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Objectives To assess the standard of neonatal care being provided in Madesh Pradesh province, Nepal, identify areas required for improvement, and support government hospitals in implementing improvement plans. Methods A neonatal working group composed of 2 doctors and 2 nurses working in Madesh Pradesh government hospitals, staff from the Nepal Neonatal and Emergency Paediatric Care programme and RCPCH global links mentors, was formed. The working group conducted capacity assessments of all 12 government hospitals, comprising 3 surveys. The first was an assessment of the services available, filled out by global links mentors with support from hospital staff. This included the number of maternity beds, number of deliveries per month, staffing levels, equipment available and number of neonatal referrals to other hospitals per month. The other 2 surveys were qualitative surveys aimed at nurses and doctors working in government hospitals, evaluating their confidence and experience in managing common neonatal conditions. The surveys were sent via email and Whatsapp and were translated into Nepali. The working group analysed the results of the capacity assessments of each hospital, identified the barriers to opening neonatal units and created individualised improvement plans for each separate government hospital. Results In April 2023, of 12 government hospitals in Madesh Pradesh province, 5 had inpatient neonatal beds. A lack of trained nursing staff was identified as the biggest barrier to opening inpatient neonatal beds in 6 of the 7 hospitals without neonatal inpatient care. Inadequate equipment was a factor in 2 of the hospitals and 1 hospital did not have space to create inpatient neonatal beds. 27 doctors completed the doctor confidence survey and 32 nurses completed the nurse confidence survey, with all 12 government hospitals represented. Management of preterm neonates was identified as the area of least confidence for doctors with 18% stating they needed full training, while commencement of CPAP was the area of least confidence for nurses with 28% stating they need full training, as seen in graph 1. Conclusion The Capacity assessments mapped the need for newborn services and challenges faced by government hospitals in Madesh Pradesh. This informed the creation of a neonatal network 1 and ongoing projects including newborn nursing training.2 A further 3 government hospitals have opened neonatal units and 2 hospitals which had existing neonatal units have expanded and increased their admissions. References R D'Souza, et al. Unpublished data RCPCH conference 2024 submission. H Watson, et al. Unpublished data RCPCH conference 2024 submission.
McLoughlin et al. (Tue,) studied this question.