ESSENTIAL CARE, COMPLICATIONS MANAGEMENT, PERINATAL NETWORK

In line with WHO priorities on newborn survival and quality of care, these are the three main working areas around which the NEST Model is structured.

The NEST Model takes a gradual, step-by-step approach to address the complexity of newborn care. The first step is to ensure that preventive and nurturing care practices are fully embedded and established as the standard in everyday clinical practice. Only once these foundations are firmly in place can more advanced care strategies be introduced. The Paolo Chiesi Foundation is committed to supporting this transition by helping health systems manage infants with respiratory problems, asphyxia or jaundice.

In addition, a comprehensive approach to perinatal care must be adopted across every stage of the perinatal period, including pregnancy, childbirth and the postpartum period. Quality care and better newborn outcomes require close collaboration between midwifery (nursing), obstetric and neonatal teams. It is therefore essential to involve midwives and obstetric staff, both within the facility and beyond.

Setting up organized networks that include facilities at different levels of care is essential to establish effective mechanisms for transferring babies from one service to another, ensuring appropriate care for every newborn. Effective networks bring together all maternal and newborn health stakeholders, including local institutions, civil society organizations, professional associations and families, to promote health through a systemic approach. Promoting health during pregnancy and at birth reduces long-term adverse outcomes and improves quality of life.

Finally, family-centered care and the zero separation principle are the core strategies embedded across all three main working areas to meet the needs of newborns:

Essential Care

In line with the WHO publication “Standards for improving the quality of care for small and sick newborns in health facilities”, the NEST Model sets out the basic life-saving interventions that every newborn should receive, including:

• Immediate and continuous breastfeeding: Ensuring that every newborn receives breast milk soon after birth and on an ongoing basis, providing optimal nutrition and immune protection.
• Infection prevention and control: Implementing strict hygiene measures and protocols to prevent and manage infections, reducing the risk of illness in newborns.
• Thermal care: Maintaining the newborn’s body temperature through methods such as warming the environment and skin-to-skin contact.
• Kangaroo Care: Encouraging skin-to-skin contact between the mother (or another caregiver) and the baby to improve temperature regulation, growth and bonding.
• Neonatal resuscitation: Ensuring that facilities are well equipped and staff are trained to respond promptly to breathing difficulties at birth.

Complications Management

This care focuses on managing newborns with complications such as:

• Respiratory problems: These include breathing difficulties and meconium aspiration syndrome, in which the baby inhales meconium-stained fluid, causing obstruction and inflammation of the lungs.
• Asphyxia: A lack of oxygen (hypoxia) and reduced blood flow (ischemia) to the brain and organs, which can lead to brain injury.
• Jaundice: This can be caused by high levels of bilirubin (hyperbilirubinemia), which turn the skin and eyes yellow; if left untreated, it can cause permanent brain damage (kernicterus).

In line with WHO guidelines, the NEST Model promotes the use of simple, effective devices such as bubble CPAP (continuous positive airway pressure) and safe phototherapy for jaundice, together with early identification and management of emergencies.

Perinatal Network

In line with the WHO “continuum of care” approach, this component aims to build structured referral networks (“hub and spoke”) linking primary, secondary and tertiary health facilities. The objectives are to:

• Ensure appropriate and timely care for all newborns, including small and sick infants.
• Promote effective pathways for transferring babies from one service to another.

NEEDS ANALYSIS FOR EACH DOMAIN

Before any implementation, a thorough needs assessment is essential to evaluate the skills, available resources and existing gaps in each health facility. This step lays the groundwork for effective planning and lasting improvements in newborn care.

The main objectives of the needs assessment are to:

• Collect accurate, context-relevant data
• Understand the local healthcare environment
• Identify priority areas for improving newborn outcomes

The assessment can take different forms: focus group discussions, one-to-one consultations with hospital staff, or multi-stakeholder exchanges among health sector partners. It is usually carried out by multidisciplinary teams that include neonatologists, nurses, midwives, obstetricians and, in some cases, external stakeholders such as NGOs.

The needs assessment process is applied across the NEST Model’s three main working areas—Essential Care, Complications Management, and the Perinatal Network— each of which covers a set of key domains reflecting the system components needed to ensure high-quality care:

1. Human Resources: Assessing staffing levels, skills and training needs.
2. Infrastructure: Assessing the physical environment, including the layout, fittings and condition of neonatal units and delivery areas.
3. Equipment & Commodities: Checking the availability, functionality and maintenance of essential equipment (e.g. CPAP devices, phototherapy units) and the necessary medical supplies.
4. Data Systems: Reviewing the data collection tools and systems in place for monitoring newborn outcomes, as well as those used for quality of care and decision-making.
5. Communication: Understanding how information flows between care teams and facilities, as well as between providers and families, with a focus on promoting continuity of care.
6. Protocols & Guidelines: Checking the availability, clarity and application of standardized protocols and clinical guidelines for newborn care.

