A 13-Year Initiative to Expand Access to High-Quality Emergency Obstetric and Newborn Care (EmONC) and Family Planning Services in Tanzania

The Program to Reduce Maternal Deaths in Tanzania was a 13-year initiative that worked to expand mostly rural communities' access to high-quality emergency obstetric and newborn care (EmONC) and family planning services. The Tanzanian Ministry of Health and its partners worked together to enhance the quality of maternal and perinatal care and improve health outcomes in Kigoma region.

Sub-Saharan Africa accounts for only 15% of the world's population but bears nearly 70% of the global burden of maternal deaths and about 40% of global newborn deaths. More than half of maternal and newborn deaths result from complications during childbirth and are largely preventable. However, poor quality of care in low-resource settings is often a greater contributor to poor health outcomes than health coverage. The Tanzanian program model of decentralized reproductive, obstetric, and newborn care from hospitals to more accessible, lower-level health facilities through infrastructure upgrades and training of non-physician health care providers demonstrated substantial reduction in maternal and perinatal deaths. The panel will present the history of the program, key program interventions, a population-based multilevel decomposition analysis that shows how a rapid increase in facility deliveries is mostly attributable to the increase in quality of health facilities, and an innovative birth companionship model that was scaled up and led to a policy change in Tanzania.

Lessons learned from the program can inform policymakers and program managers in settings where similar approaches could be used to improve and sustain the utilisation of quality facility care at birth.