Readiness to Provide Neonatal Care Services in 208 Ethiopian Hospitals Prior to Implementation of the Saving Little Lives Program

INTRODUCTION: Despite improved health service accessibility, neonatal mortality in Ethiopia remains high at 33 per 1000 live births. Thus, improving health facilities' readiness across infrastructure, basic amenities, equipment, medications, laboratory services, Kangaroo Mother Care, infection prevention and control, staffing, and guidelines availability is critical for improving the quality of neonatal care and survival. OBJECTIVE: The aim of this study was to evaluate the readiness of Ethiopian hospitals to provide services to small and sick newborns. METHODS: This was a cross-sectional study including 208 hospitals across four regions in Ethiopia in 2021-2024, prior to the implementation of the Saving Little Lives program. Data was collected using an adapted World Health Organization's Service Availability and Readiness Assessment tool and are presented using composite scores. RESULTS: The mean composite readiness score for the 208 hospitals for providing services to small and sick newborns in labour and delivery wards was 59%, with domain-specific scores of 47% for basic amenities, 56% for essential neonatal care, and 74% for newborn resuscitation. Significant variation was seen across hospital levels, and basic amenities were available in 68%, 49%, and 43%, essential neonatal care in 68%, 81%, and 71%, and newborn resuscitation in 68%, 66%, and 50% of referral, general, and primary hospitals, respectively. The mean composite readiness score to provide newborn care in the neonatal care units was 57%. Scores varied by hospital levels, with scores of 73%, 64%, and 50% for referral, general, and primary hospitals, respectively. Domain-specific scores were 63% for basic amenities, 65% for equipment, 67% for medications, 63% for laboratory services, 25% for Kangaroo Mother Care, 68% for infection prevention and control, 55% for staffing, and 51% for guidelines availability. Functional bCPAP machines were available in 14% of labour and delivery wards and in 35% of neonatal care units. CONCLUSIONS: There was a substantial gap in readiness to provide care for small and sick newborns, and significant variations across hospital levels. Immediate actions must be taken to address the observed gaps to reach the sustainable development goal of reducing neonatal mortality to at least 12 per 1000 live births by 2030.