Abstract: Tanzania has experienced fundamental policy shifts during the last fifty years. This included experimentation with reforms based on socialism and neoliberalism, and involved powerful actors. The public health service has been one of the main targets for policy and structural reforms, and staff on the ground has had to cope with new measures under changing regimes. This article explores the public health services in Tanzania mainland from 1967 to 2009 from a health worker perspective. How did shifting policies influence government health workers in their daily work, and how did they perceive and respond to the policies? Oral narratives were collected mainly in rural Mbulu District, north central Tanzania. The retrospective views challenged some perceptions in two previous studies from Tanzania. We argue that the top-down experiments undertaken by development experts and politicians on the national and global arena during the socialist period (1967–1985) and the neo-liberalist period (1986 to the present) had both intended and unintended outcomes. Some policies pursued during both periods provided government health workers with acceptable working conditions, while others resulted in deplorable conditions with long term negative consequences for the Tanzanian public health sector. We also argue that there were some differences in the health workers’ experiences depending on the geographical location and size of the facilities in which they worked. The historical experiences of the government health workers in this study provide a useful background to understanding some of the present challenges in the public health sector in Tanzania.