions, as well as activities related to One Health Systems Strengthening, helping generate actionable insights and foster collaboration among stakeholders. 

Prevalence of parasitic diseases in Zanzibar 

All eleven districts across the main islands of Pemba and Unguja islands in Zanzibar are endemic for STH, and all but one on Unguja island are endemic for urogenital SCH. 

In 2024, Unlimit Health supported the MoH with an impact assessment to guide treatment planning and to inform the pathway to elimination as a public health problem. The survey provided a detailed understanding of the distribution of SCH and STH in school-aged children (SAC) after several rounds of treatment across Unguja, Pemba and other islands.

Results showed SCH prevalence at 2.41% and STH prevalence at 58.43%. This information will inform the 2026 treatment strategy, reducing the potential of over- and under-treatment through a more targeted approach. 

In addition to treatment delivery, interventions such as health education, community sensitisation, and improved access to clean water and adequate sanitation have helped reduce disease burden. However, some shehia-level areas (the smallest administrative unit in Zanzibar) still show higher SCH prevalence.

Persistent transmission and reinfection are likely linked to factors such as proximity to freshwater with intermediate host snails, frequent contact with infested water, inadequate safe water supply, and poor sanitation. 

Our support 

Eliminating SCH transmission and controlling neglected tropical diseases (NTDs) are priorities for Zanzibar so that by 2030, these diseases will no longer be a public health problem. The MoH was one of the first in Africa to adopt an elimination strategy, implementing their Zanzibar Elimination of Schistosomiasis Transmission (ZEST) project from 2011 – 2018.  

Treatment delivery 

Unlimit Health has primarily supported the SCH and STH programme, which is integrated with the lymphatic filariasis programme. Treatments are community-based (pre-SAC and adults) and in schools for SAC. They are delivered by community drug distributors, health workers and teachers.  

The World Health Organization (WHO) recommends coverage surveys to evaluate how many people actually take the medicines provided.  

In Zanzibar, the latest survey in 2025 covered five districts after PC for SCH, STH, and LF. The results showed that three out of five districts met the ≥75% coverage target for SCH among SAC, all five districts achieved the ≥75% coverage target for STH, while four districts met the ≥65% coverage target for LF. 

Health systems strengthening 

Zanzibar is investing in health system strengthening through various initiatives and infrastructure. The MoH in Zanzibar promotes a One Health Systems Strengthening (OHSS) approach to maximise on the whole health system and promote efficiency and effectiveness throughout.  

Unlimit Health has supported two OHSS workshops in Zanzibar. The first brought together different stakeholders to identify barriers to implementing One Health approaches. The second focused on building knowledge and skills, where participants developed a Theory of Change and outlined key competencies for in-service training, aligned with the four ‘C’s of One Health: communication, coordination, collaboration, and capacity building. A third workshop, planned for early 2026, will focus on advocacy for One Health activities.