Developing paediatric subspecialty training in resource-limited settings; the first neonatology subspeciality program...

Neonatal mortality remains high in Tanzania, where progress toward Sustainable Development Goal 3.2 is constrained by a severe shortage of trained workforce. To achieve the goal, Tanzania, with approximately two million annual births, aims to reduce neonatal mortality from 24 to fewer than 12 deaths per 1,000 live births by 2030. In 2020, only five neonatologists, including expatriates, were available nationwide. To fill this gap, the MSc Neonatology subspecialty program was established at Muhimbili University of Health and Allied Sciences in 2021. This study describes the processes and investment involved in establishing neonatal subspecialty training in Tanzania and examines short-term achievements.

A retrospective review of documents related to the program's development, implementation, and evaluation was conducted. Curriculum development and implementation were funded by The Else Kröner-Fresenius-Stiftung through the German Society of Tropical Pediatrics and International Child Health. The curriculum was developed using Kern's six-step model, with input from national stakeholders and neonatology experts, and aligned with African neonatal subspecialty training standards. The program was accredited by the Tanzania Commission for Universities in April 2021, with the first cohort enrolling in October 2021. Program evaluation was conducted by an independent assessor using Organization for Economic Co-operation and Development/Development Assistance Committee (OECD/DAC) standards, drawing on quantitative and qualitative data from multiple stakeholders.

By December 2024, eight fellows had enrolled in the program. Five had graduated, and two more completed their training in 2025. All graduates returned to their base hospitals, increasing the number of neonatologists by 50% and raising the total from five (40% local) to fourteen (92.9% local) across nine hospitals, expanding coverage to five of 31 regions. Fellows gained advanced clinical competencies, strengthened research skills, and contributed to mentorship and capacity building. Coinciding with program implementation, a 2.7% reduction in neonatal deaths was observed at MNH, although causality cannot be inferred.

The program has strengthened Tanzania's neonatal workforce, clinical expertise, and research capacity. It has improved access to evidence-based newborn care and highlights the value of collaborative, in-country, context-specific training. Ongoing evaluation of neonatal outcomes is essential to assess long-term effectiveness and scalability in resource-limited settings.