Bridging the Survival Gap: Strengthening Post-Discharge Care for Preterm Infants in Tanzania.

Background: Despite notable progress in inpatient neonatal care expansion in Tanzania, expanding from 14 facilities in 2018 to 362 by 2025, a critical survival gap persists during the post-discharge transition. National policies heavily prioritize pre-discharge mortality, leaving the high-risk, 60-day post-discharge window unaddressed. This study evaluates targeted policy, financing, and digital health interventions designed to mitigate post-discharge neonatal mortality. Methods: We analyzed integrated implementation pathways within the Tanzanian health sector, specifically examining the institutional feasibility, scaling capacity, and clinical outcomes of the NEST360 Implementation Tracker (NEST-IT) and the Essential Coaching for Every Mother Tanzania (ECEM-TZ) mobile health framework. Results: Implementation data demonstrate that NEST-IT is a highly viable data-surveillance tool, achieving a 93% feasibility rate for daily clinical use and providing real-time data to drive national quality improvement targets. Concurrently, the ECEM-TZ digital platform effectively circumvents nurse-midwife resource limitations by providing a 54-message educational framework that improves caregiver knowledge and triples postnatal check-up attendance. Conclusion: Eliminating post-discharge mortality requires expanding longitudinal care frameworks. To achieve Tanzania's national target of 15 neonatal deaths per 1000 live births, strategic imperatives must include institutionalizing zero-rated mHealth tools, formalizing community health worker follow-up protocols, and explicitly integrating specialized outpatient neonatal services into the standard benefit package of the 2026 universal health insurance rollout.