Care for neonates in Haiti’s health system: outcomes and lessons

Abstract Background The rate of facility births in Haiti has doubled over the past two decades, but without comparable reductions in maternal or neonatal mortality. To care for newborns requiring hospitalization in Haiti, we worked with the public health leadership in the Haitian department of the South (Sud) to establish a ward for compromised neonates in a large public hospital with over 3000 annual deliveries but no neonatal care capacity. Methods Significant investments were made in establishing basic neonatal services, training nurses, installing and managing a supply chain, and strengthening infrastructure. We present outcomes for 1399 neonates admitted to the ward during the first two years of operation. Results Two-thirds of admissions were made from the hospital’s maternity ward after birth, while the remaining babies were born at home or at referring facilities. Inborn neonates had better rates of hospital survival than those born elsewhere; they were also more likely to be born via cesarean section and to be admitted immediately following birth. Babies born elsewhere were more likely to die during their hospital stay. There were no differences between the proportion of premature or low-birth-weight babies born at the hospital or elsewhere. Nursing care proved to be a critical part of the care delivery system. Conclusions To support maternal and newborn care, we conclude that integrated, high-frequency nursing training is necessary for both maternity and neonatal nurses. Resources are needed to address prematurity as an important outcome, especially as it is indicative of poor prenatal care, regardless of place of birth.