Better care brings new hope for mothers, newborns

DAR ES SALAAM: FOR a mother living far from a major hospital, the difference between life and death during pregnancy or childbirth can depend on the distance to the nearest health facility, the availability of essential equipment and whether trained health workers are on hand when complications arise.

Across Tanzania, improvements in maternal and newborn healthcare are increasingly visible not only in referral hospitals in major cities but also in health centres and district hospitals that previously offered limited services.

The transformation forms part of the country’s broader ambitions under Dira 2050, which places health and human wellbeing among its priorities. The long-term goal is to reduce preventable maternal, newborn and child deaths while expanding access to quality healthcare.

Official data from the 2022 Tanzania Demographic and Health Survey and Malaria Indicator Survey show that maternal mortality declined to 104 deaths per 100,000 live births, from 556 in 2015/16. The survey also recorded underfive mortality at 43 deaths per 1,000 live births, infant mortality at 33 and neonatal mortality at 24 per 1,000 live births.

Behind these national figures is a transformation taking place in individual health facilities, where doctors and nurses say improved equipment, specialist services and infrastructure are changing how mothers and newborns receive care.

At Matongo Health Centre in Simiyu Region, for example, an upgrade from a dispensary has expanded the range of services available to surrounding communities.

The medical officer in charge, Dr Alfred Lucas said the improvement has significantly increased the facility’s capacity.

“This centre was a dispensary, but it was upgraded to become a health centre. After the upgrade, services were improved and additional services were introduced,” he said.

The expansion is also reflected in the number of women giving birth at the facility. Dr Lucas said the centre now assists between 80 and 95 mothers to deliver every month.

At Burige Health Centre, Medical Officer in charge, Dr Omary Mkumba said modern maternity beds and other medical equipment have improved conditions for women giving birth.

“Initially it was a dispensary and now it is a health centre. We have started providing surgical services, so pregnant women who have complications and cannot deliver normally can undergo surgery here,” he said.

For women in rural areas, such improvements can reduce dangerous delays caused by travelling long distances to referral hospitals when complications arise.

The same principle is evident at Lyabukande Health Centre, where upgraded services have brought emergency obstetric care closer to the community.

Dr Beatric Antony, the medical officer in charge, recalls that before the upgrade, women requiring emergency surgery had to be transferred to a district hospital about 62 kilometres away.

“Before the centre was upgraded, when a mother had a complication during delivery and needed emergency surgery, we had to refer her to the district hospital, which is 62 kilometres from here,” she said.

“Now we provide those services here. When a mother develops an obstetric complication, we can perform the operation and save both the mother and the baby.”

Dr Enock Joseph, an anaesthesia specialist at Lyabukande, said reducing travel time can be particularly critical for mothers experiencing heavy bleeding.

He recalls that some women previously had to travel 25 to 30 kilometres to access services, with poor road conditions compounding the risks.

“Some mothers were bleeding, and the roads themselves could be a challenge. The longer the journey, the more the bleeding could continue,” he said.

“With the services now available here, a mother can receive care much closer to home and without losing valuable time.”

** Better equipment, stronger hospital services**

Improvements are not limited to maternity wards. The availability of medicines, medical supplies, diagnostic equipment and specialists is also strengthening the capacity of referral hospitals to provide routine and advanced care.

At Sekou Toure Regional Referral Hospital in Mwanza, Dr Bahati Msacky said improved access to medicines and medical supplies has strengthened service delivery.

“MSD has been an institution that we work with very well. We have good relations, and the availability of medicines and medical supplies is about 98 per cent,” he said.

He said the hospital has moved from a situation in which patients sometimes had to obtain medicines and diagnostic services outside the facility to one in which more services are available within the hospital.

“Now they can get enough medicines. They can get enough diagnostic services and medical equipment. Specialist and highly specialised services have also been enabled at our hospital,” Dr Msacky said.

