Ethiopia, located in Sub-Saharan Africa, faces significant challenges in improving neonatal health and reducing mortality rates among newborns. Despite commendable progress in neonatal care over the past two decades, the region still grapples with a high neonatal mortality rate of approximately 27 deaths per 1,000 live births recorded in 2020.[1] This rate is tenfold higher than that of developed countries. The private sector can play a transformative role in addressing these challenges by leveraging its expertise, resources, and innovative solutions to enhance neonatal care in Ethiopia.

Key factors causing neonatal deaths in Ethiopia include limited access to quality healthcare, birth defects and lack of awareness both at health worker as well as community level. 

Limited access to quality healthcare, the main deliberating factor to the life of a newborn

One of the primary reasons for neonatal deaths in Ethiopia is the limited access to quality healthcare services, especially in rural and remote areas. Many pregnant women and newborns lack access to skilled healthcare providers, well-equipped facilities, and life-saving medical interventions due to geographic distances. The concentration of healthcare facilities in urban centers exacerbates disparities in neonatal care, leaving underserved areas with unacceptably high mortality rates among newborns.

The geographic location is often also linked to poverty and lack of access to nutritious food and clean water which impacts maternal health during pregnancy and neonatal health after birth. Malnutrition and inadequate living conditions can lead to compromised immune systems, making newborns more susceptible to infections and illnesses.

Furthermore, challenges within the wider healthcare system, including a shortage of qualified healthcare providers, inadequate infrastructure, and limited availability of medical supplies (such as blood) and equipment, can impede the delivery of quality maternal and neonatal care. In a not-well functioning healthcare system, the chances of lack of proper hygiene and timely treatment are delayed or worsened. Therefore, there is an increased chance of infections, such as sepsis, pneumonia, and other neonatal infections. These significantly contribute to the number of neonatal deaths in Ethiopia. Limited access to preventive measures, proper hygiene, and timely treatment exacerbates the risk of infections.

Too many babies have some kind of birth defect; pre-term, congenital anomalies and low birth weight are the leading causes of neonatal mortality

Premature births are a leading cause of neonatal mortality in Ethiopia. Worldwide, about 15 million (more than one in 10) babies are born preterm each year and Ethiopia accounts for 4.4 % of this figure. Infants born before completing a full-term pregnancy are at higher risk of various health complications and require specialized care, which may not be readily available in all regions of the country. Addressing prematurity-related challenges requires targeted interventions and improved access to specialized neonatal care.

In addition, a significant number of neonatal deaths in Ethiopia can be attributed to congenital anomalies, structural or functional abnormalities present at birth. Early detection and management of congenital anomalies are crucial, but access to specialized medical care is often limited in rural areas. Strengthening healthcare infrastructure and increasing awareness among healthcare providers can aid in addressing congenital anomalies.

Low birth weight, often linked to maternal malnutrition and inadequate prenatal care, is associated with an increased risk of neonatal mortality. Low birth weight infants are more susceptible to infections and other health challenges. According to WHO’s 2014 estimation, 4.53% of total deaths in Ethiopia was due to low birth weight.

Addressing maternal malnutrition through nutritional programs and promoting adequate prenatal care can help reduce the incidence of low birth weight and its associated risks.

Awareness and skills of emergency healthcare workers and birth attendants; a key determinant in life or death of a newborn

Birth asphyxia, which occurs when a newborn has difficulty breathing immediately after birth, is another major cause of neonatal mortality in Ethiopia. The lack of skilled birth attendants and access to emergency obstetric care increases the likelihood of birth asphyxia-related complications. Training healthcare providers and improving access to emergency services will significantly reduce the miss-out rate and improve quality of appropriate care.

Many mothers and caregivers in Ethiopia lack awareness and education regarding essential newborn care practices and early warning signs of neonatal health issues. As a result, timely intervention may be delayed, leading to adverse outcomes. Educating mothers and healthcare providers through awareness programs can enhance neonatal care practices and reduce mortality rates. The lack of knowledge and awareness leads to insufficient utilization of antenatal care services during pregnancy and inadequate postnatal care for both the mother and newborn contribute to neonatal mortality.

The crucial role of the private sector in turning the tide for newborns in Ethiopia: Introducing innovative and affordable medical technologies, capacity strengthening for healthcare workers and policy makers plus strengthening the overall health infrastructure

In combating the challenges of neonatal health in Ethiopia, the active involvement of the private sector is crucial.[1] Private entities can contribute significantly by introducing innovative and affordable medical technologies, strengthening healthcare infrastructure, providing training and capacity building, and promoting quality regulation and compliance.

The private sector can address the gaps in medical equipment and supplies by introducing innovative, cost-effective neonatal medical technologies. Devices like Continuous Positive Airway Pressure (CPAP) machines, oxygen concentrators, pulse oximeters, and bilirubinometers are indispensable for effective neonatal care and can substantially reduce mortality rates. Collaborating with local distributors and healthcare institutions will ensure these life-saving technologies reach even the remotest areas.

The private sector’s expertise in distribution and logistics can significantly strengthen healthcare infrastructure in Ethiopia. Partnering with local distributors and healthcare institutions, private entities can extend their reach to rural regions, ensuring equitable access to neonatal care services. Building robust supply chains will help overcome challenges posed by remote locations and improve the availability of medical devices and supplies.

Private companies experienced in neonatal care can offer essential training sessions for healthcare providers and biomedical engineers. Equipping healthcare workers with necessary skills and knowledge is critical for the timely and proficient operation of neonatal medical devices. By focusing on capacity building, the private sector can help reduce delays in intervention and improve overall neonatal care quality.

The private sector must adhere to strict quality and safety regulations enforced by the Ethiopian Food and Drug Authority (EFDA). Complying with these regulations ensures that medical devices and supplies meet high standards of quality and safety. Collaborating with the government through formal agreements, such as Memoranda of Understanding (MOUs), demonstrates the private sector’s commitment to improving neonatal health in Ethiopia.

In conclusion: Collaborative efforts between private sector and government in Ethiopia, key to reduce newborn mortality.

In conclusion, Ethiopia’s efforts to improve neonatal health and reduce mortality rates are commendable but face persistent challenges. The private sector’s active involvement is vital in addressing these obstacles. By introducing innovative and affordable medical technologies, strengthening healthcare infrastructure, providing training, and complying with quality regulations, the private sector can substantially contribute to reducing neonatal deaths in Ethiopia. Collaborative efforts between the private sector and the government, supported by strategic partnerships and awareness campaigns, will pave the way for a brighter and healthier future for Ethiopia’s youngest citizens.

References:

[1] Mengistu, B. A., Yismaw, A. E., Azene, Z. N., & Mihret, M. S. (2020). Incidence and predictors of neonatal mortality among neonates admitted in Amhara regional state referral hospitals, Ethiopia: prospective follow up study. BMC pediatrics20, 1-14.

[2] Union, A. (2016). Africa health strategy 2016–2030. Addis Ababa: African Union.