By Jackson Okata
Nairobi, Kenya — A severe shortage of nurses in neonatal units across Africa is leaving thousands of newborns without life-saving care, with new data showing that only a fraction of essential medical tasks are being carried out.
Findings presented at the International Maternal Newborn Health Conference 2026 in Nairobi, Kenya, reveal that in some hospitals, only one in three critical care tasks for newborns is completed by trained nurses. The rest are either delegated to mothers and unsupervised students or missed entirely.
The analysis by NEST360, which examined facilities in Kenya, Malawi, Nigeria and Tanzania, paints a stark picture of overwhelmed health systems struggling to cope with rising demand for neonatal care.
In many units, a single nurse is responsible for up to 50 babies per shift, far exceeding international standards that recommend one nurse for every two critically ill newborns or four stable infants.
“We saw nurses were only able to do one-third of the care we measured. Another third was delegated to mothers and students who were largely unsupervised, and one-third of care was not done at all,” said Dr Abdulazeez Imam, an Assistant Clinical Professor at the London School of Hygiene & Tropical Medicine.
Particularly alarming, the study found that inexperienced trainees frequently handle high-risk procedures such as administering intravenous medication. In some cases, four in ten IV drug administrations were carried out by students with minimal supervision, while one in ten doses was missed altogether.
“These are extremely delicate procedures,” Imam said. “A small, sick newborn weighing 700 grams needs precise drug calculations that must be double-checked. When that is not done properly, the consequences can be fatal,” reads part of the study
Burnout and broken systems
Beyond the gaps in care, the report highlights a workforce pushed to breaking point. Nurses described working for years without leave, leading to exhaustion that directly affects the quality of care they provide.
One nurse quoted in the study said she had gone more than two years without a break.
“I didn’t go on leave for almost two and a half years,” she said. “At least when additional nurses came in, we could finally take a break to rejuvenate.”
The data shows that nurses tend to prioritise clinical assessments and handovers at the start of shifts. At the same time, routine but essential tasks such as monitoring vital signs, feeding, or hygiene are often left to families or students.
Small staffing increases, measurable gains
Researchers found that even modest staffing increases can improve outcomes. In a pilot intervention in which three additional nurses were deployed to neonatal units, nursing time per baby rose by 28%, from 34 to 43 minutes per shift.
This translated into a measurable increase in nurse-delivered care, particularly for high-priority clinical tasks.
“What we saw is that staffing increases improve delivery of care, especially for the most critical interventions,” Imam said. “This provides strong evidence for policymakers.”
The cost of closing the gap
However, scaling up staffing remains a major financial challenge.
According to Alice Tarus of NEST360, even meeting minimum standards would require substantial investment. Using Malawi as a case study, researchers estimate that an additional 300 to 400 nurses would be needed to staff neonatal units nationwide adequately.
Hiring general nurses alone could cost around $3 million annually, while integrating specialised neonatal nurses could push that figure to $8 million per year. Training, equipment, and mentorship would add further costs.
Despite this, experts argue that the investment is both feasible and necessary.
“It’s not little, but it’s doable,” Tarus said. “We need to increase the number of general nurses, train them on-site, and start investing in specialised neonatal nursing.”
She also warned that poor pay and working conditions are driving nurses out of the profession or out of the country, worsening the crisis.
A call for urgent reforms
The findings add to growing evidence that improving nurse staffing is one of the most effective ways to reduce newborn deaths in low-resource settings.
Experts are now calling for governments to prioritise workforce expansion, introduce neonatal nursing specialisations, and strengthen health system planning, particularly for understaffed night shifts.
Without urgent action, they warn, the most vulnerable patients, newborns fighting for survival, will continue to bear the cost of overstretched systems.
