Unsafe care at birth is a human rights violation negatively impacting gender equality. Globally, 300,000 women and 5 million babies die annually around birth. With proper care, most would survive. Therefore, clinical guidelines production has expanded for low-resource settings. The guidance is, however, often incompatible with realities. This leaves birth attendants de facto without guidance and with disrespectful work conditions, while care at birth remains unchanged. In collaboration with birth attendants at Zanzibar’s main hospital, the PartoMa study developed a booklet of context-tailored clinical guidance for safe care at birth and quarterly seminars to strengthen its use. A limited pre-post study suggested associated reductions in stillbirths and improved immediate state of health of newborns. The proposed action-based implementation research aims to examine whether the promising pilot intervention of context-tailored guidance and training can be upscaled. Specifically, the aims are to:
1. Assess intervention modifications needed and effects of implementation in five PartoMa naïve maternity units, through a stepped wedge cluster randomized trial;
2. Co-create and assess a pre-service PartoMa-based curriculum on health students’ in-service ability to deliver best possible care;
3. Assess mechanisms that enhance or limit birth attendants’ ability to deliver best possible care, including opportunities and barriers in the PartoMa intervention;
4. Based on experiences from 1-3, develop a toolkit for co-creation of effective context-tailored guidance and training, within and beyond obstetrics; 5. Strengthen research capacity in Tanzania by conducting 1-4 in a robust, multidisciplinary team of North-South and South-South partnerships. The proposed research is called for by Tanzanian birth attendants, and in line with ministry of health strategies in Zanzibar and Tanzania mainland, and follows global priorities to end the devastating burden of lost lives at birth.