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Background <p>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.</p> Methods <p>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.</p> Results <p>For 65 neonatal units, the median time between baseline and 2023 HFAs was 31&#xa0;months (Interquartile Range (IQR) 29–34&#xa0;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 (<i>n</i> = 20, 31%), and half of hospitals lacked 24&#xa0;h laboratory coverage (<i>n</i> = 25, 45%) with no change over time. There were improvements in neonatal data clerk (<i>n</i> = 32, 49% to <i>n</i> = 58, 89%) and biomedical technician (<i>n</i> = 45, 69% to <i>n</i> = 56, 86%) coverage between baseline and 2023 HFAs.</p> Discussion <p>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.</p>

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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

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  • 发表日期：

    2025年11月12日

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  • Rebecca E. Penzias,
  • Eric O. Ohuma,
  • Opeyemi Odedere,
  • Olabisi Dosunmu,
  • George Okello,
  • Hannah Mwaniki,
  • Robert Tillya,
  • Josephine Shabani,
  • Samuel K. Ngwala,
  • Evelyn Zimba,
  • Morris Ondieki Ogero,
  • Christine A. Bohne,
  • Olukemi Tongo,
  • Veronica Chinyere Ezeaka,
  • Vincent O. Ochieng,
  • Ekran Rashid,
  • William M. Macharia,
  • John Wainaina,
  • Irabi Kassim,
  • Donat Shamba,
  • Nahya Salim,
  • Grace T. Soko,
  • Msandeni Chiume,
  • Alice Tarus,
  • Edith Gicheha,
  • Julius Thomas,
  • Georgia Jenkins,
  • James H. Cross,
  • Rosemary Kamuyu,
  • Junwei Chen,
  • Simon Cousens,
  • Elizabeth M. Molyneux,
  • Maria Oden,
  • Rebecca Richards-Kortum,
  • Joy E. Lawn,
  • David Gathara,
  • Mbozu Sipalo,
  • Millicent Alooh,
  • Steve Adudans,
  • Dolphine Mochache,
  • Christina Mchoma,
  • Joseph Bilitinyu,
  • Pius Chalamanda,
  • Mirriam Dzinkambani,
  • Ruth Mhango,
  • Fanny Stevens,
  • Joseph Mulungu,
  • Blessings Makhumula,
  • Loveness Banda,
  • Charles Banda,
  • Brian Chumbi,
  • Chifundo Banda,
  • Evelyn Chimombo,
  • Nicodemus Nyasulu,
  • Innocent Ndau,
  • Pilirani Kumwembe,
  • Edna Kerubo,
  • Nyphry Ambuso,
  • Kevin Koech,
  • Noel Waithaka,
  • Calet Wakhungu,
  • Steven Otieno,
  • Felix Bahati,
  • Josphine Ayaga,
  • Jedida Obure,
  • Nellius Nderitu,
  • Violet Mtambo,
  • George Mkude,
  • Mustapha Miraji,
  • Caroline Shayo,
  • Camilius Nambombi,
  • Christopher Cyrilo,
  • Temilade Aderounmu,
  • Akingbehin Wakeel Wale,
  • Odeleye Victoria Yemisi,
  • Akinola Amudalat Dupe,
  • Samuel Awolowo,
  • A. Ojelabi Oluwaseun,
  • John Ajiwohwodoma Ovuoraye,
  • Balogun Adeleke Mujaid,
  • Adedoyin Fetuga,
  • Juilana Okanlawon,
  • Flora Awosika,
  • Awotayo Olasupo Michael,
  • Omotayo Adegboyega Abiodun

摘要

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.