ESSENTIAL NEONATAL CARE, RESPIRATORY PROBLEMS, AND JAUNDICE – PERINATAL NETWORK

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

The NEST Model adopts a gradual, stepwise approach to addressing the complexity of care provided to newborn infants. The first step focuses on ensuring that preventive and nurturing care practices are fully integrated and established as the standard of care in everyday clinical practice. Only after this foundation is firmly in place can more advanced care strategies be introduced. The Chiesi Foundation is committed to facilitating this transition by supporting health systems in caring for infants with respiratory issues, asphyxia, or jaundice.

Furthermore, a comprehensive perspective on perinatal care must be embraced across all stages of the perinatal period — encompassing pregnancy, delivery, and postpartum. Quality care and improved newborn outcomes require a collaborative partnership between midwifery (nursing), obstetric, and neonatal teams. Therefore, it is essential to involve midwifery and obstetric personnel both at the facility level and beyond.

Establishing hub-and-spoke networks that involve facilities at different levels is key to setting up effective referral and back-referral mechanisms, ensuring appropriate care for all babies. Successful networks engage all stakeholders working in maternal-newborn care, 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 consequences and improves quality of life.

Finally, Family-Centered Care and Zero-Separation are the core strategies that are integrated across the three primary working areas to meet the needs of neonatal infants:

Essential Neonatal Care

In line with the WHO publication “Standards for Improving Quality of Care for Small and Sick Newborns in Health Facilities,” the NEST Model defines basic, life-saving interventions that should be provided to every newborn, including:

• Immediate and sustained human milk: Ensure every newborn receives breast milk promptly after birth and continuously, providing optimal nutrition and immune protection.
• Infection prevention and control: Implement strict hygiene measures and protocols to prevent and manage infections, reducing newborn illness risk.
• Thermal care: Maintain the newborn’s body temperature through methods like warming the environment and skin-to-skin contact.
• Kangaroo care: Promote skin-to-skin contact between mother (or an alternative caregiver) and baby to improve temperature regulation, growth, and bonding.
• Neonatal resuscitation: Ensure that facilities are equipped and staff are trained to promptly manage breathing difficulties at birth.

Extra Care for Babies with Complications

It focuses on managing newborns with complications such as:

• Respiratory problems: Include breathing difficulties and meconium aspiration syndrome, where the baby inhales meconium-stained fluid causing lung blockage and inflammation.
• Asphyxia: Refers to oxygen deprivation (hypoxia) and reduced blood flow (ischemia) to the brain and organs, risking brain damage.
• Jaundice: Caused by high bilirubin levels (hyperbilirubinemia), leading to yellowing of skin and eyes; if untreated, it can cause permanent brain damage (kernicterus).

In line with WHO guidelines, the NEST Model promotes the use of simple and effective devices, such as Bubble CPAP, safe phototherapy for jaundice, and early identification and management of emergencies.

Perinatal Network

Following the WHO’s “continuum of care” approach, this component aims to create structured referral networks (“hub and spoke”) linking primary, secondary, and tertiary healthcare facilities. The objectives are to:

• Ensure appropriate and timely care for all newborns, including small and sick infants
• Promote safe referral and counter-referral pathways

NEED ANALYSIS FOR EACH DOMAIN

Before any implementation, a thorough needs analysis is essential to assess the competencies, available resources, and existing gaps within each healthcare setting. This step lays the foundation for effective planning and sustainable improvements in neonatal care.

The main goals of the needs analysis are to:

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

This analysis can take various forms—focus group discussions, bilateral consultations with hospital staff, or multilateral exchanges among healthcare partners. It is typically carried out by multidisciplinary teams, including neonatal doctors, nurses, midwives, obstetricians, and sometimes external stakeholders such as NGOs.

The needs analysis process is applied across all the NEST Model’s main working areas—Essential Neonatal Care, Respiratory Problems, Jaundice, and the Perinatal Network—each of which involves a set of key domains that reflect the systemic components needed to ensure high-quality care:

• Human Resources: Assessment of staffing levels, skillsets, training needs
• Infrastructures: Evaluation of the physical environment, including space, layout, and conditions of neonatal units and delivery areas.
• Equipment & Commodities: Review of the availability, functionality, and maintenance of essential equipment (e.g., CPAP machines, phototherapy units) and necessary medical supplies.
• Data Systems: Analysis of existing data collection tools and systems used for monitoring neonatal outcomes, quality of care, and decision-making.
• Communication: Understanding how information flows among healthcare teams, facilities, and between providers and families, with a focus on promoting continuity of care.
• Protocols & Guidelines: Verification of the availability, clarity, and application of standardized protocols and clinical guidelines for newborn care.

