From MDGs experience to SDGs Actions: Insights from Tanzanian Nurses and Midwives.

Background: Nurses and midwives constitute the largest proportion of the health workforce and play a central role in achieving maternal and child health outcomes. During the Millennium Development Goals (MDGs) era, particularly MDGs 4 and 5, their engagement was considered essential. However, anecdotal evidence from low- and middle-income countries suggests that nurses and midwives were insufficiently involved in MDG-related planning and decision-making. This study explored the enabling and inhibiting factors influencing Tanzanian nurses' and midwives' participation in the implementation of MDGs 4 and 5, with the aim of identifying lessons to strengthen engagement during the Sustainable Development Goals (SDGs) era. Methods: A descriptive, holistic case study design was employed. Data were collected in 2017 from five hospitals in Tanzania (three public and two private) using surveys, focus group discussions, and semi-structured interviews. Participants included 66 clinical nurses and midwives and eight nursing and midwifery administrators. Quantitative data were analyzed descriptively, while qualitative data were analyzed using inductive content analysis to identify key themes related to awareness, participation, enablers, inhibitors, and future engagement. Results: Most participants reported awareness of the MDGs, primarily through mass media, workplace meetings, and colleagues. However, awareness was uneven across facilities, with notable gaps in some hospitals. Nurses' and midwives' participation in MDGs 4 and 5 was largely limited to routine clinical activities, such as patient education and record-keeping, rather than involvement in planning or decision-making processes. Major enablers included their professional knowledge, numerical dominance in the workforce, and close proximity to patients. Key barriers included heavy workloads, limited time, inadequate representation in policy forums, insufficient empowerment, and organizational and resource constraints. Despite these challenges, participants expressed strong willingness to engage more actively in future global health initiatives. Conclusion: Nurses and midwives in Tanzania played a largely indirect and constrained role in the implementation of MDGs 4 and 5, with participation primarily embedded in routine clinical practice rather than strategic decision-making. Strengthening leadership support, improving access to information, enhancing professional empowerment, and increasing involvement in policy and planning processes are critical to maximizing nurses' and midwives' contributions to the achievement of Sustainable Development Goal 3 and future global health agendas.