Severe nurse shortages across African neonatal units are leaving newborns without essential care, with only a fraction of required tasks being completed, new data shows.
Research presented at the International Maternal Newborn Health Conference 2026 found that nurses are able to deliver just one-third of the care newborns need. Another third is delegated to mothers and largely unsupervised students, while the remaining care is missed altogether.
“When we looked at the data at baseline, we saw nurses were able to do one-third of the care we measured,” said Dr Abdulazeez Imam, Assistant Clinical Professor at the London School of Hygiene & Tropical Medicine.
“One third was delegated to mothers and students who were largely unsupervised, and then one third of care was not done at all.”
The findings, from the NEST360 programme across Kenya, Malawi, Nigeria, and Tanzania, highlight a stark mismatch between staffing levels and clinical need. In some facilities, a single nurse is responsible for as many as 50 babies per shift—far exceeding international recommendations of one nurse for two critically ill newborns or four stable ones.
The consequences extend beyond missed tasks to potentially dangerous practices. Researchers found that high-risk procedures, including intravenous drug administration, are often carried out by students with minimal supervision.
“What was most concerning was when it came to intravenous medications,” Imam said. “A small and sick newborn who weighs 700 grams needs a very small volume of medication… We noted that four in 10 IV medications were given by nursing students who had minimal supervision; one in 10 was actually missed.”
Under pressure, nurses prioritise certain clinical tasks while delegating others. Routine but essential care—such as monitoring vital signs, cleaning babies, and changing diapers—is frequently left to families. The strain is also taking a toll on healthcare workers themselves, with burnout increasingly common.
“This is a comment from one of the nurses,” Imam said. “‘I didn’t go on leave for almost two and a half years… At least now we can take a break to rejuvenate ourselves.’”
Data presented at the conference suggest that even modest increases in staffing can improve care. In facilities where three additional nurses were deployed, nursing time per patient increased by 28%, alongside measurable gains in care delivery.
“What we saw was that staffing increases improve delivery of care, particularly in high-priority tasks,” Imam said. “Our findings provide strong evidence for policymakers on the benefits of improving neonatal nursing numbers.”
However, scaling up staffing remains a major challenge. According to Alice Tarus of NEST360, current staffing ratios fall far short of global standards.
“For a 12-hour shift, the median number across facilities is one nurse to nine babies on admission,” she said. “But when you account for clinical need, you need one nurse for two babies requiring intensive support, and one for four stable babies.”
Bridging that gap will require significant investment. In Malawi alone, an estimated 300 to 400 additional nurses are needed to meet recommended standards across 37 hospitals.
“If you think about hiring all general nurses, the cost is around US$3 million annually… If you bring in specialised neonatal nurses, that rises to about US$8 million per year,” Tarus said.
“Training adds further costs, but this is doable.”
Despite the financial burden, experts argue that the cost of inaction is far higher. Proposed solutions include scaling up recruitment, introducing specialised neonatal nursing training, improving pay to retain staff, and strengthening workforce planning—particularly for understaffed night shifts.
“So what actions can we take now?” Tarus said. “We need more nurses… we need to train them on-site, invest in neonatal specialisation, and ensure governments take ownership.”
The findings add to growing evidence that workforce shortages are a critical bottleneck in improving newborn survival—and that without urgent investment, many of the most vulnerable patients will continue to go without lifesaving care.