Useful resources:

To streamline the needs assessment process, the Paolo Chiesi Foundation, together with Professor Ousmane Ndiaye and the members of the Technical Advisory Group, has developed a set of checklists to assess existing resources and identify gaps.

ACTION PLAN

In the second step of the NEST Model’s approach, we focus on the Action Plan. This is a structured framework that sets out the steps needed to address the needs, gaps and challenges identified during the needs assessment for each area.

It serves as a roadmap for prioritizing, addressing and implementing solutions in a systematic and sustainable way.

1. Review the needs assessment findings

PURPOSE: Understand the key information and data gathered during the needs assessment.

ACTIONS:

• Review the needs assessment report and its summary to clarify the issues or areas that require particular attention.
• Identify the most pressing needs and prioritize them based on factors such as urgency, impact and the resources required.

2. Define clear objectives, expected results and activities

PURPOSE: Define the objectives for each identified need and, accordingly, outline the targeted interventions.

When planning an intervention, the first question is not “what do we need to do?” but “what do we want to achieve?”

Starting with clear objectives ensures that all actions and resources are focused on solving the real problem, rather than on activities that may have no impact.

ACTIONS:

• Start with the objective → What medium- to long-term change do we want to see if this need were met?
• Define the expected results → What results will show the progress made?
• Define SMART indicators (Specific, Measurable, Achievable, Realistic, Time-bound) to measure results/objectives → How will we measure success?
• Design a set of activities to achieve these results → What will we do to achieve them?
• Set a timeline and deadlines to ensure smooth and accountable implementation → When, and by whom?

3. Identify resources and stakeholders

PURPOSE: Determine the resources, people and support needed to implement the plan

ACTIONS:

• Identify the key stakeholders (e.g. team members, departments, external partners) who are essential to implementing and supporting the intervention, as well as those who will be affected by it.
• Assess the available resources (e.g. budget, time, equipment, skills).
• Identify any resource gaps and develop plans to fill them -> Ask: Can the gap be filled internally (training, reassignment)? Do we need external support (NGOs, donors, Ministry of Health)?
• Assign clear responsibilities to the team in charge of implementing the action plan: who leads each activity, who supports it, and who assesses its progress.

Useful resources:

IMPLEMENTATION

Once the Action Plan has been developed, the third step is to implement the activities and strategies it sets out.

It is essential to ensure clear accountability for implementing each aspect of the Action Plan:

• Start carrying out the tasks, making sure deadlines are met. Monitor the implementation process to ensure it stays aligned with the overall objectives.
• Manage any unforeseen issues that may arise during implementation.

Throughout implementation, it is essential to continuously track the progress of the Action Plan, adjust it where needed, and keep key stakeholders informed of the progress made.

QUALITY MONITORING AND EVALUATION

To successfully implement the Action Plan and achieve its objectives, quality monitoring and evaluation must be built in from the outset, not as an afterthought but as an essential part of the development process.

Monitoring is the ongoing collection of data on project activities, outputs and outcomes to assess progress towards the planned objectives and results. It is a continuous, real-time activity that helps project teams stay on track and make the necessary adjustments.

These are the key elements of monitoring indicators: define measurable indicators that reflect the project’s objectives. They can be quantitative (e.g. the number of patients reached) or qualitative (e.g. participant satisfaction).

• Data collection tools: choose the appropriate tools and methods for data collection (surveys, interviews, focus groups, observation, etc.).
• Frequency: set a data collection schedule (daily, weekly, monthly, etc.).
• Responsibility: assign roles for collecting, reporting and analyzing data to ensure accountability.
• Data management: ensure appropriate data storage, management and analysis to support decision-making.

A structured evaluation, carried out at mid-term or at the end of the implementation cycle, makes it possible to assess progress against what was planned in the original Plan. More importantly, it generates lessons that guide future improvements and strategic choices.

Monitoring + Evaluation = Learning

The real value of this approach lies in using the lessons learned from monitoring and evaluation to strengthen systems, scale up effective practices and avoid repeating mistakes. This learning approach is at the heart of the NEST Model’s commitment to sustainability and quality.