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 wellbeing. There are limited data and no cur‑ rent World Health Organization (WHO) standards for staftobaby ratios in neonatal units in low and middleincome 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 governmentled quality improvement (QI) processes were implemented. Stafng data were col‑ lated from baseline HFA (Sept 2019–March 2021) and mid2023 HFAs, and quarterly QI processes. The unit of analysis was the neonatal unit with day and night staftobaby ratios calculated. Ratios were aggregated overall, by country, by hospital level, and by neonatal unit occupancy rates. Staf coverage and skillmix were also analysed for nurses, doctors, clinical ofcers, 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 wardspecifc nurses compared to 8 (12%) at baseline during the day. Between baseline and 2023 HFAs, median nursetobaby 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 neonatalunits had a doctor providing care, or oncall 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 num‑ ber of staf providing care. Neonatal survival in hospitals requires better staftobaby ratios and more skilled staf. To meet the projected shortfall in the health workforce, governments must invest in training more health workers for neonatal care.
AKU Student
no
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.,
Shabani, J.,
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.
Available at:
https://ecommons.aku.edu/eastafrica_fhs_mc_paediatr_child_health/608
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This work is licensed under a Creative Commons Attribution 4.0 International License.
Included in
Maternal, Child Health and Neonatal Nursing Commons, Pediatrics Commons, Public Health Commons