For the pregnant mothers of Madudumizi, a remote village in the Kilosa District of Tanzania, everything changed when a brand new clinic, complete with a new deep borehole providing clean water on tap, opened.
“Before, we had to walk several hours to the next village to the clinic, with the journey including a river crossing that could be dangerous,” explains Salma, a pregnant mother who has three other children aged 24, two and five months. Mothers previously died due to the length of the journey, she adds, while others died traversing the river, which becomes violent in the rainy season.
The clinic was built with funds from international children’s charity World Vision, and forms part of a 20-year development programme aiming to transform the lives of 27,000 people across 13 villages in the region, with interventions across everything from health and nutrition, to water access and education. The programme, called “Ulaya”, is itself just a glimpse of World Vision’s overall presence in Tanzania, where last year the NGO spent some $48 million (£35m) – raised through a combination of child sponsorships, donations, and government grants – to target some three million children across the country.
Tanzania is a rapidly developing country, clocking 6.2 per cent growth in the first three months of 2026. Infrastructure projects like a new rapid rail system and the controversial East African Crude Oil Pipeline bring opportunities for an urban elite in cities like Dar Es Salaam, the largest city in East Africa. But with half of the country’s population of 70 million still living on less than $3 per day, and inequality only widening as the economy grows, the work of NGOs like World Vision remains critical to efforts to tackle major challenges like maternal mortality and malnutrition.
The past year, however, has seen NGOs, including World Vision, raise the alarm as countries including the US and UK have slashed their overseas aid budgets and threatened the viability of projects like Ulaya. Overall foreign aid from wealthy nations fell by 26 per cent in 2025 compared with 2024. Although country-by-country data is not yet available, Tanzania – which received $3.2 billion in aid in 2024 – is expected to be disproportionately affected, as funding is be prioritised towards countries considered more “fragile” or affected by conflict.
What’s more, a visit to Ulaya – which The Independent undertook last month – reveals how another factor, climate change, is beginning to seriously undermine aid efforts. From health and nutrition to agriculture and infrastructure, nearly every aspect of daily life is being disrupted – and what is happening in Tanzania reflects a broader pattern unfolding across much of sub-Saharan Africa, where climate pressures are steadily eroding development gains.
Speak to rural communities across Tanzania, and most will tell you a similar story of an increasingly obvious “climate whiplash”, where rainy seasons are becoming wetter, and dry seasons are becoming drier. The geographical features of Ulaya – an area situated on the floodplain of the Mkondoa River, surrounded by hills, and with poor-draining clay soil – mean that it is a part of the world where intensifying rainfall is the bigger concern. Indeed, floods at a level that were once considered “once-in-a-generation” events have been striking the area repeatedly, according to World Vision, with major flooding events occurring in 2020, 2024 and again in 2026.
“Until around 2019, we had regular rainy and dry seasons, but now, because of climate change, people cannot predict when the rains will come and do not know when to plant their crops,” says Elisei Chilala, coordinator for the Ulaya Area Programme. He adds that 98 per cent of people in the area are farmers who depend on rain-fed agriculture to both eat and sell at the market, making them particularly vulnerable to extreme weather.
“Climate change is really impacting everything we are doing here, from health and nutrition to infrastructure and water programmes,” adds Leonard Slaa, an advisor recently hired to World Vision’s small Ulaya team with the specific remit of responding to the climate threat. “Climate denialism does not exist here in Tanzania because people see the impacts of climate change every day,” he continues. “People are waiting for the floodwaters to go down as we speak.”
Travelling into Ulaya by Land Cruiser from Kilosa Railway Station – a striking, glass-and-concrete complex completed in 2024 that has halved the journey from Dar Es Salaam – the impact of this year’s extreme rains quickly becomes clear. After turning off the main highway, the road gives way to a deeply rutted stretch of red clay. Leonard explains that the surface has been torn apart by vehicles driving through heavy rainfall, making travel far more difficult for villagers trying to reach town.
Along the roadside, rows of dried-out maize point to root damage caused by flooding, while elsewhere villagers can be seen replanting rice paddy fields that were buried under silt washed in by floodwaters. As our vehicle crosses the mighty Mkondoa River on a colonial-era steel bridge, the river’s swollen waters and fast-moving current – together with eroded banks and fallen trees along its edges – give a sense of the threat it has become in the climate crisis.
At the clinic in Madudumizi, Nurse Ida describes how major flooding events are accompanied by a rise in illnesses including malaria and respiratory infections. “People are more likely to catch colds, and rates of pneumonia are also higher,” she says. “The floodwaters have also led to more malaria cases compared with last year.”
The link between rising temperatures and the spread of these diseases is well-documented. Mosquitoes thrive in the standing water left behind by floods, while Tanzania’s rainy season is typically followed by a sharp increase in viral respiratory illnesses such as RSV, rhinovirus and influenza.
Efforts to address the village’s disease burden have become further complicated by aid cuts that are gradually trickling down to the village level. Certain tablets that the US Agency for International Development (USAID) used to provide to treat malaria are no longer available in 2026, according to Nurse Ida. “There are other tablets available from the government, but there are not always enough, and they are only available if you have enough money,” she says, adding that people are falling “very sick” as they choose to remain home and attempt treatment with traditional medicines.
