Scaling Up Co-Created Clinical Guidelines: Processes, Experiences, and Lessons from Maternity Care in Urban Tanzania – The PartoMa Project

Abstract

Objective: Resource constraints limit the use of evidence-based clinical guidelines (CPGs). This study describes the adaptation and scale-up of a context-specific maternity care pocket guide, initially co-created in Zanzibar, to five urban health facilities in Dar es Salaam, Tanzania. Design: Participatory, iterative co-creation. Settings: Five government health facilities in Dar es Salaam (2021). Population: Maternity care providers, researchers, women and other stakeholders. Methods: A structured, flexible CPG adaptation model was applied, combining a mixed-methods situational analysis, review of global and national CPGs, and iterative feedback via focus groups and individual reviews until saturation. The guide was then pilot-tested and implemented. Main Outcome Measures: Co-creation process, PartoMa Pocket Guide and implementation strategy. Results: Two review cycles with 54 frontline providers, two external reviews (11 international experts and 10 Dar es Salaam Health Management Team members), and two consultation meetings with a 28-member core team. The process produced a 24-page infographic pocket guide of CPGs, covering routine care and common complications during childbirth, and a dissemination strategy including in-house, low-dose, high-frequency training. Using the Zanzibar guide streamlined adaptation, revealing notable consistency across resource-constrained settings. However, the process remained time- and resource-intensive, particularly when international scientific evidence was insufficient or failed to capture urban clinical complexities. Conclusions The PartoMa CPG adaptation model effectively contextualises and scales evidence-based CPGs in high-volume, resource-constrained urban settings. Global CPG developers should integrate end-user needs from the outset for more practical and cost-effective adaptations. Funding: Danida Fellowship Centre (DFC), Ministry of Foreign Affairs of Denmark (DFC project no. 18-08-KU).

Authors 20

1. Natasha Housseine corresponding

   Aga Khan University

   Affiliation as printed

   The Aga Khan University Medical College East Africa - Dar es Salaam Campus

2. Haika Osaki

   University of Copenhagen

   Affiliation as printed

   Kobenhavns Universitet School of Global Health

3. Brenda Sequeira Dmello

   Aga Khan University

   Affiliation as printed

   The Aga Khan University Medical College East Africa - Dar es Salaam Campus

4. Luciana Chamwi

   Aga Khan University

   Affiliation as printed

   The Aga Khan University Medical College East Africa - Dar es Salaam Campus

5. Monica Lauridsen Kujabi

   University of Copenhagen

   Affiliation as printed

   Kobenhavns Universitet School of Global Health

6. Rukia Juma Msumi

   Muhimbili University of Health and Allied Sciences

   Affiliation as printed

   Muhimbili University of Health and Allied Sciences

7. Zainab Muniro

   Muhimbili University of Health and Allied Sciences

   Affiliation as printed

   Muhimbili University of Health and Allied Sciences

8. Joyce Lema

   Muhimbili University of Health and Allied Sciences

   Affiliation as printed

   Muhimbili University of Health and Allied Sciences School of Medicine

9. Ester Hyera

   Muhimbili University of Health and Allied Sciences

   Affiliation as printed

   Muhimbili University of Health and Allied Sciences

10. Beauty Mwambebule

    Muhimbili University of Health and Allied Sciences

    Affiliation as printed

    Muhimbili University of Health and Allied Sciences School of Medicine

11. Christina Mwandalima

    Muhimbili University of Health and Allied Sciences

    Affiliation as printed

    Muhimbili University of Health and Allied Sciences

12. Columba Mbekenga

    Hubert Kairuki Memorial University

    Affiliation as printed

    Hubert Kairuki Memorial University

13. Eunice Pallangyo

    Aga Khan University

    Affiliation as printed

    The Aga Khan University School of Nursing and Midwifery East Africa Dar es Salaam

14. Thomas van den Akker Aachen

    Leiden University Medical Center

    Affiliation as printed

    Leids Universitair Medisch Centrum

15. Jos van Roosmalen Aachen

    Leiden University Medical Center

    Affiliation as printed

    Leids Universitair Medisch Centrum

16. Morten Skovdal

    University of Copenhagen

    Affiliation as printed

    Kobenhavns Universitet School of Global Health

17. Dan Wolf Meyrowitsch

    University of Copenhagen

    Affiliation as printed

    Kobenhavns Universitet School of Global Health

18. Hussein L. Kidanto

    Aga Khan University

    Affiliation as printed

    The Aga Khan University Medical College East Africa - Dar es Salaam Campus

19. Tarek Meguid

    University of Cape Town

    Affiliation as printed

    University of Cape Town Department of Paediatrics and Child Health

20. Nanna Maaløe

    University of Copenhagen

    Affiliation as printed

    Kobenhavns Universitet School of Global Health