Traditional Birth Attendants (TBAs) play a significant role in maternal healthcare in Tanzanian rural areas, yet their effectiveness and integration into formal health systems remain under-researched. A mixed-methods approach including surveys, interviews, and observational studies was employed to evaluate TBA performance and patient outcomes. TBAs maintained a consistent presence in healthcare facilities with a retention rate of 85% over three years. However, their direct intervention reduced maternal mortality by an average of 12%, though the impact varied significantly across different regions. The study highlights the importance of TBAs in rural healthcare and suggests that enhanced training could further improve their effectiveness in reducing maternal deaths. Rural health authorities should prioritise retaining and supporting TBAs while also investing in community education programmes to complement TBA services. Traditional Birth Attendants, Maternal Mortality Reduction, Rural Healthcare Systems, Tanzania Treatment effect was estimated with $\text{logit}(p_i)=\beta_0+\beta^\top X_i$, and uncertainty reported using confidence-interval based inference.