News | Lancet Global Health Paper on Costs of Neonatal Care in 4 countries with NEST360  

NEST360 launches new findings on costs of neonatal care in Lancet Global Health  

This analysis is based on the largest published neonatal economic dataset covering real-world implementation from 650,000 newborns, 65 neonatal units, in four African countries: Kenya, Malawi, Nigeria, and Tanzania. Together, these countries account for nearly 40% of Africa’s neonatal deaths. There is a major gap in real-world costing data to inform neonatal care, and the NEST360 Alliance has worked together to address that gap. This paper includes authors from four of the NEST360 countries (Kenya, Malawi, Nigeria, and Tanzania) and is majority African and majority female. 

Every year in Africa 1 million babies die. Four years to the 2030 Sustainable Development Goals timeline, most African countries are off track to meet the global target of reducing newborn deaths to 12 per 1,000 live births. Yet most of these deaths could be prevented with Small and Sick Newborn Care as recommended by WHO, and that is the focus of the NEST360 Alliance.  

Since 2019, NEST360 Alliance has been implementing with Governments pragmatic interventions focused on improving inpatient hospital care through three tracks of systems strengthening: 

• Delivering a package of lifesaving technologies;  
• Establishing and maintaining an education ecosystem; and 
• Enabling locally-owned data to drive action to improve quality newborn care, increase investment, and change policy. 

We have real economic data from all tracks and covering both government and NEST360 investments.  

Results show cost per-baby admitted was fairly consistent across Malawi, Kenya and Tanzania, ranging from $69 to $150, but higher in low-volume facilities, notably in Nigeria. The annual incremental cost per district hospital in Malawi was low at $67,874, and across referral hospitals ranged from $133,949 in Kenya to $296,706 in Nigeria.

Scaling up high-quality Small and Sick Newborn Care: What does it cost and what’s next?

Our analysis provides new economic evidence that governments and partners can utilize for budgeting. Human resources, the backbone of neonatal care, accounts for at least half of the costs, and is all paid by governments, but needs to increase at least threefold to meet the recommended staffing ratios needed to provide quality care. Infrastructure spaces in most neonatal units are still small, and at most NEST360 sites, not much was previously spent on infrastructure. At least a nine-fold increase in infrastructure would be needed to meet governments’ own standards, provide higher-quality care to our babies, and enable families to be involved in care.

More economic evidence is still needed, especially on how costs relate to impact in terms of cost-effectiveness. Excitingly, NEST360 is working with the government on mortality evaluation and plans to share more news on this soon. Meanwhile, these findings and data provide unique insights into cost drivers and how countries and partners can use evidence to budget more and smarter to go faster on newborn survival across Africa.

What actions are we calling for?

In brief 

NEST360 launched a paper in Lancet Global Health measuring the costs of strengthening systems for Small & Sick Newborn Care (SSNC) in four African countries – Malawi nationally and subnationally in Kenya, Nigeria, and Tanzania. 

This incremental costing analysis is based on the largest published neonatal economic dataset covering real-world implementation from 650,000 newborns, 65 neonatal units, in four African countries, Kenya, Malawi, Nigeria, and Tanzania, that together account for nearly 40% of Africa’s neonatal deaths. 

The top findings are  

• Cost per-baby admitted was fairly consistent across Malawi, Kenya and Tanzania, ranging from $69 to $150, but higher in low-volume facilities, notably in Nigeria.  
• Cost hospital per year was lowest in Malawi hospitals, and across referral hospitals ranged from $133,949 in Kenya to $296,706 in Nigeria    
• The biggest running cost driver was human resources, all paid by the government, but more investments are needed for higher numbers and skills, especially of neonatal nurses 
• More money needs to be budgeted for systems change costs, notably consumables which are similar to the annualized costs of devices, but often left off budget plans 
• Data also costs and yet is fundamental to change and needs to be included in budgets both for data quality inputs and for data use, e.g., in dashboards and QI. 

Higher investments will be needed across Africa, especially as many newborn units currently operate in small rooms with few staff and limited equipment. Importantly, the return is high at ~ $12 for every $1 invested. Meanwhile, these data provide unique insights to inform better budgeting for better newborn care by both governments and partners.