Zanzibar — The late afternoon sun settles gently over the narrow streets of Unguja as groups of teenagers stream out of a university hall, their conversations animated and hopeful.
Just an hour earlier, many of them sat through a youth friendly reproductive health session, the kind that didn't exist for their parents, and which until recently, many young Zanzibaris could only imagine.
Today, however, these sessions are becoming part of a growing movement across Zanzibar, a movement that is empowering young people with the information, services and support they need to take charge of their sexual and reproductive health.
At the center of this transformation is Start Small, a youth-focused initiative led by MSI Tanzania in partnership with the Zanzibar Fighting Against Youth Challenges Organisation (ZAFAYCO).
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The two-year project which kicked off in 2024 is designed to ensure that adolescents and young people, especially students, can access accurate information, youth-friendly services, and safe spaces to discuss sensitive issues without fear or judgment.
For years, Zanzibar has grappled with rising concerns about unplanned pregnancies, sexually transmitted infections (STIs) and unsafe abortions among young people. Stigma, silence and widespread misconceptions around reproductive health often left teenagers confused, misinformed, and vulnerable.
"Before Start Small, many young people simply did not know where to go for credible information or services," recalls Abdallah Abeid, the Executive Director of ZAFAYCO.
"We were seeing girls dropping out of school because of early pregnancies and boys facing health complications because they feared seeking help. Today, the story is changing, and Start Small has played a major role in that shift." According to Abeid, ZAFAYCO's community trust, combined with MSI Tanzania's technical expertise, created a partnership capable of reaching young people in ways that neither organization could achieve alone.
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"We have seen thousands of youth reached and hundreds accessing services each month. The project is not just giving information; it is giving hope," he emphasizes.
He says the project employs a dynamic range of methods tailored to youth realities, including youthfriendly clinical services, including contraceptives, STI testing, post-abortion care, and counselling, doorto-door and community outreach, bringing SRH services closer to households and Life-skills and entrepreneurship support, recognizing that youth development must be holistic.
Domitira Masalla, the Start Small Project Manager, highlights how these components reinforce one another.
"Young people trust environments that understand them. By meeting them where they are, in schools, universities and communities, we remove barriers. They don't feel judged.
They feel seen and that is what has driven the success of Start Small," she explains. Masalla notes that youthled discussions and peer educators have been crucial in tackling misinformation, particularly myths about contraceptives.
"We discovered early on that misinformation is one of the biggest barriers. Many girls believe contraceptives cause infertility or cancer, many boys think SRH services are only for women. Through open dialogue and demonstrations, we have been able to break these myths," she says.
At the State University of Zanzibar (SUZA), Start Small's influence is visible among students who now speak more confidently about their health and future plans. Hassan Khairalla Tawakal, Assistant Dean of Students at SUZA, notes that students are now more aware of their bodies, their rights and their options.
"We have witnessed an increase in students approaching health staff and participating in SRH clubs. Education is shaping their decisions, and many are openly saying that the sessions have helped them avoid risky behavior," he says.
He adds that integrating SRH into campus life has been transformative.
"When you provide knowledge, you empower a generation. And this generation is responding positively."
In southern Unguja, where Start Small has been particularly active, the impact is measurable. Clinics that once saw little youth engagement are now reporting increased demand for services, including long-term contraceptive methods such as implants and IUDs. At Nungwi Health Centre, Saida Kheri Hamadi, a nurse and midwife, has observed this firsthand.
"Before, we would see maybe 16 clients a day for youth-related SRH services. Now, on busy days, that number reaches about 25," she says.
"Youth are coming back for follow-ups, asking questions, bringing their friends. That shows trust." Hamadi also notes that stigma is slowly dissolving. "Young girls now walk into the clinic without hiding their faces. That is a big change for this community."
Similarly, at Mwera Health Centre, embedded nurses from MSI Tanzania, Siwangu Steven Mhagama and Munawar Mussa, play a key role in providing youthfriendly counselling. "Youth often just need reassurance," says Mhagama.
"They need someone to tell them, 'You're not doing anything wrong by wanting to protect your future.' When they hear that, they open up."
Ms Mussa adds that Start Small has enhanced the capacity of health providers.
"We have been trained to approach youth differently, with patience, respect and understanding. That approach has made a massive difference." A key indicator of the project's success can be seen in the contraceptive prevalence rate (CPR) in parts of Zanzibar, which has shown steady improvement.
Saida Abubakar Mohammed, Coordinator of Maternal and Child Health Services at the Ministry of Health Zanzibar, confirms that in 2023, before Start Small intensified its work, the CPR in some areas was around 15 percent. Today, it has reached 17.5 percent.
"This growth may seem small, but in public health, it is significant, especially among youth populations," she says proudly. She notes that contraceptive uptake among young women has been particularly encouraging.
"Young people are making informed choices and this is a major step forward for maternal and reproductive health." The South Unguja District Medical Officer (DMO), Dr. Mohammed Mtumwa Mnyimbi, echoes this sentiment.
"Improving youth reproductive health is fundamental to preventing maternal complications and unsafe abortions. Start Small complements our district health strategies by reaching young people early, before problems occur," he states.
According to Dr. Mnyimbi, the initiative also reduces pressure on the health system.
"When youth have the right information and services, they avoid higher-risk situations. This prevents emergencies, reduces unsafe abortions and supports healthier communities." One of Start Small's distinctive strengths is its understanding that youth wellbeing extends beyond health.
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The project incorporates lifeskills training, career planning and basic entrepreneurship support, elements that resonate strongly with young people seeking stability and purpose. Many youths face financial and social pressures, says ZAFAYCO's Abeid.
"When you combine SRH with life skills and economic empowerment, you show them that their lives can move in a positive direction. You give them choices, and choices build confidence," he says.
Despite the progress, challenges remain. Misconceptions about emergency contraceptives, beliefs that family planning is only for married couples, and cultural sensitivities around youth sexuality continue to influence community attitudes.
"Changing social norms takes time," says Domitira Masalla.
"But every conversation, every youth club meeting, and every clinic visit moves us closer to a healthier, better-informed generation." The project carefully navigates cultural and religious contexts, working respectfully with communities to reduce fears of backlash.
"We engage parents, teachers, religious leaders, and community members," Masalla adds. "When the whole community understands why this work matters, change becomes sustainable."
As the sun sets on Nungwi, Mwera, or SUZA campuses, the conversations among youth reflect a new era, one where silence is giving way to empowerment, stigma is giving way to knowledge, and young people are taking control of their futures.
Start Small may have begun quietly, but its impact is echoing loudly across Zanzibar, one informed, empowered young person at a time.
