A Child Is Born

“Now I’m doing well, and my baby is doing well,” says Paskalina Qawock (35).

She looks down at the baby nestled in her arm. Just a few hours ago, she gave birth to her sixth child, a little girl named Angelina.

It all began without complications the day before, but it could have ended tragically. When labor started, she was at home, about ten kilometers from this hospital: the longtime partner of NCA, Haydom Lutheran Hospital in the Manyara region of Tanzania. The hospital is a six-hour drive from the nearest major city, Arusha. Many people travel far to get here.

Paskalina arrived like many others: in the backseat of a three-wheeled motorcycle. For the first time, her husband came along. In previous births, it was her mother-in-law who accompanied her, as her husband drank heavily. Now he has stopped drinking entirely. He has started going to church, singing in the choir, and spends time with the family, Paskalina says.

Everything went well — until just after birth.

“Urgent!”

After birth, Paskalina began to bleed heavily — a postpartum hemorrhage. This is a life-threatening complication and one of the leading causes of maternal death worldwide, especially in poorer countries.

Fortunately, Paskalina was at Haydom Lutheran Hospital, founded by Norwegian missionaries in 1955 and supported by Norwegian Church Aid for many years.

“When a woman starts bleeding heavily after the placenta is delivered, it’s extremely urgent,” says midwife Sabina Mmao, who is with Paskalina today.

“Here at Haydom, we know that. We shout: ‘Urgent! PPH!’ (postpartum hemorrhage). People rush into the room to help. Everyone brings what is needed and takes on roles,” she explains.

“We administer a combination of three medications when such bleeding occurs. While giving the medications, we try to locate the source of the bleeding to stop it,” says the midwife.

Saving lives

This expertise is the result of systematic work over years, led by Haydom Lutheran Hospital through a research program.

The results have gained international attention: Between 2021 and 2023, maternal deaths were reduced by 75% and newborn deaths by 40% at 30 health facilities in the five regions where the program was implemented.

The findings were published in 2025 in one of the world’s most prestigious medical journals, the New England Journal of Medicine. The Safer Births Bundle of Care program is a collaboration between Haydom Lutheran Hospital, Norwegian researchers, Norad, Laerdal Global Health, and Tanzanian authorities.

Lucky

It’s still less than a day since Paskalina gave birth. Although she’s tired, she’s doing well. “She’s very lucky to have given birth here,” says midwife Sabina Mmao.

All Paskalina’s children were born at Haydom, but the other births were uncomplicated. But giving birth is always unpredictable and when a woman have given births numerous times, the risk increases.

“We get good services here,” says the mother of six.

The same afternoon, she is discharged from the hospital. Her mother-in-law will accompany her home. With a big smile and her daughter in her arms, Paskalina climbs into the backseat of a three-wheeled motorcycle—just as she arrived before giving birth.

Millions die

Each year, around 300,000 women globally die due to pregnancy and childbirth. According to UNICEF, 2.3 million newborns die within their first month of life.

This is also a major issue in Tanzania. The Safer Births Bundle of Care (SBBC) program has improved treatment for the leading causes of these deaths. For mothers, it’s often postpartum hemorrhage; for babies, it’s usually lack of oxygen.

The success is a collection of training and clinical tools, a “bundle.” Effective technical equipment suited to Tanzanian conditions has been developed, and healthcare workers actively use data to improve. They frequently practice realistic scenarios. Additionally, the culture has shifted — mistakes are no longer met with blame but seen as learning opportunities.

Hospital director Paschal Mdoe describes years of work and research in collaboration with Norway’s Laerdal Global Health, culminating in the SBBC project, supported by Norad and the World Bank’s Global Financing Facility.

“This program is a low-cost initiative that can be implemented anywhere in the world and have a major impact. It equips healthcare workers with the skills to act correctly and at the right time,” says Mdoe.

New tools

Several innovative tools have helped save lives. One such tool is NeoBeat, a small device placed on the newborn’s abdomen to measure heart rate, allowing breathing assistance to begin quickly. Another is Moyo, a small device that monitors fetal heartbeat. Both are rechargeable. A device for providing breathing support to newborns has also been developed.

