Innovative Models for Advancing Child Health in Africa

Overview of Funding

The Trump administration has made the decision to shutter the U.S. Agency for International Development (USAID) and cut a large portion of global health programs, particularly those focused on maternal and child health. 

The Trump administration’s proposed State Department budget for FY 2026 includes a $6.2 billion reduction to overall global health programs. In accordance with the proposal, the budget for maternal and child health programs is expected to shrink from appropriated levels of $1.28 billion in FY 2024 to $85 million in FY 2026. While it is unclear what Congress will ultimately enact in FY 2026 for maternal and child health, realistically, it is safe to assume there will be cuts, and it is unlikely that other bilateral donors will offset these significant funding reductions. 

The global health sector, more than most aid sectors, has benefited from philanthropic funding. While comprehensive estimates for philanthropic contributions to global health in 2024 are not currently available, the Gates Foundation’s 2024 Annual Report provides an indicative funding figure of approximately $4 billion for global health and related global development. However, given the substantial expected reduction in U.S. aid support, it is unlikely that philanthropic funding will supplement this fiscal gap.

In the wake of these cuts, there are opportunities to consider different models to advance global health goals, particularly in the realm of child survival interventions. These interventions will face some of the steepest global health funding reductions, in comparison to the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) spending, which has thus far been protected by Congress. Thus, creating and investing in other aid models will be vital to supporting global health goals, especially those for maternal and child health.

NEST360’s Mission and Impacts

One such model to support global health goals is Newborn Essential Solutions and Technologies (NEST360), an international alliance of 23 organizations across Africa, the U.K., and the U.S. working to end preventable newborn deaths in African hospitals. NEST360 partners with governments, educational institutions, professional societies, and national nongovernmental organizations (NGOs) to deliver lifesaving care to vulnerable newborns in hospitals across Africa. The goal is to establish sustainable, high-quality care systems that can prevent newborn deaths. Through close collaboration, the alliance supports countries accelerating their national newborn health targets, making measurable progress in Kenya, Malawi, Nigeria, Tanzania, and Ethiopia.

The NEST360 partnership has early indications of positive impact, with interim findings comparing 2024 with data collected within calendar years of 2021 and 2022: 

• Kenya, Malawi, Nigeria, and Tanzania saw significant reductions in in-hospital neonatal mortality, particularly among admitted newborns weighing 1,000–1,999g and >2,000g.
• In these countries, inpatient neonatal mortality reductions ranged across hospitals, with significant reductions from 14% to 54% over this period.
• Notably, Malawi reached a 16% reduction in neonatal mortality across all Level 2 hospitals nationwide as of 2024.

NEST360 Tanzania

Program Overview

In Tanzania, the NEST360 program is implemented in partnership with the Ifakara Health Institute, Dar es Salaam Institute of Technology (DIT), Muhimbili University of Health and Allied Sciences (MUHAS), and wider NEST360 alliance members. Phase 1 of the program (2019–23), launched in collaboration with the Tanzanian Ministry of Health, reached seven hospitals and eleven clinical and technical skills labs.

During Phase 1, the NEST360 team installed a comprehensive bundle of technologies designed to improve care for mothers and newborns, focusing on four key interventions: respiratory support, jaundice management, thermal management, and Kangaroo Mother Care (KMC). In addition to technology installation, the team provides training and ongoing support to ensure proper use and maintenance of these technologies. This includes instructing hospital technicians on how to embed these tools into routine clinical practice. The program strengthens existing hospital data systems and protocols, and the NEST360 team worked closely with facility leadership to turn policies into everyday care practices.

Now, in Phase 2 (2024–28), NEST360 Tanzania is expanding to 28 implementing hospitals nationwide. To support this scale-up, the program is adopting a hub-and-spoke model that emphasizes strengthening services at district level facilities. This model is designed to expand access to quality newborn care across a wider network, enhance the referral system, and ease the burden on regional hospitals. These continued efforts are expected to ultimately lead to improved outcomes for mothers and newborns throughout the country.

Unique Program Features

NEST360 Tanzania has several unique features that were directly observed by the authors during a recent visit. While in the country, the authors visited both Amana Regional Referral Hospital, a Phase 1 site, and Ubungo District Hospital, a Phase 2 site. These visits provided a valuable opportunity to see the NEST360 approach in action — both in a well-established implementation and during an early stage of rollout.