At Geita Regional Referral Hospital, Dr Fatma Yasinta said the growing availability of specialists has reduced the need to refer mothers and children elsewhere for treatment.

The hospital offers outpatient and inpatient services covering obstetrics and gynaecology, paediatrics, surgery, internal medicine, orthopaedics, emergency care and paediatric surgery.

“We have specialists in all the areas I have mentioned, and some departments have two specialists,” she said.

However, Dr Yasinta stresses that specialists cannot deliver effective care without the necessary equipment. “A doctor cannot work alone without medical equipment.

That is why we receive modern equipment through MSD,” she says, citing digital X-ray machines, ultrasound equipment and CT scanning among the technologies available at the hospital.

The hospital is also extending specialist services to communities through outreach programmes.

“We conduct outreach to lowerlevel facilities. We take specialists there to bring services closer to the people,” Dr Yasinta said.

She added that some health centres have been equipped to perform surgeries that previously required patients to be referred to higher-level hospitals.

**Maternity care closer to families **

At Simiyu Regional Referral Hospital, Dr Atanas Kyambakubi said a modern mother-and-child building has expanded the hospital’s capacity to manage different maternal health needs.

“We have two specialists, and we also have a modern building that receives mothers of different conditions,” he says.

The building has two operating rooms for surgical procedures, while delivery rooms allow women to have companions of their choice, including their husbands or relatives, during childbirth.

The involvement of family members reflects a growing recognition that safe motherhood is not solely the responsibility of healthcare workers but also benefits from support at home and during delivery.

At Sinza Hospital in Dar es Salaam, maternity nurse Sister Aunia Ndosi said conditions have improved considerably compared with earlier years.

She recalls a time when maternity services faced shortages of equipment and diagnostic capacity. Today, digital Dopplers, cardiotocography machines and patient monitors help health workers monitor women during labour.

The maternity department has about six patient monitors, which help staff observe the condition of both the mother and unborn baby.

At Sinza’s antenatal clinic, maternal and reproductive health specialist Gloria Urio said between 300 and 400 pregnant women attend the clinic every month, with nearly half beginning antenatal care before 12 weeks of pregnancy.

Early attendance allows health workers to identify potential risks, provide iron and folic acid supplements and monitor mothers throughout pregnancy. Ms Urio also said fathers are becoming more involved in antenatal care, with about half of the women attending the clinic accompanied by their partners.

This involvement helps men understand pregnancy-related danger signs, the importance of proper nutrition and the need to seek medical attention promptly when complications arise.

**Saving newborns through specialised care **

For newborns, particularly premature babies, the expansion of specialised services and access to modern equipment is equally important.

At Sinza Hospital, newborn specialist Dr Mashaka John said the hospital established its neonatal department in March 2024 after previously referring complicated newborn cases to larger hospitals.

Since its establishment, the unit has treated 1,041 newborns.

The department initially had one Continuous Positive Airway Pressure (CPAP) machine for babies experiencing breathing difficulties but now has five. It also has four phototherapy machines for treating jaundice, four infusion pumps and an oxygen system supported by five flowmetres and four cylinders.

“For premature babies, respiratory problems are common because their lungs are not yet mature,” Dr Mashaka explained.

CPAP machines help babies who cannot breathe adequately on their own by providing respiratory support.

A similar experience is reported at Simiyu Regional Referral Hospital, where nurse Julieth Christopher said the machines have transformed the management of premature babies experiencing breathing difficulties.

“Previously, when we gave them ordinary oxygen, it was not enough. But now we have CPAP, which helps them to breathe, and we are seeing very good results,” she said.

The hospital also uses phototherapy to treat newborns with jaundice and warmers to prevent babies from losing body heat.

“Previously we used to put babies in baby coats and they would lose heat, which was also a risk for newborn deaths,” Ms Christopher said.

“Now we have warmers that help maintain the temperature that is appropriate for their bodies.”

