Current staffing landscape in neonatal units in Africa: Insights from the African Neonatal Network

Abstract

Background: Despite recommendations, healthcare workforce standards for neonatal units in low- and middle-income countries remain largely undefined.
Methods: Fourteen hospitals in the African Neonatal Network responded to an annual facility survey and a health facility survey co-developed by faculty in the African Neonatal Network and Vermont Oxford Network. All analyses use descriptive statistics.
Result: Most neonatologists/paediatricians (71%) were on call at home some of the time, with 21.4% available on call in the hospital. 
Most hospitals (71%) considered neonatal nursing a specialty. Nurses typically had specific patient assignments (93%), with nurse-to-patient ratios based on acuity (64%). The median number of full-time equivalent nurses was 16, with an average of 6 nurses on day shifts and 5 on night shifts. Respiratory support varied, with mechanical ventilation used most at nurse-to-patient ratios of 1:1 to 1:4 and 1:1, and 1:3 to 4 ratios (21%), and CPAP most commonly at a 1:3-4 ratio (43%). For stable, growing premature infants weighing over 1500 grams, 5 (36%) hospitals reported ratios of 1:3-4 while eight (57%) hospitals reported ratios of either 1:5-7 or 1:8-10. The median number of patients per nurse was 4 on weekdays, and 5 on nights and weekends. 
Conclusion: This study underscores the urgent need for standardized staffing guidelines tailored to the unique contexts of sub -Saharan African neonatal units. Addressing staffing inconsistencies and retention issues is essential to enhance the quality of neonatal care and improve health outcomes. Collaborative efforts are imperative to establish standardized workforce criteria,  ultimately promoting better health for newborns.