The first 28 days of life are the most critical and vulnerable for a child’s survival. Every year, an estimated 2.4 million newborns die globally within the first month of life due to preventable causes, such as preterm birth, intrapartum-related complications like birth asphyxia, infections, and birth defects.
The statistics are more concerning in low-resource settings, where access to quality healthcare systems is limited. For all global neonatal mortality, high-income countries account for only 1 percent. The average neonatal mortality rate (NMR) of high-income countries is 4 per 1,000 live births; meanwhile, it is 33 per 1,000 live births in low-and middle-income countries (LMICs).
The COVID-19 worsened neonatal mortality in LMICs, due to restricted movements and unprecedented disruptions in many countries health systems. A 2022 WHO pulse survey reported that over 40% of African countries experienced disruptions to routine maternal and neonatal health services.
Moreover, it resulted in many birth attendants, especially in rural areas, not accessing updated knowledge and hands-on practice for managing neonatal emergencies. This created an urgent need for an alternative scalable model that could deliver critical knowledge when the traditional face-to-face method is not accessible.
A Remote Training Model That Works
To address this gap, the Essential Newborn Care (ENC) Training model was developed and deployed remotely through a partnership led by the American Academy of Paediatrics (AAP) and Laerdal Global Health. This model delivers critical skills to healthcare workers involved in newborn resuscitation and care in low-resource settings.
The training followed a Low-Dose, High-Frequency (LDHF) approach; short, repeated practice sessions that reinforce retention and build confidence. Facilitators were trained remotely, and health workers received hybrid learning at their facilities.
What the Data Show
The Essential Newborn Care (ENC) Now! initiative, was implemented in Nigeria and Bangladesh. These countries were among the six countries with the highest numbers of neonatal deaths. The findings demonstrated effectiveness of the approach:
- Bag-Mask Ventilation (BMV) performance improved significantly between baseline and post-training.
- Across all study sites, pass rates significantly improved from baseline (BL) to post-training (PT).
- Pass rates for both Objective Structured Clinical Exam (OSCE A and B) were high immediately post-training and remained strong at endline, demonstrating retention of applied clinical skills.
- Performance on the NeoNatalie Live (NNL) manikin scenarios generally continued to improve from post-training to endline (EL), indicating sustained gains through low-dose, high-frequency (LDHF) practice.
Why This Matters for Health Systems
This remote training model promises beyond skill-building, what is possible when health systems invest in accessible, context-specific, and data-driven training models.
- Access: Remote facilitation overcomes geographic and logistical barriers, reaching providers in rural, low-resource, or conflict-affected settings.
- Retention: The LDHF approach reinforces essential clinical skills through regular and short practice sessions. This helps health workers retain critical knowledge over time and enhance their readiness in real-life situations.
- Scalability: The hybrid facilitation model combines remote orientation with local, on-site mentoring and enables rapid rollout without compromising training quality.
Conclusion
Remote ENC training shows promising result. Therefore, to strengthen newborn care at scale, governments, NGOs, and health partners should integrate remote LDHF training models into national health strategies by investing in ongoing mentorship and ensuring local adaptation. This is a practical way forward to scale impactful solutions and maintain a focus on quality improvement.
