Tanzania turns to PPPs to tackle neonatal death rates

The initiative comes at a critical moment. Although Tanzania has made notable progress in reducing under-five mortality over recent decades, newborn deaths remain persistently high.

According to the UN Inter-Agency Group for Child Mortality Estimation (UN IGME 2023), the country records 24 neonatal deaths per 1,000 live births, double the WHO Sustainable Development Goal (SDG) target of 12 by 2030.

National figures further show that nearly half of all under-five deaths occur within the first 28 days of life, often from preventable causes such as birth asphyxia, prematurity and infections.

Against this backdrop, the PPP aims to strengthen initial stabilisation, the critical hours and days immediately after birth, by equipping doctors and nurses in primary and district hospitals with essential skills, including respiratory support, thermal regulation, infection management and effective use of modern neonatal equipment.

Speaking in an interview with The Citizen yesterday, Dr Naomi Mwamanenge, a paediatrician and neonatologist who also serves as Treasurer of the PAT described the shift as long overdue.

“Tanzania is now focusing on improving the survival of newborns who have historically been overlooked,” she said.

“Most under-five deaths are actually driven by complications arising in the first 28 days. Research has shown us that inadequate knowledge and limited utilisation of available technologies at lower-level facilities contribute substantially to these deaths,” she noted.

Dr Mwamanenge of the Aga Khan Hospital noted that although the government has invested in modern equipment across many health facilities, the skills gap remains significant.

“We have the equipment, yes, but many doctors struggle to use it effectively. That is why this programme is so important. We are training doctors and nurses from all regions to understand both the theoretical and hands-on aspects of managing newborns from day zero,” she said.

The programme, Fundamentals of Critical Care in Neonatology, is designed to ensure consistent standards of care across the country.

“Whether a newborn is taken to Aga Khan or to a district hospital, they should receive the same quality of initial care. That level of uniformity is what will save lives,” she emphasised.

The Ministry of Health has prioritised improving neonatal and maternal care through its National Roadmap Strategic Plan (One Plan II), which aligns with the WHO’s Every Newborn Action Plan (ENAP).

The PPP complements government efforts to decentralise specialised care by empowering lower-level facilities to manage complications early, thereby reducing unnecessary referrals and the risks associated with long-distance transfers.

According to the Ministry, more than 40 percent of neonatal deaths occur during transfer from primary facilities to higher-level centres, a statistic that this initiative seeks to address directly.

A Resident in Paediatrics and Child Health at the Aga Khan University Medical College and one of the programme facilitators, Dr Rukshar Osman, said the collaboration is tailored to strengthen frontline workers’ skills where gaps are most evident.

“Our objective is to enhance the knowledge and competence of doctors and nurses working in level I and II hospitals so they can stabilise newborns before referral,” she explained.

She added: “We have made important strides in reducing maternal mortality, but neonatal mortality remains high at 24 per 1,000 live births. By strengthening the capacity of the public sector, we hope to change this trajectory.”

The ten-week programme consists of online, oral and practical sessions. Participants in the first cohort are expected to return to their facilities as trainers of trainers, extending the programme’s reach.

“Initial stabilisation saves lives. If a baby is properly managed at birth and in the crucial first hours, the chances of survival increase significantly,” Dr Osman said.

For Dr Habakkuk Silas of Nkinga District Hospital in Tabora, the training has been transformative.

“This opportunity has been a blessing. I have learnt many practical skills, including respiratory support, an area we often mismanage without fully realising it,” he said.

“Many deaths occur among newborns referred from lower-level facilities to hospitals. Through this training, we now understand what must be done correctly at the primary level to prevent such losses.”

In neonatal care, the partnership with Aga Khan institutions, renowned for high standards, advanced research and clinical excellence, offers a crucial opportunity to bridge quality gaps in public facilities.