Celebrating NEST360 Phase 1

Written by: Carrie Noxon

Here we are in 2024, and while NEST360 teams continue to build on activities started in Phase 1, it is a great time to look at all we have accomplished thus far through the combined individual contributions of our vast team.

Only seven years ago, NEST360 came away from the 2017 MacArthur 100 & Change competition as a runner-up. While the $15M award was far too short of the bold $100M grand prize we sought, it ultimately set NEST360 on a better path than we could have imagined at the time. That loss strengthened the resolve of NEST360’s founding alliance members, a dedicated and passionate group of engineers, clinicians, researchers, and device manufacturers. These members of NEST360 regrouped, added partner organizations, and secured the support of a robust coalition of foundations, and, within a year, raised the balance of funding needed to save lives and improve newborn care in Africa. With that funding and six partners in the alliance — in 2019, NEST360 Phase 1 officially began.

During Phase 1, the partnership exceeded expectations in each pillar of NEST360 (innovation, education, and implementing data-driven change) and improved care for small and sick newborns in sub-Saharan Africa’s hospitals in targeted countries. Our Phase 1 accomplishments are summarized below and represent years of collective hard work and dedication by the governments of participating NEST360 countries, in-country collaborators, and the people of NEST360.

Phase 1 accomplishments:

  • 15 Target Product Profiles for Neonatal Care Equipment were created and made available by NEST360 | UNICEF
  • 23 medical devices achieved NEST360 qualification
  • 4 innovative technologies for neonatal care were developed and made commercially available
  • 3,381 medical devices were delivered to hospitals in sub-Saharan Africa
  • 99% up-time was maintained for the NEST360-qualified devices
  • 90% up-time was maintained for all newborn care devices in NEST360 facilities
  • 49 skills labs were established in the 4 NEST360 countries
  • 14,442 clinicians were trained using NEST360 training materials
  • 1,858 biomedical technicians were trained on maintaining equipment by NEST360
  • 115,000 training videos were downloaded
  • data to drive quality has been gathered at facilities and converted into action
  • 10 publications of learnings in the NEST360 Supplement for BMC Pediatrics
  • 138,448 downloads of our NEST360 education global public goods
  • Four countries implementing with NEST360 have added NEST360 education content to their national medical training
  • Launch of the Implementation Toolkit, with comprehensive set of resources for scaling newborn care

Most importantly, lives have been saved.

“I gave birth to twins at another hospital, and the babies were struggling with rapid breathing. We were transferred to University College Hospital (UCH), and things improved after the twins were placed on a CPAP machine. Their breathing became normal again, and my joy was restored. I am so grateful that this technology helped with their survival and am so thankful to all the staff involved who were able to make me a happy mother of two.”

-A mother who had twins at University College Hospital in Lagos, Nigeria

When considering all NEST360 has achieved in Phase 1, it is remarkable to think back to the various, complementary scopes of work that were the beginnings of NEST360. At its core, the driving principle behind every effort was to give every newborn everywhere the same chance at lifesaving care – a principle that carries through the work of NEST360 today. Those who set the foundations of NEST360 with the 100&Change proposal dared to dream bigger than one device in one hospital in one country.

Back row: Pelham Keahey, Robert Miros, Dr. Robert Murphy, Honorati Masanja, Theresa Mkandawire, Maria Oden, Wale Coker, Front row: Elizabeth Molyneux, Aba Asibom, Queen Dube, Joy Lawn, Kara Palamountain, Karen Turney, Rebecca Richards-Kortum

In a 2019 article on Pumani, Rebecca Richards-Kortum spoke on behalf of the team when she noted, “There’s more work to be done. We know for CPAP to have its full potential it needs to be introduced as part of a quality program that focuses on improving essential newborn care.”

Knowing this, the early NEST360 partners created a plan to reduce neonatal mortality in sub-Saharan Africa by 50% through systemwide, evidence-based changes. These changes would need to be made in multiple areas including newborn care policy, development of the right equipment at the right price, maintenance of that equipment to end equipment graveyards, training for clinicians and nurses, and capturing data for actionable change at the facility-level.

This plan is being done by supporting a health systems package in hospitals that provides lifesaving care to help meet ENAP coverage target 4 of 80% of districts having at least one Level 2 in-patient unit, with respiratory support, for small and sick newborn care through sustainable change. NEST360’s impact in Phase 1 reached four countries and 67 hospitals, with 600,000 deliveries and 90,000 admissions annually in the newborn units.

The story of NEST360 Phase 1 is also one of growth and perseverance. Even when the global pandemic slowed the world down in 2020, the dedicated people of NEST360 did not stop progress toward improving neonatal survival through systemwide improvements to hospital-based care across the NEST360 Phase 1 countries – Malawi, Nigeria, Tanzania, and Kenya. When equipment stopped shipping, supplies were hard to come by everywhere, and travel ceased, NEST360 was determined to maintain momentum for newborn care by drawing from its collective strengths and reaching out to governments and other partners.

With the support of governments and coordination with hospital partners, during the global pandemic, NEST360 helped establish remote training options for neonatal care education. The hospitals and design studios coordinated on PPE manufacturing. Data and quality improvement teams continued data gathering and finding the best way to continue mentoring and learning about the needs at facilities. Hatch Technologies, 3rd Stone Design, and others worked on solutions to supply chain challenges. As NEST360 worked alongside governments and partners, relationships were made stronger.

These are just some examples where the determination of the people of NEST360 has made the difference in improving small and sick newborn care.

Phase 1 successes are proof of what NEST360 can accomplish. By witnessing those successes, our funders expressed their continued confidence in the people and principles of NEST360 by giving us the means to continue into Phase 2. From an initial six partnering organizations who came together for 100&Change (Rice University, 3rd Stone Design, Northwestern, London School of Hygeine & Tropical Medicine, MUBAS, and KUHeS), NEST360 grew to 13 partners by 2018. And, now, in 2024, as we enter Phase 2, we are an alliance of 22 partnering organizations committed to building on the solid foundations of the Phase 1 accomplishments.

In closing out Phase 1, we recognize with deep gratitude the combined effort and achievements of our team that have provided us the opportunity to keep moving forward to the goal of giving every newborn everywhere the same chance at life.