In order to assess the availability of Emergency Obstetric and Neonatal Care (EmONC) services in Tanzania Mainland, a Cross-sectional survey of a National sample of obstetric care facilities was conducted in 2015. We adapted the Averting Maternal Deaths and Disabilities (AMDD) tool and did spatial mapping using a calibrated Global Positioning System (GPS) Essential Software for Android and Arc Geographical Information System (GIS) software. Data were analysed using STATA, SPSS and Excel computer programs. Ethical approval was granted by the National Institute for Medical Research and the Ministry of Health, Community Development, Gender, Elderly and Children. We identified 5207 obstetric care facilities which is equivalent to 59.7 facilities per 500,000 population. We surveyed 2405 (46.2%) facilities of which 251 (10.4%) had provided all the 7 Basic Emergency Obstetric and Neonatal Care (BEmONC) in past 3 months. Among these, 130 had provided Comprehensive Emergency Obstetric and Neonatal Care (CEmONC). The UN benchmarks for BEmONC and CEmONC facility densities were attained or exceeded by 40% and 76% in all 25 regions respectively. EmONC facilities were dominated by hospitals and were clustered in cities and townships. In conclusions, the distribution of EmONC facilities in Tanzania Mainland is suboptimal in more than half of regions with clustering around cities and townships.

Background: Tanzania has implemented the Maternal and Perinatal Death Surveillance and Response (MPDSR) system for more than a decade. However, multiple assessments have shown that the quality of maternal death reviews at facility and district levels has often been limited by inadequate specialist participation, weak root-cause analysis, and insufficient follow-through on action plans. These limitations have reduced the effectiveness of MPDSR in driving quality improvement and preventing avoidable maternal deaths. To address these gaps and strengthen accountability and clinical learning, the Ministry of Health introduced daily Virtual Maternal Death Reviews (VMDR) in 2021. This study describes the implementation and outcomes of VMDR from 2022 to 2023. Methods: A descriptive observational study was conducted using a mixed-methods approach. The analysis included maternal deaths that were notified through the national MPDSR system and subsequently selected for VMDR sessions between January 2022 and December 2023. Cases were eligible if they met the WHO definition of a maternal death and had sufficient clinical documentation from facility or district review committees to allow determination of the cause of death and contributing factors. Quantitative data were summarised using descriptive statistics, while qualitative insights from VMDR discussions were synthesised to identify modifiable clinical and system-level factors and response actions. Results: A total of 369 VMDR sessions were conducted, reviewing 687 maternal deaths across all regions. The leading causes of death were obstetric haemorrhage (49%), hypertensive disorders of pregnancy (16%), and anaesthesia-related complications (10%). Common modifiable contributing factors included inadequate clinical competency (82%), suboptimal provider practices and attitudes (69%), weak leadership and accountability (42%), and gaps in surgical and anaesthesia care. VMDR participation facilitated improved oversight and prompted remedial actions such as redeployment of specialists, improvement of essential supplies, and initiation of structured mentorship and continuing medical education. Conclusion: The VMDR model strengthened the quality and consistency of maternal death reviews and improved accountability in responding to identified gaps. Sustaining VMDR requires continued leadership to maintain confidentiality in line with existing culture and norms.

This study aimed to assess the implementation of the MDSR system. The mixed cross-sectional study was conducted in 12 regions. The quantitative analysis used ordinal intervals: Excellent, Good, Satisfactory and Poor. Qualitative analysis developed themes to inform MDR system implementation. The findings showed that leaders were following up at the health facility, the community, and individual clients. The system implementation at the regional level was Satisfactory (75%-84%), and at the district and health facility level was Poor (below 75%). Generally, responses to the action plan at all levels studied were rated Poor. The timeliness of notification to MD was found to be Satisfactory (75%–84%) in three regions and Poor in Dar es Salaam and Mwanza. The daily notification of MDs was 57.3% of the 349 weekly reports. The completeness variables improved significantly to Excellent scores (above 95%) after a week, but not for notifications. Therefore, the system produces data that goes beyond numbers, thereby making it not inferior. The system generates MD data through timely notifications and weekly reporting, with the latter yielding twice as much.