“We needed equipment suited to the conditions here — usable even with unreliable electricity and transport, and with too few staff,” Mdoe says.

“Most places, people own a mobile phone. Where you can charge a phone, you can also charge a Moyo or NeoBeat. And where there are healthcare workers, they can be trained to use this.”

No blame

“PPH!”

Someone shouts from a corner of the maternity ward. Blood pours onto the floor from a woman in labour. Things must happen quickly. The room is full of staff, each with a role.

Fortunately, this is an exercise. One of the staff members lies on the bed wearing MamaNatalie—a birthing simulator used for training. Artificial blood flows out. These kinds of drills happen frequently here. When it happens for real, like with Paskalina, staff should instinctively know what to do.

After the drill, there’s an evaluation of what went well and what didn’t.

“SBBC has helped staff move away from a culture of blame. If something goes wrong, we don’t blame each other. We continue practicing scenarios and learning,” says midwife Sabina Mmao.

Dr. Vickfarajaeli Zebedayo Daudi, clinic manager and pediatrician, emphasizes the importance of training.

“Knowledge is power. If you just start a program without follow-up and monitoring, it won’t last,” she says.

In its first phase, the program was implemented in 30 health facilities in five regions. The Tanzanian Ministry of Health participated in planning, and high-burden areas were selected in addition to this region. Now the program has expanded to 142 hospitals and health facilities in the same regions.

Born premature

In the neonatal intensive care unit, 20-year-old Theodora Nelson sits with her tiny son in her arms. The maternity and newborn wards have just moved into a brand-new building with modern equipment. Mothers sit together with their babies. The small bodies lie in tiny beds lined up in rows.

Theodora’s son is very small and barely opens his eyes. The boy, not yet named, was born prematurely at week 29, 11 weeks before his due date. He is her first child.

Theodora lives 55 kilometers away. She was referred to Haydom due to severe preeclampsia and arrived by ambulance with her mother. Upon arrival, she began experiencing pain, and the boy was born a month ago.

Dr. John Fissod, head of the pediatric department, says the boy was placed on a ventilator after birth.

“He initially weighed only one kilo and lost a lot of weight. He received IV fluids, and we placed breast milk on his lips,” he explains.

The boy developed a milk intolerance, but that changed, and they resumed feeding him breast milk via a machine. His weight is now increasing. Once he reaches 1.5 kilos, he will be discharged.

“I’m glad he’s gaining weight and getting better,” says Theodora, though her smile is faint.

Grateful

In another room, Marcelina Nangai (42) lies with her newborn daughter—her ninth child. The birth went well. Of all nine births, only this one and one other took place in a hospital. The rest occurred at home with help from a traditional birth attendant. All her births were uncomplicated, except once when labor was stalled and she was admitted to a hospital, where things went well.

“This time I wanted to go to the hospital because it’s my ninth child, and I was afraid I wasn’t as strong as before. Giving birth at home isn’t good if complications arise,” she says.

A woman she knows gave birth at home, had complications, and lost her baby.

“I’m very glad I could give birth here because I know I can get good help if something goes wrong,” she says.

Her oldest child is 21. She now has three boys and six girls. A neighbor accompanied her during the birth. She no longer has a husband — he died a few years ago. Now she gets help from her older children with the younger ones.

A hub

Just outside the hospital, there are only a few houses — then it’s countryside for miles. Yet Haydom Hospital has become a hub for research and exchange. Researchers, healthcare workers, and students from around the world come here to learn, teach, and work. A guesthouse accommodates visitors. The hospital is like a small village.

Hospital director Paschal Mdoe says the authorities hope to implement the SBBC program nationwide. Other countries also want to learn.

“We’ve had representatives from Malawi, Kenya, Uganda, and Zambia come here to learn,” he says.

Norwegian Church Aid is already leading a similar program in Nigeria.

“This program has had a tremendous impact. When a mother dies, it sets the family back. It affects the whole family,” says hospital director Mdoe, who is also a gynecologist.

“When I experience the death of a woman or child, it stays with me forever. Inside, I cry. If a healthcare worker can learn to save lives, they become motivated and fulfilled in their job. Many say: ‘Now I’m doing well. Now I know what to do. I know I can save lives.’”