Co-design of the Implementation Toolkit for Small and Sick Newborn Care: a global open-access knowledge management...

Most births worldwide (> 80%) occur in health care facilities, yet 2.3 million newborns die annually. If the know-do gap between evidence and implementation was closed, an estimated 752,000 newborn deaths could be prevented per year. We describe the co-design of the Implementation Toolkit (Newborn Toolkit) for Small and Sick Newborn Care (SSNC), a web platform and linked community of global implementers, facilitated by NEST360 and UNICEF to enable access to curated resources, including guidelines, practical tools and peer learning for contextual adaptation.

A systematic three step co-design process was followed. Step 1) Structure: We used an organising framework of WHO and UNICEF ten core components for systems strengthening for SSNC. We then reviewed relevant knowledge management platforms to identify elements facilitating user engagement. Step 2) Content: > 300 implementers collated publications and tools according to the ten core components. Step 3) Refining and building community: User data analytics plus direct feedback from the global communities of practice provided data to improve website content and community uptake, notably regular webinars.

Step 1) Structure: In 2020, the Newborn Toolkit website structure was co-designed based on the ten core components. Step 2) Content: Working groups, organised by core components, collated over 1,100 resources in 15 languages. Step 3) Refining and building community: Cross-country learning was facilitated through 45 webinars with multi-disciplinary speakers from all continents including caregivers, clinicians, non-governmental organisation representatives, engineers, and data scientists. French language translation and engagement was added between 2023-2025. Unique user counts increased with 28,146 in 2023 to 62,561 in 2025 from 198 countries and territories. The most viewed content includes WHO guidelines, neonatal floor plans, the ABC device costing tool, and data tools.

Given the urgency for accelerated progress for newborn survival by 2030, faster implementation of proven solutions is needed. It is crucial that implementers can access evidence and tools to adapt for their specific context, rather than "reinventing the wheel". Systems change is complex, requiring novel approaches to make it doable, such as standard, simplified action pathways available on the Newborn Toolkit. Gaps to address include evidence availability in multiple languages.