Every year, millions of newborns around the world take their first breath, and for many in sub-Saharan Africa, it is also their last. To put this into context, in 2022, about 2.3 million children died within the first 28 days of life. Nigeria has a high neonatal mortality rate, put at 30 to 40 deaths per 1,000 live births. Many of these deaths occur in the first 24 hours after birth and are preventable with timely and skilled care.
In our recent study published in Simulation in Healthcare, we offer new evidence that digital learning platforms can help save newborn lives by strengthening the capacity of frontline health workers in Nigeria. The study, supported by the Bill & Melinda Gates Foundation and implemented by the American Academy of Paediatrics (AAP), examined how nurses, midwives, and doctors in northern Nigeria were affected by a digitally delivered Essential Newborn Care (ENC) training program.
Saving lives: digitally
When the COVID-19 pandemic disrupted in-person training across much of Africa, medical educators had to innovate. The Nigerian team adopted a remote facilitation model that combined online sessions via Zoom with in-facility, hands-on practice supported by neonatal simulators, particularly NeoNatalie Live (NNL), a high-fidelity manikin that provides digital feedback on newborn resuscitation skills.
Health workers from four secondary health facilities in Borno, Yobe, and Gombe States participated in the training, guided by facilitators from the Pediatric Association of Nigeria (PAN), AAP, and InSiGHt Health Consulting (IHC). Using the digital ENC Course and the NeoNatalie app, participants learned evidence-based practices such as drying and stimulating the baby immediately after birth, avoiding unnecessary suctioning, ensuring proper ventilation at 40 breaths per minute, delaying cord clamping, and promoting skin-to-skin contact and early breastfeeding.
What we found
At the end of the exercise, we conducted Interviews and focus group discussions (FGDs) with the participants. Our findings revealed that the participants not only learned new techniques but also transformed their approach to newborn care. Many reported abandoning outdated and potentially harmful practices, such as turning babies upside down after delivery, and instead applying methods that prioritise the newborn’s breathing and bonding with the mother.
These behavioural shifts were more than theoretical. Several health workers observed tangible improvements in their wards (i.e., fewer asphyxiated babies, fewer referrals, and fewer deaths). One facility that used to record around 11 neonatal deaths per month reported a reduction to just 3 following the training.
Barriers on the path to progress
Yet, the journey was far from smooth. The study participants identified several barriers that limited the full potential of digital training.
First, access to simulators was a recurring issue. With only a few NeoNatalie manikins available per facility, health workers often had to queue for practice, which constrained learning opportunities.
Second, poor internet connectivity, a common challenge across many parts of Nigeria, disrupted real-time instruction and feedback. Third, workload pressures and staff shortages made it difficult to apply newly learned skills in busy maternity wards. Some health workers admitted that when labour rooms became crowded, they reverted to older shortcuts to save time. Finally, resistance to new practices among untrained colleagues slowed adoption.
Way forward
These challenges have shown that training alone is not enough. Digital learning can empower health workers with new skills, but systemic barriers, ranging from inadequate staffing to weak infrastructure, must also be addressed for sustainable impact.
Thus, successful scale-up requires “a dual focus on education and health system strengthening.” That means providing more training equipment, improving connectivity, redistributing workloads, and ensuring that refresher training is built into health systems. Continuous mentoring, peer-to-peer learning, and institutional support can help trained staff sustain and spread their skills.
Conclusion
Our study suggests that we can save more lives by improving healthcare workers’ skills and capacity in newborn care. This study from Nigeria offers hope: that by combining technology, training, and teamwork, health systems can bridge the gap between knowledge and survival.
Furthermore, we acknowledge the challenges of implementing a digital education in resource-constrained settings. Yet, there is evidence that digital and simulation-based training can be locally adapted, affordable, and impactful, even in fragile contexts. As Nigeria and other countries work toward the Sustainable Development Goal of ending preventable newborn deaths, scaling up such innovations is critical.
