Landscape analysis of neonatal nursing in Zambia, after five years oftraining

Abstract

Background: Sub-Saharan Africa faces a critical shortage of trained neonatal nurses; hence, undermining progress toward the Every Newborn Action Plan target for district-level Level 2 neonatal care. Since 2021, Zambia has introduced two neonatal nursing programs (one-year post- Diploma; two-year Master’s) to build a competent workforce. Scale up of  raining remains suboptimal due to various challenges and neonatal mortality remains a leading cause of underfive deaths.
Objective: To describe Zambia’s neonatal nursing training outputs to date,  assess progress against national workforce targets, and identify system  gaps and pragmatic strategies to accelerate scale-up.
Approach: We synthesized program administrative data and cohort information from Lusaka College of Nursing and Midwifery (LUCON) and the University of Zambia (UNZA) and triangulated with  the Zambia Paediatric Workforce Training Plan (2020–2030). Descriptive summaries cover enrolment, graduation, deployment, and faculty/preceptorship capacity. 
Findings: National analysis estimated a need for 500 neonatal nurses, with a 2030 public-sector target of 250. Since 2021, 85 post-Diploma neonatal nurses have completed training, and 14 Master’s graduates have been produced; 31 post-Diploma nurses are currently in training (2025). Trainees are drawn from all provinces, but deployment is uneven, with 17.6% not yet deployed to designated neonatal units. Faculty and preceptorship deficits constrain scale up. LUCON currently meets tutor needs for a class of 40 but lacks 3 clinical instructors. Master’s trainees report limited supervised clinical time and delayed graduation due to research and mentorship gaps. Orientation standards are inconsistent compared with high-income benchmarks, and no  established posts for neonatal nurses in the public establishment weaken retention and motivation. 
Conclusions: Zambia has demonstrated early, scalable outputs in neonatal nurse training but  remains off-track to meet interim milestones of 120 nurses by 2025 and 250 by 2030. Implications for Practice and Policy: Priorities include: create funded establishment posts for neonatal  nurses; adopt a Clinical Nurse Educator (CNE) model to standardize orientation and bedside teaching; expand clinical instructor capacity and protected preceptorship time; provide  scholarships and fast-track pathways to complete master’s research; and optimize deployment to high-need facilities to close equity gaps.