The following observations highlight key aspects of the NEST360 program’s design and impact:

• Local institution leadership. NEST360 Tanzania works in partnership with Ifakara Health Institute — a renowned health research organization in Africa with research and technical support units throughout Tanzania — as well as DIT, MUHAS, the London School of Hygiene and Tropical Medicine, Hatch Technologies, and the Rice360 Institute for Global Health Technologies. While each partner plays a vital role in supporting hospital-based implementation and innovation, the implementation is led by Ifakara Health Institute in collaboration with the Tanzanian Ministry of Health.
   
• Peer-to-peer collaboration with Ifakara Health Institute, the Tanzanian Ministry of Health, and Rice University. Collaboration between universities and researchers enables effective knowledge transfer and problem-solving among experts from Tanzania, the U.S., and other partner countries and is a key feature of NEST360. This differs from other global health donor-recipient models that can be more top down in terms of implementation, training, and reporting.
   
• Intense data collection and real time analysis through use of an online dashboard at the hospital level to identify rates and causes of neonatal mortality. This is key to identifying what needs to be changed (training, equipment, quality of care) in order to improve outcomes and quality of care for newborns.
   
• Focus on biomedical engineering needs and skill building. The biomedical engineering or technical skills lab, one of which is established at DIT, provides in-service hospital biomedical technicians with training on how to maintain neonatal ward equipment. This approach enables these technicians to make device repairs at their respective facilities and promotes self-sufficiency.
  
  As part of Phase 2, NEST360 Tanzania is focused on building the quality of care at district-level hospitals. By strengthening services at these facilities, the program aims to reduce unnecessary referrals to regional hospitals and shift care-seeking behavior to district hospitals. Improving confidence in district hospitals encourages patients to seek care closer to home.
   
• Cost recovery through a concierge approach in patient care. While not directly related to NEST360, an innovative cost recovery approach at Amana Regional Referral Hospital is worth highlighting. To address funding gaps for essential medicines, consumables, and other critical needs, the hospital has introduced their own concierge inpatient wing. This service offers enhanced amenities and elective procedures to patients who opt to pay privately for additional comfort for themselves and their families. While maintaining equitable, high-quality care for all patients is essential, this kind of cost recovery scheme demonstrates innovation and an entrepreneurial approach to hospital sustainability.

Need for New Global Health Models

In conclusion, in the wake of steep global health funding declines, particularly for maternal and child health, philanthropic organizations should consider investing in new models, such as NEST360. NEST360 is uniquely characterized by partnerships involving research institutes with various funding sources. The initiative is led by local research institutions in collaboration with Ministries of Health and operates within a global peer-to-peer network of researchers and global health professionals.

Due to the investments made by philanthropic organizations, the NEST360 alliance of partners has learned critical lessons on how to operationalize the four lifesaving interventions of respiratory support, jaundice management, thermal management, and KMC and how to determine what works best in different settings. Going forward, the challenge for NEST360 partnership is to scale up and sustain these lessons and operational practices in lifesaving newborn care interventions to a broader number of facilities throughout NEST360 countries.

These efforts require the NEST360 model to be simplified in terms of data collection and analysis but also adapted to be scalable, including appropriate components to lower-level facilities. This also now requires Ministries of Health to continue to demonstrate leadership commitment and invest their own funding to prioritize the scale-up of lifesaving newborn care. For example, Tanzania’s Ministry of Health committed to enhance the infrastructure of 25 hospitals’ newborn wards with an investment of an additional $7.1 million.

Time-limited investment by philanthropic organizations to support work similar to NEST360 would aid programs in their efforts to investigate how to operationalize lifesaving interventions. This is one way to continue advancing achievements in maternal and child health in the wake of U.S. government funding cuts. These efforts should also include concomitant financial and leadership commitments from a country’s Ministry of Health to ensure the application, implementation, and expansion of these interventions. 

Acknowledgments

NEST360 is made possible by generous commitments from the Gates Foundation, ELMA Philanthropies, the Children’s Investment Fund (CIFF), The Lemelson Foundation, Sall Family Foundation, and the Ting Tsung and Wei Fong Chao Foundation under agreements to William Marsh Rice University.

This publication was produced on behalf of Rice University’s Baker Institute for Public Policy. Wherever feasible, the material was reviewed by external experts prior to its release. Any errors are the responsibility of the author(s) alone.

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