Improving neonatal outcomes through system strengthening: Lessons from Level-2 Small and Sick Newborn Care (SSNC) Implementation in Afar Region, Ethiopia
1
Emory University, Addis Ababa, Ethiopia
2
Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, United States
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Afar region of Ethiopia faces high neonatal and under-five mortality rates at 33 and 93 per 1,000 live-births, respectively, driven by weak healthcare infrastructure, limited access to quality services, and sustained impacts of harsh environmental conditions, COVID-19, and internal conflict. For more than 2 million populations of the region, only 2 of the 9 hospitals provide level-2 Neonatal Intensive care Unit (NICU) services due to shortage of trained staff and infrastructure gaps. To address these, Emory University, in collaboration with UNICEF, MoH, and Regional Health Bureau, implemented health-system strengthening for Small and Sick-Newborn Care (SSNC) interventions, involving infrastructure renovation, provision of essential equipment, and training and mentorship at Dubti General Hospital and Ayisaita Primary Hospital. This study evaluated the intervention’s effect on neonatal outcomes.
METHODS:
This implementation-research was conducted at the two hospitals, with baseline data collected in 2020 on neonatal deaths and contributing factors, including poor quality of care, inadequate infrastructure, and limited provider skills. A 21-day NICU training for healthcare workers was followed by on-the-job training, six rounds of on-site clinical mentorship, and provision of essential devices. Monthly data on admissions, recoveries, deaths, and referrals were monitored, complemented by quarterly review meetings and learning sessions till December 2024.
RESULTS:
The recovery rate among NICU admissions improved from 63% to 89% at Dubti General Hospital and from 76% to 86% at Ayisaita Primary Hospital. The death rate decreased from 17.5% to 6% and 14% to 7%, respectively. Referral rates also decreased from 11% to 3% at Dubti, and 8% to 5% at Ayisaita hospitals (p<0.01). Challenges related to infection prevention facilities and blood supplies were the main contributors of deaths.
CONCLUSIONS:
Capacity-building, provision of essential equipment, and on-site clinical mentorship substantially improved NICU outcomes. Sustaining progress through internal mentorship and expanding the approach to additional hospitals is recommended.
Afar region of Ethiopia faces high neonatal and under-five mortality rates at 33 and 93 per 1,000 live-births, respectively, driven by weak healthcare infrastructure, limited access to quality services, and sustained impacts of harsh environmental conditions, COVID-19, and internal conflict. For more than 2 million populations of the region, only 2 of the 9 hospitals provide level-2 Neonatal Intensive care Unit (NICU) services due to shortage of trained staff and infrastructure gaps. To address these, Emory University, in collaboration with UNICEF, MoH, and Regional Health Bureau, implemented health-system strengthening for Small and Sick-Newborn Care (SSNC) interventions, involving infrastructure renovation, provision of essential equipment, and training and mentorship at Dubti General Hospital and Ayisaita Primary Hospital. This study evaluated the intervention’s effect on neonatal outcomes.
METHODS:
This implementation-research was conducted at the two hospitals, with baseline data collected in 2020 on neonatal deaths and contributing factors, including poor quality of care, inadequate infrastructure, and limited provider skills. A 21-day NICU training for healthcare workers was followed by on-the-job training, six rounds of on-site clinical mentorship, and provision of essential devices. Monthly data on admissions, recoveries, deaths, and referrals were monitored, complemented by quarterly review meetings and learning sessions till December 2024.
RESULTS:
The recovery rate among NICU admissions improved from 63% to 89% at Dubti General Hospital and from 76% to 86% at Ayisaita Primary Hospital. The death rate decreased from 17.5% to 6% and 14% to 7%, respectively. Referral rates also decreased from 11% to 3% at Dubti, and 8% to 5% at Ayisaita hospitals (p<0.01). Challenges related to infection prevention facilities and blood supplies were the main contributors of deaths.
CONCLUSIONS:
Capacity-building, provision of essential equipment, and on-site clinical mentorship substantially improved NICU outcomes. Sustaining progress through internal mentorship and expanding the approach to additional hospitals is recommended.
| eISSN: | 2654-1459 |
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