Tanzania is winning the battle between mothers and newborn deaths as the latest figures reveal a significant decline.
“Tanzania is committed to reducing maternal and neonatal mortality rates and ensuring safe delivery as part of its national development plan. Safer birth bundles are one of the key strategies to support this effort.”
A groundbreaking study published in The New England Journal of Medicine shows that Tanzania’s innovative health programs (centred on regular on-site training for healthcare workers) reduced maternal deaths by 75% and early neonatal deaths by 40%. A three-year study conducted at 30 Heibulden Healthcare facilities in Tanzania followed around 300,000 mother baby pairs under the Safer Birth Bundle of Care (SBBC) program. The program focuses on improving mothers and babies care during the day of birth, a critical time when women are involved in labor and have babies.
Maternal health is a key focus of the United Nations Sustainable Development Goals (SDGS) in particular, target 3.1, aimed to reduce the mortality rate of less than 70 per 100,000 births worldwide by 2030.
The Tanzania program combines ongoing simulation-based training for frontline healthcare professionals, along with innovative clinical tools to improve labor monitoring (fetal heart rate monitoring) and neonatal resuscitation. It also uses data to promote continuous improvement and ensures healthcare professionals have the skills, confidence and ability to manage their birth-related agents, both mothers and newborns.
“We work closely with healthcare professionals, equip the tools we need to improve the quality of care, ensuring effective management of both mothers and babies during and after birth,” Dr. Kamala said.
“When the safer birth bundle care programme developed earlier in 2015/16, there were around 556 maternal deaths per 100,000 births and 25 neonatal deaths per 1,000 births to give you a measure of the burden of maternal and neonatal deaths in Tanzania,” he said.
Published studies demonstrate the “transformational impacts” of safer birth bundle care programs conducted in 30 hospitals in five high-running areas in Tanzania, where there were approximately 300,000 mother baby pairs.
Maternal deaths at the start of the program were recorded at 240 per 100,000 births, with postpartum bleeding and hypertension disorder being the main causes of death, he said. During the 24-month survey period, this number fell to about 60 per 100,000 births, representing a 75% decline. The number of neonatal deaths due to dyspnea and complications, primarily associated with advance payments, fell 40% from seven deaths per 1,000 births.
“These results are amazing,” Dr. Kamala said.
According to Dr. Kamala, a 75% reduction in maternal deaths was not expected, and an important lesson was a key role in on-site team simulations, including reflexive debriefing led by competent trained individuals, including post-delivery bleeding.
“This seems like a major part of the program’s success,” he said. “We are pleased with these outcomes and hope that other countries will adopt and expand the safer birth bundle of care programs… Beyond the numbers, safer birth bundle of care programs have driven a dramatic cultural change in our healthcare system,” he said. “Healthcare workers are more confident and better equipped to handle birth-related complications in both mothers and babies.”
Maternal Death Drop
Dr. Kamala attributes a 60-70% reduction in neonatal deaths in Gaita and Manyala to several factors.
“Firstly, many people were the first site to implement, giving the region time to adapt and experience the impact of the program. Most importantly, both regions were burdened with a high burden of stillbirth and neonatal death, achieving ideal goals for focused interventions.
Dr. Kamala said another possible explanation was cultural differences in practice, with some healthcare facilities reporting inaccurate data due to fear of responsibility and shame. However, with the implementation of the project, the reporting has become more accurate after deployment. Some areas, such as Tabora, reported an increase in the number of referrals to research hospitals from other care centers after the program was implemented. These are likely to slow hospitalizations, he said, which increases the likelihood of a decline in health outcomes.
The study found that neonatal deaths decreased by 40% within the first 24 hours of birth after the program was implemented.
Dr. Kamala said that Tanzania’s notable advances in reducing maternal mortality by 80% is driven by strategic investments and innovative programs focused on improving mother and child survival.
“More than 2,000 new medical facilities have been developed, free medical services are provided to pregnant mothers and children under the age of five, and emergency obstetric care will help ensure timely life-saving interventions, including improving transport to rural hospitals.
“Most importantly, the Ministry of Health is working with healthcare workers, hospitals and development partners to strengthen the skills of frontline healthcare workers, an important factor in fostering this progress.
“Political leadership, along with strategic partnerships and fundraising, was important in promoting progress in maternal and neonatal health,” he said.
The program was made possible through support of Global Health in Women, Children, Adolescence, Norad, UNICEF, Raeldal, and Global Finance Facilities for the Ministry of Health and Haydham Lutheran Hospital. Their partnership and investment expanded the scaling of safer birth bundle care to 30 hospitals, supporting research. “The government is currently expanding its programme to over 150 sites and plans to expand it to three regions nationwide starting this year,” he said.
Dr. Kamala outlined that recommendations for major policy to other governments could be adopted to prioritize mother health.
“First, we focus on relatively simple, cost-effective interventions essential to prevent the death of maternal and neonatals. For example, stronger primary health care provided in the community is also important, as well as working in close collaborations with national, local and local health authorities.”
He said that the Tanzanian approach reduced and maintained the safer birth bundle of care programme by aligning the initiative with national guidelines for obstetrics and neonatals. Additionally, the creation of mentorship programs and regular supervision helped to maintain results.
Looking ahead
Tanzania is currently expanding to three new regions in 2025, followed by a nationwide expansion.
The success of this program has attracted attention from other countries as Botswana, Ethiopia, Lesotho and Namibia have expressed interest in adapting the program to the health care system. In Nigeria, the program has already begun in two states, Gombe and Borno, marking an important step in scaling.
