Executive Summary

Neonatal conditions are the leading cause of death in low-income countries and the leading cause of lost years of life across sub-Saharan Africa. A baby born in Africa faces around ten times the risk of neonatal death compared to a baby born in Europe or the US. Indeed, Africa is the continent with the highest neonatal mortality rates and the slowest progress to reduce neonatal mortality.

Every year, 1.1 million African newborns die. Most of these deaths could be prevented if front-line hospitals in every single district could provide quality care to small and sick newborns. Together, we can and must make this possible.

NEST360: Newborn Essential Solutions & Technologies: Under the leadership of African governments, the NEST360 alliance co-designed and supported implementation of a package of care to improve newborn survival in district hospitals, including:

• Delivering and maintaining a bundle of rugged, effective devices for newborn care;

• Educating clinicians and biomedical technicians to use and maintain devices;

• Implementing evidence-based care for small and sick newborns using locally owned dashboards to track and improve quality of care; and

• Catalyzing country-led change and investment to strengthen newborn care and technology management policies to promote equitable scaling and sustainability.

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Accomplishments

In Phase 1, NEST360 implemented the NEST360 package for ~90,000 babies annually admitted to the newborn wards at a learning network of 67 hospitals (of 43 originally targeted) across Malawi, Tanzania, Kenya, and Nigeria. Despite delays and challenges of implementing during COVID, NEST360 countries made remarkable progress. In Malawi, clinicians are using the NEST360 package to care for small and sick newborns at hospitals in every district of the country. The Federal MOH in Nigeria activated the National Newborn Technical Working Group and established critical newborn federal and state guidelines, standards, costed strategic plans, and pre-service and in-service educational materials. The innovative online educational and mentoring strategies introduced by NEST360 in Kenya reached nearly four times the number of originally targeted practicing clinicians and biomedical technicians across the country. In Tanzania, the NEST360 package was implemented at seven hospitals; the Tanzania Ministry of Health has committed to national scale of the NEST360 package, providing an initial investment of US$17 million for infrastructure, devices, and human resources.

With UNICEF, we developed Target Product Profiles for high-quality newborn technologies that meet the needs of African hospitals. We identified commercial devices meeting these requirements and built a global distribution network to deliver more than 2,000 qualified newborn care devices with >99% up time.

Our multi-country team created open-source NEST360 educational resources to support hands-on clinical and biomedical instruction for newborn care products. Resources are integrated into nationally approved training courses for clinicians and biomedical technicians and incorporated into university training programs for nurses and biomedical technicians in Malawi, Tanzania, Kenya, and Nigeria. Codeveloped data tools and dashboards are available open-source and used by governments. The NEST / UNICEF Implementation Toolkit is reaching across Africa and beyond to share tools and learnings.

COVID-19 Response

COVID-19 has significantly impacted global efforts to reduce newborn mortality in low- and middle-income countries; a recent study confirmed anecdotal evidence of a decrease in the number of institutional births during the lockdown and an increase in both numbers of stillborn births and the institutional neonatal mortality rate. The pandemic underscores the importance of strengthening all health systems to provide critical care, including that needed by small and sick newborns, and developing a sustainable supply chain for affordable, robust medical technologies. NEST360 remains committed to its core goals for neonatal survival in sub-Saharan Africa, but is now also leveraging its platform for COVID-19 preparedness and response, including supply chains and trainings for PPE and infection control and invention education to strengthen local innovation in Africa to address the pandemic. As noted by the former President of Malawi during his June 2020 visit to the NEST innovation design studio at Malawi University of Science and Technology, “This crisis has proven that we can become a self-dependent nation, capable of producing technologies that can lead in the world.”

Racial and Ethnic Injustice Response

We recognize the wide-ranging and lasting effects of colonialism in Africa, including how global health and development efforts have historically been implemented. We have sought to practice “respectful global health” by engaging local African partners from the outset. The NEST360 partnership is based on shared ownership, leadership, design, implementation, and responsibility.

We are also committed to learning from and developing the next generation of African innovators who will develop solutions for future global health challenges.