Document Type



Paediatrics and Child Health (East Africa)


Background: Each year an estimated 2.3 million newborns die in the frst 28 days of life. Most of these deaths are pre‑ ventable, and high-quality neonatal care is fundamental for surviving and thriving. Service readiness is used to assess the capacity of hospitals to provide care, but current health facility assessment (HFA) tools do not fully evaluate inpa‑ tient small and sick newborn care (SSNC).

Methods: Health systems ingredients for SSNC were identifed from international guidelines, notably World Health Organization (WHO), and other standards for SSNC. Existing global and national service readiness tools were identifed and mapped against this ingredients list. A novel HFA tool was co-designed according to a priori considerations deter‑ mined by policymakers from four African governments, including that the HFA be completed in one day and assess readiness across the health system. The tool was reviewed by>150 global experts, and refned and operationalised in 64 hospitals in Kenya, Malawi, Nigeria, and Tanzania between September 2019 and March 2021.

Results: Eight hundred and sixty-six key health systems ingredients for service readiness for inpatient SSNC were identifed and mapped against four global and eight national tools measuring SSNC service readiness. Tools revealed major content gaps particularly for devices and consumables, care guidelines, and facility infrastructure, with a mean of 13.2% (n=866, range 2.2–34.4%) of ingredients included. Two tools covered 32.7% and 34.4% (n=866) of ingredi‑ ents and were used as inputs for the new HFA tool, which included ten modules organised by adapted WHO health system building blocks, including: infrastructure, pharmacy and laboratory, medical devices and supplies, biomedi‑ cal technician workshop, human resources, information systems, leadership and governance, family-centred care, and infection prevention and control. This HFA tool can be conducted at a hospital by seven assessors in one day and has been used in 64 hospitals in Kenya, Malawi, Nigeria, and Tanzania.

Conclusion: This HFA tool is available open-access to adapt for use to comprehensively measure service readiness for level-2 SSNC, including respiratory support. The resulting facility-level data enable comparable tracking for Every Newborn Action Plan coverage target four within and between countries, identifying facility and national-level health systems gaps for action.

Publication (Name of Journal)

BMC Pediatrics


Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.