Antenatal care (ANC) is essential for improving maternal and newborn health, yet many women do not complete the recommended follow-up visits and often experience suboptimal quality of care and weak provider-client interactions. Group antenatal care (G-ANC) offers an alternative service delivery model that combines clinical assessments with group-based education, facilitated discussion, and peer support for women with similar gestational age (GA). This study examined the facilitators and barriers to G-ANC implementation in low-resource settings in Tanzania using the Consolidated Framework for Implementation Research (CFIR).A qualitative study was conducted in the Geita Region from June to November 2024. Data were collected through Focus Group Discussions (FGDs) with pregnant and recently delivered women who participated in G-ANC. Key Informant Interviews (KIIs) included the healthcare providers (HCPs), facility leaders, and health managers. Using NVivo Version 14.0 software, we managed and analysed all interviews to explore facilitators and barriers to the implementation of G-ANC. Data were grouped and reported according to their relevance to the CFIR constructs. Implementation of G-ANC was shaped by interacting factors across all CFIR domains. Key facilitators included the perceived relative advantage of G-ANC over conventional ANC, adaptability of the model to local contexts, supportive facility leadership, effective teamwork, and peer support among women. Similarly, implementation processes such as proper scheduling of group sessions supported continuity of G-ANC services. In addition, the positive experiences of community health workers (CHWs), HCPs and pregnant women reinforced sustained implementation. Major barriers included inadequate space for meetings, workforce shortages, competing clinical demands, socioeconomic constraints and privacy concerns in group settings. Successful implementation of G-ANC in low-resource settings requires alignment between intervention design, health system capacity, and community context. Addressing multilevel barriers while strengthening identified facilitators is critical for the successful adoption of G-ANC and its integration into other maternal and newborn health services.

Introduction : Global experts and agencies often downplay the value of routine Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH) data. Therefore, we demonstrate the significance of a Health Information Management System (HMIS) for tracking progress and assessing the utility of RMNCAH data in improving healthcare systems, particularly in low-resource settings. Methods : We utilized HMIS and related datasets to evaluate the availability and usefulness of RMNCAH routine data in Tanzania between 2014 and 2024. Results : Increases in service delivery points correlated with the following improvements in key maternal health indicators: antenatal visits before 12 weeks (15.1% to 42.9%; 2014–2023), institutional births (64.4% to 85.8%; 2014–2023), cesarean sections (5.6% to 11.6%; 2014–2022), and postnatal visits (45.3% to 91.6%; 2014–2023). The RMNCAH scorecard transitioned from predominantly red in 2014 to green in 2024, reflecting improved maternal and perinatal mortality surveillance. Obstetric haemorrhage and pre-eclampsia accounted for two-thirds of maternal deaths; competency and accountability were critical determinants. Neonatal deaths and stillbirths during 2018–2023 numbered 50,123 and 82,995, respectively, with 80% of neonatal deaths attributed to prematurity, birth asphyxia, and sepsis. Limited neonatal services contributed to mortality, with only 14 hospitals containing neonatal care units in 2018, compared with 156 district and 28 regional hospitals in 2024. Conclusion : When systematically tracked and analyzed, routine RMNCAH data provide crucial evidence to inform policymaking and track RMNCAH intervention outcomes. Our findings underscore the importance of stakeholders investing in routine data collection to facilitate data-driven decision-making and real-time progress tracking. KEY MESSAGES What is already known on this topic Global experts and agencies downplay the value of RMNCAH routine data, particularly in low-resource settings. What this study adds This study demonstrates how routine RMNCAH data can inform RMNCAH interventions and track progress. How this study might affect research, practice, or policy Our findings highlight the value of stakeholders investing in routine data collection to enhance data-driven decision-making and facilitate real-time progress tracking.

This study aimed to assess the implementation of the MDSR system. The mixed cross-sectional study was conducted in 12 regions. The quantitative analysis used ordinal intervals: Excellent, Good, Satisfactory and Poor. Qualitative analysis developed themes to inform MDR system implementation. The findings showed that leaders were following up at the health facility, the community, and individual clients. The system implementation at the regional level was Satisfactory (75–84%), and at the district and health facility level was Poor (below 75%). Generally, responses to the action plan at all levels studied were rated Poor. The timeliness of notification to MD was found to be Satisfactory (75–84%) in three regions and Poor in Dar es Salaam and Mwanza. The daily notification of MDs was 57.3% of the 349 weekly reports. The completeness variables improved significantly to Excellent scores (above 95%) after a week, but not for notifications. Therefore, the system produces data that goes beyond numbers, thereby making it not inferior. The system generates MD data through timely notifications and weekly reporting, with the latter yielding twice as much.