Establishment and scale up of special care baby units in Sierra Leone: a descriptive case study of implementation service expansion and interim facility outcomes

Résumé fourni par la source

Neonatal mortality remains a significant challenge in low-resource settings, with Sierra Leone experiencing one of the highest neonatal mortality rates globally. Neonatal mortality accounts for 30% of under-five mortality in Sierra Leone, with the majority of deaths resulting from prematurity, birth asphyxia, and bacterial infections. Before 2016, structured newborn care was largely absent in Sierra Leone. The aim of this case study report is to document how Special Care Baby Units (SCBUs) were established and scaled up in Sierra Leone and to examine implementation approaches, service expansion, interim facility level outcomes, challenges, and lessons learned to inform similar efforts in other low resource settings. This study employed a descriptive case study design and programmatic review of the national SCBU scale-up in Sierra Leone from 2017 to 2024. Data sources included policy and strategic documents, programme reports, meeting minutes, supervisory records, and aggregated facility-level monitoring data from the national SCBU database. Quantitative data on admissions and in-facility outcomes were summarized descriptively by year, and temporal trends in survival were assessed using a test for trend across programme years. Qualitative information from documentary sources was analyzed using manual thematic synthesis to identify key implementation enablers, bottlenecks, and lessons. Guided by national policy and implemented through a phased eight-step approach, the Ministry of Health, in partnership with UNICEF and other stakeholders, expanded SCBUs from 4 facilities in 2017 to 16 facilities across 14 of 16 districts by 2024. Annual SCBU admissions increased from 1031 in 2017 to 12,350 in 2024, reflecting major expansion in access to specialized inpatient newborn care. In-facility survival across the SCBU network improved from 78% in 2017 to 87% in 2024, with trend analysis showing an overall improvement over time. Documentary thematic analysis identified policy support, government leadership, partner coordination, phased implementation, training and mentorship, and monitoring systems as major enablers, while staffing shortages, dependence on redeployed or volunteer personnel, equipment maintenance, and sustainability of financing remained key challenges. The SCBU initiative in Sierra Leone demonstrates that a phased, government-led approach can rapidly expand specialized newborn services in a low-resource setting. The principal contribution of this study is to document how national scale-up was achieved, the systems required to support implementation, and the early facility-level trends observed during programme maturation. While these findings are encouraging, stronger longitudinal and post-discharge outcome data are needed to assess long-term impact on neonatal survival and morbidity.

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