Changes in Health Facility Readiness for Providing Quality Maternal and Newborn Care After Implementing the Safer Births Bundle of Care Package in Five Regions of Tanzania

<b>Background:</b> Maternal and newborn morbidity and mortality remain a pressing challenge with uneven progress globally and in Tanzania. The capacity of health facilities to provide quality care is critical to improving outcomes. This study aimed to assess changes in health facilities' readiness to provide quality maternal and newborn care, and hence aimed to inform improvements in quality-of-care interventions in Tanzania. <b>Methods:</b> A before and after assessment of 28 comprehensive emergency obstetric and newborn care health facilities implementing the Safer Births Bundle of Care package in five regions of Tanzania was carried out in December 2020 and January 2023. We adapted the World Health Organization's Service Availability and Readiness Assessment tool, which covered amenities, equipment, staff, guidelines, medicines, and diagnostic facilities. Composite readiness scores were calculated for each category and results were compared at the health facility level. For categorical variables, we tested for differences by Fisher's exact test; for readiness scores, differences were tested by linear fixed and mixed model analyses, considering dependencies within the regions. We used <i>p</i> < 0.05 as our level of significance and measured change from baseline using a paired t-test. <b>Results:</b> The overall readiness improved significantly from 67.6% to 83.7% (<i>p</i> < 0.05). Statistically significant improvements were seen in medical equipment (77.1% to 94.0%), diagnostic/treatment commodities (69.3% to 83.1%), and availability of guidelines (50.8% to 96.7%). Changes in amenities (78.1% to 84.2%) and staff (63.0% to 61.7%) were not significant. The overall readiness improved in all facility types and the change was statistically significant in district hospitals and health centres (<i>p</i> < 0.05). There were significant differences in improvement between regions (<i>p</i> < 0.05) <b>Conclusions:</b> The overall readiness has improved significantly, reflecting a positive change. However, there remains a need for further enhancement, particularly in terms of staffing, to ensure high-quality maternal and newborn care. Authorities should take swift action to address the identified gaps, selecting the most effective and practical interventions while closely monitoring progress in readiness and sustaining the gains.