For elections to produce accountable government, citizens must reward politicians who deliver benefits. Yet there is relatively limited causal evidence of changes in public opinion in direct response to specific government programs. This question is examined in Tanzania, which has implemented large health programs targeting diseases such as HIV/AIDS and malaria. Tanzania’s 2010–11 antimalaria campaign took place concurrently with a national household survey. Exploiting discontinuities based on interview dates to estimate the effect of these programs on the popularity of local politicians, this article shows that a bed net distribution campaign resulted in large, statistically significant improvements in approval of political leaders, especially in malaria endemic areas. Effects were largest shortly after program implementation but persisted for up to six months. These findings suggest that citizens update their evaluation of politicians in response to programs, especially those that address important problems, and that the effects decay over time, but not completely.