From constraints to solutions: leveraging low-cost, scalable simulation for safer neonatal resuscitation

Neonatal mortality remains a major global health challenge, disproportionately affecting low-resource settings where access to timely and effective resuscitation is limited. Simulation-based training provides a safe and effective method to develop and sustain the cognitive, technical, and behavioural skills essential for neonatal resuscitation, while improving teamwork, confidence, and patient safety. Despite established evidence of its effectiveness in enhancing these skills, widespread implementation of simulation-based training remains limited in resource-constrained settings due to financial, infrastructural, human resource and organizational barriers. This review proposes simulation as a patient safety intervention that supports the shift from traditional error-focused to system resilience approaches. Scalable innovations including low-cost manikins, in situ simulation, telesimulation, and structured debriefing offer practical and sustainable solutions. Future research linking simulation-based training to measurable improvements in neonatal outcomes is essential to inform policy, guide investment, and promote global health equity.