Useful resources

To streamline the needs analysis process, the Chiesi foundation, in collaboration with Prof. Ousmane Ndiaye and the members of the Technical Advisory Group, has developed various checklists to assess existing resources and identify areas of deficiency:

Assessment checklist: Perinatal Healthcare Indicators – NESt Project’s Hospitals

ACTION PLANS

In the second step of the NEST model’s approach, we focus on the Action Plan. This plan is a structured method that outlines the necessary steps to respond to the needs, gaps, and challenges identified during the needs analysis for each domain. It serves as a roadmap for prioritizing, addressing, and implementing solutions in a systematic manner.

1. Review the Needs Analysis Findings

Objective: understand the key insights and data gathered in the needs analysis.

Actions:

• Revisit the needs analysis report and summary to clarify the problems or areas requiring attention
• Identify the most pressing needs and prioritize them based on factors such as urgency, impact, and resources required

2. Set Clear Objectives, Expected Results, and Activities

Objective: define what you aim to achieve for each identified need, and outline targeted interventions accordingly.

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

Starting with clear goals ensures that all actions and resources are focused on solving the real problem—rather than just doing activities that may not lead to impact.

Actions:

• Start with the goal → What medium/long-term change do we want to see if this need is addressed?
• Define expected results → What outcomes will demonstrate progress?
• Define SMART indicators (Specific, Measurable, Achievable, Relevant, Time-bound) to measure results/goals  → How will we measure success?
• Design a set of activities that serve the results → What will we do to achieve the results?
• Set a timeline and deadlines to keep implementation on track and accountable → When and by whom?

3. Identify Resources and Stakeholders

Objective: determine what resources, people, and support are needed to implement the plan.

Actions:

• Identify the key stakeholders (e.g., team members, departments, external partners) that are essential for implementing and supporting the implementation, and those who will be affected by the intervention
• Assess available resources (e.g., budget, time, materials, skills)
• Identify any gaps in resources and make plans for acquiring them → Consider: Can the gap be solved internally (training, reallocation)? Do we need external support (NGOs, donors, MoH)?
• Assign clear responsibilities to the team that will be involved in the implementation of the Action Plan → Who leads each activity, Who supports it, Who reviews progress

Useful resources:

https://chiesi.sharepoint.com/:x:/r/sites/chiesi-foundation/_layouts/15/Doc.aspx?sourcedoc=%7BE8AD0800-C812-47E9-8151-B947573F455E%7D&file=Template%20NEST%20mise%20en%20oeuvre.xlsx&action=default&mobileredirect=true

THE IMPLEMENTATION

After the development of the Action Plan, the third step is to implement the activities and the strategies laid out in the Action Plan.
It is crucial to ensure clear accountability for the implementation of each aspect of the action plan:

• Begin executing the tasks, ensuring adherence to timelines
• Monitor the implementation process to ensure it stays aligned with the overall objectives
• Address any unforeseen challenges that may arise during execution

During the implementation, it is pivotal to continuously track the progress of the action plan and adjust it as needed, and communicate progress to key stakeholders involved.

QUALITY MONITORING

To successfully implement the action plan and achieve the set objectives, quality monitoring and evaluation should be embedded from the start—not as an afterthought, but as a core component of the development process.

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

Below are the key components of monitorinindicators: define measurable indicators that reflect the project’s goals. These can be quantitative (e.g., number of patients reached) or qualitative (e.g., participant satisfaction)

• data collection tools: choose appropriate tools and methods for collecting data (surveys, interviews, focus groups, observation, etc.)
• frequency: establish a schedule for collecting data (daily, weekly, monthly, etc.)
• responsibility: assign roles for data collection, reporting, and analysis to ensure accountability
• data management: ensure proper storage, management, and analysis of data to support decision-making

A structured evaluation, conducted either midway or at the end of the implementation cycle, assesses progress against the initial plan. More importantly, it generates insights that drive future improvements and strategic choices.

Monitoring + Evaluation = Learning

The real value lies in using the insights from Monitoring and Evaluation to strengthen systems, scale what works, and avoid repeating what doesn’t. This learning mindset is at the heart of the NEST model’s approach to sustainability and quality.

Useful resources: