Evaluating and Improving the Implementation of Tanzania’s National Neonatal Care Guideline: A Mixed-Methods, Multilevel Study Protocol Using the Consolidated Framework for Implementation Research

This mixed-methods implementation science study aims to evaluate and improve the implementation of Tanzania's 2019 National Neonatal Care Guideline. Guided by the Consolidated Framework for Implementation Research (CFIR), the study will be conducted across three purposively selected public hospitals representing the tertiary, regional, and district levels of the Tanzanian healthcare system. Phase 1 involves a diagnostic evaluation using healthcare worker surveys, clinical observations, facility audits, in-depth interviews, and focus group discussions to assess current guideline adherence and identify multilevel barriers and facilitators. Phase 2 employs a participatory co-design process, including stakeholder workshops and CFIR-ERIC matching, to develop context-specific implementation strategies tailored to each hospital level. Phase 3 pilots these strategies over 12 months and evaluates their feasibility, acceptability, and preliminary effectiveness using a Theory of Change approach. The findings will inform evidence-based recommendations for improving neonatal care quality and outcomes in Tanzania and similar low-resource settings.