Table 1.

Summary of the quality improvement process which was implemented in 2017–2019 at Tosamaganga Hospital (Iringa, Tanzania).

Area of Intervention	Year	Action
Infrastructures	January 2017	A Neonatal ward was constructed near the Maternity Ward, divided into three areas: Neonatal Intensive Care Unit (one room), Neonatal Sub-intensive Care Unit (one room) and Kangaroo Mother Care Unit (two rooms)
Equipment	January 2017	Four oxygen concentrators (increased over the years up to 10), two phototherapy machines, four infusion pumps and a syringe pump, a capillary hemoglobin dosing machine and an electric aspirator were purchased. The staff received training on their use.
Protocols	2017 and 2019	Operational protocols were updated and presented to the staff in dedicated training sessions. Laminated copies of the most commonly used protocols were displayed for quick consultation even by on-call staff during night shifts and holidays. A further update of the ward guidelines was carried out in 2019, in light of the publication of the first edition of the national neonatal guidelines.
Procedures	January 2017	New procedures were introduced: antenatal administration of dexamethasone for lung maturity and magnesium sulfate for neuroprotection, positioning of an umbilical venous catheter in newborns weighing <1200 g, administration of paracetamol in newborns with suspected patent ductus arteriosus, administration of hydrocortisone in newborns with oxygen dependence and suspected bronchopulmonary dysplasia.
Staff	2017	A dedicated nursing team was created, consisting of 5 nurses (increased over the years up to 8). From February 2017, a Tanzanian doctor started working in Neonatology.
Training activity	2017–2019	Over years, the Neonatal Unit and Maternity Ward staff were periodically trained on partogram use and interpretation, management of a complicated pregnancy (gestational hypertension, gestational diabetes, prolonged rupture of the membranes); management of labor and delivery (1st, 2nd, 3rd stage), prolonged rupture of the membranes, complicated labor and the most common maternal peripartum complications, neonatal resuscitation, management of common neonatal severe conditions (sepsis, jaundice, asphyxia, prematurity, respiratory distress syndrome), essential newborn care and care of low-birth-weight and very-low-birth-weight infants.