Document Type
Article
Department
Paediatrics and Child Health (East Africa)
Abstract
Background Implementing small and sick newborn care (SSNC) requires skilled health workers; however, there is a shortage, adversely impacting patient outcomes and health worker well-being. There are limited data and no current World Health Organization (WHO) standards for staff-to-baby ratios in neonatal units in low- and middle-income countries (LMICs) to inform policy, planning, and investment.
Methods In 65 neonatal units (36 in Malawi, 13 in Kenya, 7 in Tanzania, and 9 in Nigeria), a health facility assessment (HFA) for SSNC and government-led quality improvement (QI) processes were implemented. Staffing data were collated from baseline HFA (Sept 2019–March 2021) and mid-2023 HFAs, and quarterly QI processes. The unit of analysis was the neonatal unit with day and night staff-to-baby ratios calculated. Ratios were aggregated overall, by country, by hospital level, and by neonatal unit occupancy rates. Staff coverage and skill-mix were also analysed for nurses, doctors, clinical officers, laboratory technicians, data clerks, biomedical technicians, and engineers.
Results For 65 neonatal units, the median time between baseline and 2023 HFAs was 31 months (Interquartile Range (IQR) 29–34 months). In 2023, only 3 (5%) neonatal units had zero neonatal ward-specific nurses compared to 8 (12%) at baseline during the day. Between baseline and 2023 HFAs, median nurse-to-baby ratios were 1:6 (IQR 1:3–1:11) during the day and 1:10 (IQR 1:6–1:17) at night, with consistency over time. At baseline, only one third of neonatal units had a doctor providing care, or on-call coverage, at all times of day and night (n = 20, 31%), and half of hospitals lacked 24 h laboratory coverage (n = 25, 45%) with no change over time. There were improvements in neonatal data clerk (n = 32, 49% to n = 58, 89%) and biomedical technician (n = 45, 69% to n = 56, 86%) coverage between baseline and 2023 HFAs.
Discussion Evaluation revealed variability by country and hospital level, and important shortfalls remain in the number of staff providing care. Neonatal survival in hospitals requires better staff-to-baby ratios and more skilled staff. To meet the projected shortfall in the health workforce, governments must invest in training more health workers for neonatal care.
Publication (Name of Journal)
Human resources for health
DOI
https://doi.org/10.1186/s12960-025-01031-1
Recommended Citation
Penzias, R.,
Ohuma, E.,
Odedere, O.,
Dosunmu, O.,
Okello, G.,
Mwaniki, H.,
Tillya, R.,
Ochieng, V.,
Rashid, E.,
Macharia, W.
(2025). Neonatal unit human resources: Coverage for six cadres and trends for staff-to-baby ratios in 65 neonatal units implementing with NEST360 in Kenya, Malawi, Nigeria, and Tanzania. Human resources for health, 23(64), 1-14.
Available at:
https://ecommons.aku.edu/eastafrica_fhs_mc_paediatr_child_health/605
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.