To reach the Sustainable Development Goals 3.1 to 3.4 for maternal, newborn, and child health, effective and cost-effective interventions are required. The Safer Births Bundle of Care (SBBC) intervention aims to improve the quality of intra- and postpartum care. The SBBC Phase I implementation was conducted in 30 health facilities in Tanzania between 2021 and 2023. Outcome data show a significant decrease in perinatal and maternal mortality. This study presents the costs of the SBBC Phase I, and a cost-effectiveness analysis, where the cost per life saved, per life year gained, and per disability-adjusted life year (DALY) averted, and the benefit–cost ratio (BCR) were estimated.

Methods Outcome data were based on the estimated number of newborn and maternal lives saved during the project. Cost data were collected retrospectively at the accounting centre at Haydom Lutheran Hospital.

Results The total cost for implementing SBBC Phase I was 4,491,204 USD. The cost per life saved was 4,669 USD, per life year gained 80 USD, and per DALY averted 144 USD, and the BCR was 36.

Conclusion The analysis of SBBC Phase I showed that it was highly cost-effective by World Health Organization standards. An economic evaluation of SBBC Phase II will provide information about its sustainability and feasibility for further scaling up.

Funding The study was supported by a Global Financing Facility (World Bank Group) innovation-to-scale award administered by UNICEF Tanzania.

The authors have declared no competing interest.

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I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Ethical considerations The SBBC Phase I project has received formal approval from the National Institute of Medical Research (NIMR) dated 26th February 2025 from a study with ethical clearance No. NIMR/HQ/R.8a/ Vol.IX/3458. The Joint BMC/CUHAS Directorate of Research and Innovations on 20th March 2025 granted the permission for publication of the Ref. No. BU/36/DRI/032/Vol I of the Certificate No. CREC/832/2024. Local permission to use the costs and outcome data was sought and obtained from the Haydom Lutheran Hospital. No consent was sought from the study population as this study used outcome data as secondary data. However, data confidentiality was ensured.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

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I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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Data that might be requested by Editors are available without restrictions from the Research Center of Haydom Lutheran Hospital, Mbulu -Tanzania.