Nurses and doctors perspectives on emergency and critical care at primary health care facilities in Kilimanjaro, Tanzania

IntroductionEmergency and critical care (ECC) services are essential to preventable death, yet they remain poorly developed in primary healthcare (PHC) settings in low-resource countries such as Tanzania. There is a critical gap in understanding the experiences of frontline healthcare workers providing ECC to critically ill patients of all ages in these contexts. This study aimed to: (1) describe the experiences of nurses and doctors in delivering ECC in Tanzania PHC primary facilities; (2) explore systemic and resource challenges; and (3) document their perspectives on essential improvements for service delivery. MethodsA qualitative phenomenological study was conducted in 2021 across three PHC facilities in Kilimanjaro, Tanzania. Purposive sampling was used to recruit 12 healthcare workers. Semi-structured, in-depth interviews were conducted, and data were analyzed using thematic analysis. ResultsThe analysis revealed three overarching themes: (1) a constrained ecosystem of care; (2) navigating clinical uncertainty and systemic failure; and (3) the human cost of systemic failure. Participants prescribed a straightforward solution: a multi-level strategy requiring government-led investment in infrastructure, holistic training, and updated policies in a second-order theme (A Frontline Blueprint for Change: Advocacy and Proposed Solutions). ConclusionTanzanian PHC workers work in resource-scarce settings that hinder care and cause preventable deaths. Their perspectives on ECC can help implement ECC practices aligned with the 2023-2026 national plan. Supporting ECC at the primary level improves patient outcomes and empowers frontline workers. Key MessagesO_ST_ABSWhat is already known on this topicC_ST_ABSPrevious studies highlight PHC facing the weakest investment in ECC infrastructure and resources in Tanzania, mainly quantifying material deficits rather than understanding frontliners daily experiences of navigating systemic failures. What this study addsThis qualitative study provides a deep analysis of the profound human and systemic consequences of ECC resource scarcity, showing how it causes moral distress among providers and preventable patient harm. Significantly, it moves beyond problem identification to offer a participant-derived "Frontline Blueprint for Change," outlining specific, actionable solutions for strengthening ECC at the PHC level. How this study might affect research, practice or policyThe findings offer concrete evidence to support Tanzanias 2023-2026 National Strategic Plan for Essential ECC. For policymakers and health administrators, this study provides a practical roadmap for targeted investment in infrastructure, equipment, and training, promoting a systemic shift for PHC facilities to deliver effective initial ECC.