Date of Award


Degree Name

Doctor of Philosophy (College of Nursing)

Schools and Centres

Nursing and Midwifery

First Supervisor

Adjunct Associate Professor Elaine Bennett

Second Supervisor

Professor Selma Alliex


In 2000, the United Nations (UN) developed the Millennium Development Goals (MDGs) as an international framework to address poverty, promote sustainable development, and improve global health. The framework was translated into 8 goals with goals 4 and 5 targeting the reduction of child mortality and the improvement of maternal health. The UN and the World Health Organization (WHO) encouraged nurses and midwives to participate in the implementation process of the MDGs, and each country had the responsibility of formulating its own implementation policies and plans. The encouragement to participate was from the understanding that nurses and midwives are the backbone of the health care system. In South Africa, for example, nurses in the public sector make 60% of the total health care workforce and are responsible for serving up to 82% of the South African population; and globally, nurses and midwives make about half of the workforce in the health care industry. Nurses and midwives are also part of the global network of the health care professionals, and therefore their frontline involvement in the implementation of health-related goals would be essential if those goals were to be attained. Maternal and child mortality and morbidity rates, whilst declining in developed countries, have been slower to reduce in developing countries such as Tanzania, especially regarding various health determining factors that disadvantage women.

The aim of this study was to investigate and describe factors that enabled or inhibited the participation of Tanzanian nurses and midwives in the implementing of MDGs 4/5, including the call from the UN and WHO to support Tanzanian nurses and midwives in the strategies to implement those goals. The study was taken with view that since nurses and midwives would be instrumental in participating in the Sustainable Development Goals (SDGs), it would therefore be important to investigate their awareness and participation in the MDGs to see if there are lessons to be learnt in that would lead to developing strategies for actions targeting improved participation in future health goals.

The study used the case study design, and data were collected by using survey, interviews, and focus group discussions from five hospitals in Tanzania. Three of the five hospitals involved in the study were public hospitals, and two were private hospitals. Closed-ended data were analysed by using descriptive analysis, while open-responses were analysed by using Inductive Content Analysis. The study results were presented in five phases in relation xx to the research questions, and each phase of data presentation was built on the previous phase to ensure consistency and logical flow of the study findings. This study has proposed the framework for future nursing and midwives’ participation in the achievement of future health care goals. The framework was developed from analysing the Tanzanian cultural context, and participant’s awareness in the implementation of the MDGs 4 & 5. The Framework, therefore proposes strategies for improved participation in future national or global health care goals. The conclusion in the study encourages the nursing and midwifery leadership in Tanzania, including the National Nursing and Midwifery Associations to play a leading role in mobilising their members to take a leading role in optimising the Tanzanian public health, and a leading role in the implementation processes of the current SDGs and future national and global health goals.

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