Dr Kyambakubi said Simiyu Regional Referral Hospital has a dedicated unit for premature babies, equipped with intensive-care capabilities, oxygen support and facilities for treating jaundice and preventing infections.

Mothers can also practise kangaroo care, which involves skinto-skin contact with their babies to help maintain body temperature and promote bonding.

At Geita Regional Referral Hospital, Dr Yasinta said a dedicated unit for premature babies has also been established, supported by specialists and equipment, including CPAP machines.

A new building is under construction with government support to expand newborn care, particularly for premature babies.

At Msalala District Hospital, newborn services have similarly benefitted from modern equipment.

Dr Joseph Miye said the hospital provides antenatal care, normal deliveries and Caesarean sections when medically necessary. With support through MSD, it has received modern anaesthesia equipment, a diathermy machine and CPAP machines.

“These machines are for babies who develop breathing difficulties at birth, whether they are born through Caesarean section or normal delivery,” he said.

Before the equipment became available, such babies had to be referred to Kahama District Hospital.

At Nyang’wale District Hospital, medical officer Dr Godwill Manyaki said the facility has received modern surgical equipment, radiant warmers and incubators.

“These are machines for giving a small baby with complications the warmth needed to withstand the environment after birth,” he said.

**Health workers witness a transformation **

The improvements have also changed the working environment for healthcare professionals.

Dr Frederick Mlekwa, a reproductive health consultant in Simiyu, said the transformation is striking compared with the conditions he encountered earlier in his career.

“For me, having started work many years ago, it feels almost like a miracle. In the past, there were no adequate tools, there were not enough specialists and buildings were in poor condition,” he said.

“Now Tanzania has changed. There are more health workers and more specialists.”

He recalls that doctors were previously expected to manage several medical disciplines simultaneously because of shortages of specialists.

“You could be the surgeon, the doctor for women, the doctor for internal medicine and the paediatrician all at the same time,” he said. “Today, almost all regional hospitals have specialists.”

At Sekou Toure Regional Referral Hospital in Mwanza, nurse Rukia Setembo has witnessed similar changes in maternity services.

She said overcrowding was once common, with mothers having to share limited space in the delivery area.

“Initially, mothers were crowded in the delivery area and only a small number could be served at the regional hospital,” she said.

The expanded maternity building now handles approximately 500 to 600 deliveries every month, while improved maternity beds have made the environment more comfortable for women.

Sustaining the gains

The changes demonstrate that improving maternal and child health requires more than constructing hospital buildings. It depends on a combination of trained professionals, reliable supplies of medicines, diagnostic services, surgical capacity, newborn equipment, effective referral systems and public awareness.

Dira 2050 places improved health for all at the centre of Tanzania’s long-term development ambitions. Its implementation framework identifies universal access to quality prenatal and postnatal care, stronger emergency obstetric services and reductions in maternal, newborn and child mortality among the country’s health priorities.

The progress reported at facilities such as Matongo, Burige, Lyabukande, Geita, Simiyu, Sekou Toure and Sinza illustrates how these ambitions are being translated into services closer to communities.

However, health workers say important gaps remain.

At Sinza Hospital, Dr Mashaka said the neonatal unit needs incubators and a ventilator, while Sister Aunia said the maternity building requires further expansion because space becomes limited when many women arrive at the same time.

Sustaining the decline in preventable deaths will therefore require continued investment across the entire referral system, from rural dispensaries and health centres to district, regional and national referral hospitals.

For Dr Mashaka, the ultimate measure of success is straightforward: Ensuring that every newborn who can be saved receives the right intervention in time.

His ambition for the coming years is to see preventable newborn deaths reduced to zero.

At community level, Ms Urio captures the same aspiration in a phrase used by health workers at Sinza: “Tuwavushe salama” let us safely carry them across.

The phrase reflects a shared ambition to place mothers and babies at the heart of Tanzania’s health transformation, linking the daily efforts of doctors, specialists, nurses and other health workers to the country’s long-term aspirations under Dira 2050.

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