Architect of post-war British social policy, Richard Titmuss understood state capacity as underwritten by volunteer action. Volunteers actualize imagined communities by nurturing the common good: social-welfare systems, Titmuss argued, should not be judged by what is given to citizens but rather by the opportunities presented for citizens to give to each other. During times of crisis, volunteers act as stopgap and scaffold for society, linking dispersed populations to public goods and it is this prosthetic potential that animates the Health Service Report Titmuss prepared for a newly independent Tanganyika. Drawing from detailed surveys of staff numbers, hospital capacities, epidemiological trends and budget constraints, the report argues that with limited human and financial resources, the state should prioritize local services, mass education, environmental hygiene and preventive care. The temptation to invest in ‘specialists from overseas, chromium-plated resources and impressive equipment’ betrays a colonial legacy; by harnessing ‘the strengths of the community development and self help movement’ the report envisions ‘a health service developing that is not separate and aloof from the life of the nation but an expression and reinforcement of national unity’ (1964: 214).

Titmuss’ proposals for a national health service had considerable political traction (Iliffe 1998). The report's recommendations were recapitulated in the Tanganyika African National Union's (TANU) first five-year development plan (1964–69), which emphasized expanding rural health infrastructure, mass health education and tight links between voluntary agencies, local populations and government (Heggenhougen et al. 1987). But more broadly, the report's underlying commitment to spatial justice achieved through volunteerism resonated with President Julius Nyerere's vision of African Socialism. In the years following independence, Nyerere set in motion a raft of policies aimed at redistributing public resources from urban centres to rural peripheries.