On a humid morning in Tanzania on Tuesday, two American presidents stood side by side in a ceremony where neither spoke. One was the son of a Kenyan whose election broke barriers for African-Americans. But it was the other one who might command as much, if not more, respect among many Africans today.
While George W. Bush is remembered at home for war, terrorism and national security, in Africa he is seen as a lifesaver who as president helped arrest a deadly epidemic and promoted development of impoverished lands. Now out of office, he has devoted his post-presidency in part to continuing to aid the world's poorest continent.
The coincidence of Mr. Bush's trip to Africa overlapping with President Obama's own journey this week threw a rare public spotlight on the mission the 43rd president has chosen for himself since leaving office more than four years ago. Building on the health care programs of his presidency, he has quietly returned to Africa three times, renovating health clinics and expanding screening and treatment programs to fight cervical cancer.
For a leader whose administration was consumed by conflict and death, Mr. Bush's former advisers say the Africa ventures offer a way to focus on life. As his travels center on lifting up the destitute, they evoke the presidency that might have been had there been no Sept. 11 attacks and no war in Iraq, a presidency that might have been free to focus more on the "compassionate conservative" agenda he embraced on his way to the White House.
Mr. Bush does not entertain what-ifs, but casts his enduring interest in Africa as an extension of public service. "I'm here to serve and I believe strongly that with power and wealth comes a duty to serve the least," he told CNN during a stop in Zambia before overlapping with Mr. Obama in Tanzania.
While in office, Mr. Bush started the Millennium Challenge Corporation to direct aid to African states that tried to reform corrupt and undemocratic governments. He also initiated the President's Emergency Plan for AIDS Relief, or Pepfar, which invested tens of billions of dollars to fighting H.I.V., and later tackled malaria and tuberculosis.
By the time he left office, millions were receiving retroviral drugs keeping them alive, and polls showed approval of the United States at 65 percent in Tanzania, and in the 70s and 80s in other African countries. During a final trip as president in early 2008, Mr. Bush was warmly greeted by huge crowds of the sort he never saw at home anymore.
The AIDS program has become a central part of Mr. Bush's own effort to shape his legacy. The presidential library he dedicated in April devoted a considerable part of its exhibits to Pepfar, while other more controversial decisions of his tenure like his counterterrorism policies on interrogation, detention and surveillance received less attention.
Andrew S. Natsios, who ran the Agency for International Development under Mr. Bush, said the former president increased development aid to Africa several times over as well as expanding trade and stepping in to help settle civil wars. "George W. Bush is a devout Christian and I know this is not fashionable to talk about, but it's true," Mr. Natsios said. "I think his faith told him there was a lot of suffering. Africa was falling behind and it was not acceptable."
Mr. Bush wanted to keep it going after leaving office, following in the footsteps of Jimmy Carter and Bill Clinton, who also have spent much of their time since office on programs helping Africa. Teaming up with the United Nations, Pepfar, the Susan G. Komen for the Cure foundation and various pharmaceutical companies, he helped form the Pink Ribbon Red Ribbon program to focus on fighting cervical cancer in Zambia in 2011. The program expanded to Botswana in 2012 and this week to Tanzania. In a paint-splattered shirt, he helped finish the renovation of a clinic in Livingstone, Zambia.
"A big part of President Bush's life — before, during and now after the White House — has been helping to heal sick people in poor countries," said James K. Glassman, the founding executive director of the George W. Bush Institute. "He just loves this work and he is reluctant to let us tell the world he's doing it."
The overlap with Mr. Obama, though, generated bipartisan praise for Mr. Bush. "I think this is one of his crowning achievements," Mr. Obama said on Tuesday. "Because of the commitment of the Bush administration and the American people, millions of people's lives have been saved."
For Mr. Obama, the presence of his predecessor added to pressure from activists who complain he has not done enough to build on those efforts. At a time of grinding spending constraints, Mr. Obama's latest budget proposal calls for $4 billion for Pepfar for the next fiscal year, down from $4.24 billion two years earlier.
Mr. Obama defended himself on Tuesday by noting that Pepfar is able to serve four times as many people as when it began in part because of increased efficiencies. He has also sought to demonstrate his own commitment to improving the lives of Africans, announcing plans to bolster trade and investment, improve the delivery of electricity and expand Pepfar to combat other diseases.
The two presidents got together in Dar es Salaam under a tree canopy at the American Embassy, where they both attended a short wreath-laying ceremony to remember those killed in an Al Qaeda bombing in 1998. Neither spoke during the event, but they talked with each other as they waited for it to begin and greeted family members afterward.
Africa and global health have become a Bush family affair. Laura Bush held a summit meeting for first ladies on Tuesday that also drew Michelle Obama. Jenna Bush Hager, their daughter, was an intern for Unicef and wrote a book on a teenage single mother living with H.I.V. She and her sister, Barbara, are founders of the Global Health Corps, and Barbara is its chief executive. It tries to improve access to health care in places like Rwanda, Uganda and Zambia.
"It became apparent to me that this was a deeply personal connection that he had to the continent," said J. Stephen Morrison, a former Clinton administration official and now a senior vice president at the Center for Strategic and International Studies. "All of these things bring him back and reconnect him."
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