Nest360: Scaling Collaboration in Newborn Care
In December 2020, the Pumani bubbleCPAP was recognized by the Million Lives Collective for its impact on 1 million babies. Pumani filled a gap for CPAP devices suitable for neonatal wards in low- and middle-income settings. The experiences of implementing Pumani led to a comprehensive approach to newborn care that encompasses more than a single medical device. It inspired an international alliance to scale solutions like the bundle of newborn technologies to end preventable newborn deaths.
Ninety-eight percent of neonatal deaths occur in low- and middle-income countries. In sub-Saharan Africa alone, most births are in hospitals, yet nearly one million newborns die annually. Providing access to quality care in hospitals can greatly reduce the number of deaths of small and sick newborns.
As part of the Sustainable Development Goals, countries across the world are working to end preventable deaths of newborns and children, including aiming to reduce neonatal mortality below 12 per 1,000 live births by the year 2030. To help meet this goal, WHO and UNICEF developed the Every Newborn Action Plan (ENAP), which calls for 80% of districts to have at least one hospital that provides Level 2 in-patient newborn care, including respiratory support with CPAP. Level 2 neonatal care combines the skills of clinicians and nurses with the life-saving technologies needed to prevent and treat conditions such as respiratory distress, jaundice, hypothermia, and infection in small and sick newborns.
To help meet this ENAP target, an alliance called NEST360 (Newborn Essential Solutions and Technologies) is working with governments in Malawi, Kenya, Tanzania, and Nigeria to establish and strengthen Level 2 newborn care units and to build a movement around scaling innovations in newborn care. NEST is a team of engineers, clinicians, distribution specialists, and quality improvement experts from 15 organizations, 10 of which are based in Africa. NEST partners with country governments to deliver a bundle of life-saving technologies to help strengthen the capacity of clinicians and biomedical technicians, build robust monitoring and quality improvement programs, and develop an investment case for small and sick newborn care.
To identify a bundle of technologies to support Level 2 care, NEST worked with UNICEF to establish Target Product Profiles (TPPs) that call out specifications for life-saving newborn technologies, including being effective, affordable, and simple to use. NEST developed a program to test and evaluate whether commercially available devices for newborn care meet these TPPs, based on their suitability for use in hospitals in low-resource settings. Products such as CPAP machines and oxygen concentrators to treat respiratory distress, phototherapy lights to treat jaundice, point-of-care diagnostic devices, thermal management technologies, hydration and nutrition support devices from a variety of vendors have been evaluated for inclusion as part of NEST360 Qualified Technologies.
NEST qualified technologies include the Pumani bubbleCPAP: a CPAP model which was recognized by the Million Lives Collective in 2020 in the Voyager category (highlighting innovations on a pathway to impact one million clients within 18 months). Also included in the list of NEST qualified technologies is Brilliance, a phototherapy light pioneered by Equalize Health that received the Million Lives Collective Vanguard recognition for treating millions of babies with jaundice in low- and middle-income settings.
To ensure that these technologies are available in hospitals in low-resource settings, NEST also worked to establish Hatch Technologies, a nonprofit global distribution organization that focuses on ensuring that medical devices are installed in newborn care units throughout sub-Saharan Africa. Hatch works with international manufacturers and local distributors to deliver technologies to hospitals and install them in newborn units. In addition, the Hatch team provides support services on these devices, which includes monitoring the equipment to ensure it is used, stocked, and maintained regularly.
In addition to newborn care technologies, NEST360 is developing educational materials to supplement country-led training of student clinical and technical health professionals and continuing education training courses for current healthcare workers. These publicly available resources include clinical and technical training modules, scenarios, device job aids, and training videos.
NEST360 is also helping countries to develop biomedical engineering technician courses that incorporate the NEST training materials. These courses involve hands-on, skills-based training intended to provide additional resources for governments to use in training technical personnel to troubleshoot and maintain neonatal equipment, such as the Pumani, at hospitals.
Providing quality small and sick newborn care before the year 2030 requires a multi-faceted system of support for neonatal care units in low- and middle-income countries. NEST360 offers assistance and support to governments in their efforts to improve neonatal care units, deploy neonatal technologies, and train personnel on best practices for newborn healthcare. What began with Pumani to fill a gap in respiratory support devices has developed into a collaborative movement focused on providing resources for governments as they establish neonatal care units in their local hospital systems and improve newborn care as part of their efforts to meet SDG 3.2.
