□ On 18 November 2024, KOFIH Tanzania Office (Country Representative Kyungbae Seo) published the results and impacts of the ‘maternal, neonatal and child healthcare system strengthening project in Pwani’ in BMC Health Services Research, an international journal in the field of public health policy. 

(https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-024-11917-w)

BMC Health Services Research is a renowned SCIE-listed journal and a Q1 journal in the field of health policy, with a recent 5-year citation index of 3.1 (2023).

□ KOFIH, in collaboration with the Tanzanian health authorities, implemented a project to improve maternal, neonatal, and child health (MNCH) environment through health system strengthening from FY2016 to FY2022. This paper is distinct from the end-of-project evaluation conducted by external experts, as it was conducted by KOFIH Tanzania Office in collaboration with key stakeholders of the project and local researchers. The evaluation was objectively conducted by the actors who were actually involved in the project, measuring the outcomes and impacts of the project, drawing lessons and reflecting on them. 

□ Based on the main intervention points of the project (△renovation of health facilities, △capacity building of health workers, and △strengthening of governance), the study analyzed key variables (① the rate of four or more antenatal visits, ② the proportion of mothers who were screened for anemia during antenatal visits, ③  the rate of caesarean deliveries, ④ the proportion of mothers who received postnatal care within 48 hours, ⑤ proportion of newborns receiving postnatal care within 48 hours, ⑥proportion of labor complications, and , ⑦ proportion of births delivered by skilled birth attendants) were measured using various statistical methodologies (t-test, analysis of variance, Tukey-Kramer test, chi-squared test, Pearson correlation test, Fisher's exact test).

□ Comprehensive emergency obstetric care (CEmONC) was available in only three health centers in 2016, whereas by 2022, 10 health centers (an increase of approximately 233%) were able to provide CEmONC, including caesarean section. A before-and-after comparison using t-tests revealed that some important maternal and child health variables were statistically significant at the 0.05 level of significance (e.g., rate of 4 or more antenatal visits 2016: 16. 96% → 2022: 32.43% (n= 18, t= -6.51, ****p < 0.0001 (95% CI: -20.49, -10.46)). To double-check that the changes in these indicators were truly significant, the team selected an equal number of control groups with very similar circumstances to the intervention facilities in Pwani and Dodoma regions, respectively, and conducted an analysis of variance (ANOVA), followed by a post-hoc test with the Tukey-Kramer test, one of the most reliable post-hoc test methodologies. 

The results showed statistical significance for changes in some key maternal and child health variables: the proportion of mothers screened for anemia (****p < 0.0001), the proportion of newborns receiving PNC within 48 hours (**p = 0.0095), and the proportion of births delivered by skilled birth attendants (***p = 0.0043).

□ The facilities survey also identified that the type of facility (health post, health center, district hospital) (*p = 0.0347), distance to the facility (****p < 0.0001), and communication, particularly internet connectivity (*p = 0.0186), are factors that positively influence maternal and child health service delivery. However, it also identified that many facilities still lack adequate infrastructure. Access to clean water, ambulances for transport, 24-hour labor dispensaries, and reliable electricity supply are areas that still require our collaboration. 

□ At the same time, the study diagnosed a number of limitations, drew lessons, and suggested alternatives. In particular, it identified key areas for improvement in the governance of project implementation (△ stable data management system, △ project operations management, and △ outcome-driven project operations). As ways to improve them, the research suggested ‘the need for selection and focus with economies of scale’, and ‘strengthening data management capacity’.   

□ Meanwhile, a previous study (Nyamtema et al., 2022) found that the minimum funding required to expand facilities for the provision of comprehensive emergency obstetric care in Tanzania is approximately USD 304,613 per facility per year. The significant expansion of comprehensive emergency obstetric care delivery facilities in just six years at a cost of approximately USD 4,000,000 (*actual cost of approximately USD 2,200,000) is highly cost-effective and requires further research in terms of economic feasibility. 

□ Kyoung Kyun Oh, former acting Country Representative of KOFIH Tanzania Office, who led the study as first and corresponding author, mentioned the significance of this study in three main ways. First, the project KOFIH has implemented is very neutrally and objectively evaluated in collaboration with local stakeholders and researchers, despite the challenges and difficulties of field research. Second, it can be used to evaluate other projects by applying similar research methodologies, and similar evaluation research approaches can be considered from the project formation and development stage. Third, it can positively showcase KOFIH's research capabilities.

□ Mr. Seo, Country Representative of KOFIH Tanzania Office, highlighted that this is the second peer-reviewed publication of the study as of 2024, and said that KOFIH Tanzania Office will continue to strive to be the leading implementing organization for global health ODA in Tanzania as well as producing knowledge.