Implementation Toolkit for Small and Sick Newborn Care: bridging the know-do gap through co-design of a global open-access knowledge management web platform and linked community

To bridge the critical know-do gap in newborn health, this paper describes the co-design, operationalization, and global scaling of the Newborn Toolkit—a web platform and community of practice that organizes over 1,100 evidence-based resources across 15 languages to facilitate the implementation of Small and Sick Newborn Care in low-resource settings.

The Gist

The Big Problem: Knowing vs. Doing

Imagine you have a massive library filled with the world's best cookbooks. These books contain the exact recipes to save lives (like how to care for a sick baby). However, in many parts of the world, the chefs (doctors and nurses) don't have these books, or if they do, the books are written in a language they don't speak, or they are so thick and complicated that no one has time to read them.

This is the "Know-Do Gap." We know what works to stop newborn babies from dying, but we aren't doing it fast enough. Every year, 2.3 million babies die, and most of these deaths could be prevented if the right information actually reached the people who need it.

The Solution: The "Newborn Toolkit"

To fix this, a group of global experts built a digital tool called the Implementation Toolkit for Small and Sick Newborn Care (or the "Newborn Toolkit").

Think of this Toolkit not just as a website, but as a giant, open-source "Swiss Army Knife" for baby care.

• It's a Central Hub: Instead of searching through thousands of different websites, journals, and dusty filing cabinets, all the best tools, guides, and checklists are gathered in one place.
• It's Organized by "Spokes": Imagine a bicycle wheel. The center of the wheel is the baby (family-centered care). The spokes holding the wheel together are the 10 essential parts of a hospital system (like having enough staff, good equipment, clean water, and strong leadership). The website is organized exactly like this wheel, so you can click on a "spoke" (e.g., "Equipment") and find everything you need for that specific part of the system.
• It's for Everyone: It's not just for doctors. It's for nurses, engineers, policy-makers, and even parents. It's designed to work on a smartphone even if your internet connection is slow (like a 2G network).

How They Built It (The Recipe)

The team didn't just build this alone in a lab. They used a method called "Co-Design," which is like hosting a massive potluck dinner where everyone brings a dish.

1. The Structure: They looked at how other health websites worked and decided to use the "Bicycle Wheel" model (the 10 core components) to organize everything.
2. The Content: They recruited over 300 experts from around the world (the "potluck guests"). These experts gathered over 1,100 resources—including guides, floor plans for hospitals, and cost calculators.
3. The Community: They didn't just put the tools online and walk away. They started a "Global Club" (a community of practice). They host monthly video calls (webinars) where a nurse in Kenya can share a success story with a doctor in Brazil. They even added French translations because so many people in Africa speak French.

What Happened? (The Results)

The results have been like watching a small campfire grow into a bonfire:

• Massive Reach: Between 2021 and 2025, nearly 160,000 unique people from 198 countries visited the site. That's almost every country on Earth!
• Real-World Use: The most popular downloads aren't just fancy theories; they are practical things like "How to draw a floor plan for a baby ward" or "How much does this oxygen machine cost?"
• Learning Together: They held 45 webinars. The most popular ones were about "Kangaroo Mother Care" (holding a baby skin-to-skin) and fighting infections. These sessions allowed people to ask questions and learn from each other's mistakes.

The Challenges (The Bumps in the Road)

Even though the Toolkit is great, there are still hurdles:

• The Language Barrier: Most of the "best recipes" are written in English. While they added French, many people in Africa speak hundreds of other local languages. It's hard to translate medical advice perfectly without losing the meaning.
• The "Power Outage" Problem: In some places, the internet is spotty or electricity is unreliable. Even if the Toolkit is free, you can't use it if your phone battery dies or the Wi-Fi cuts out.
• Too Much Information: With over 1,100 tools, it can sometimes feel like standing in a library with too many books. To fix this, they created "Action Pathways"—which are like simple, step-by-step roadmaps (e.g., "Step 1: Check for jaundice, Step 2: Do this, Step 3: Call this number") to make it less overwhelming.

The Bottom Line

The paper concludes that to save the 2.3 million babies who die every year, we can't just wait for new scientific discoveries. We already have the answers. The problem is getting those answers into the hands of the people who need them.

The Newborn Toolkit is like a bridge. It connects the "knowing" (the science) with the "doing" (the practice). By making information free, easy to find, and available in multiple languages, it helps hospitals stop "reinventing the wheel" and start saving lives faster.

In short: They built a global, digital library and a friendly community to make sure that every sick baby, no matter where they are born, gets the care they deserve.

Technical Summary

1. Problem Statement

The paper addresses the critical "know–do gap" in global newborn health. Despite robust evidence regarding interventions for Small and Sick Newborn Care (SSNC), an estimated 2.3 million newborns die annually, with 65 countries at risk of missing Sustainable Development Goal 3.2 (reducing neonatal mortality to <12 per 1,000 live births by 2030).

• The Core Issue: There is a failure to translate evidence into practice, particularly in low- and middle-income countries (LMICs). Poor quality of care, rather than lack of access, accounts for 60% of deaths from treatable conditions.
• The Gap: While frameworks exist (e.g., WHO/UNICEF ten core components for health systems strengthening), there was a lack of dedicated knowledge management platforms that organize evidence, tools, and case studies specifically for implementing SSNC in low-resource settings. Existing resources were often fragmented, not localized, or difficult to access.

2. Methodology

The authors employed a systematic, three-step co-design process to develop the "Implementation Toolkit for Small and Sick Newborn Care" (Newborn Toolkit), facilitated by NEST360 and UNICEF.

• Step 1: Structure & Framework Design

  • Organizing Framework: The platform structure was based on the WHO/UNICEF ten core components for health systems strengthening (Leadership, Financing, HR, Infrastructure, Equipment, Data, Referral, Maternal Linkages, Family/Community, Post-discharge) plus Infection Prevention and Control (IPC).
  • Design Principles: The platform was designed to be open-access, mobile-friendly, low-bandwidth compatible, and neutral in branding to signal collaborative ownership.
  • Visual Identity: A "cog" metaphor was adopted to represent the dynamism and interrelatedness of the core components, with "Family-centered care" placed at the center.

• Step 2: Content Curation & Development

  • Working Groups: Eleven working groups (one per core component + IPC) were formed, comprising over 300 implementers (clinicians, engineers, policymakers, researchers).
  • Content Strategy: Groups curated over 1,100 resources (guidelines, checklists, floor plans, costing tools). Content was filtered for quality (peer-reviewed), practicality, and alignment with WHO/UNICEF recommendations.
  • Localization: Content was translated into French (using AI-assisted tools followed by human review) to address language barriers in high-burden Francophone regions.
  • SEO & Accessibility: An editorial team ensured Search Engine Optimization (SEO) and adherence to web accessibility standards.

• Step 3: Community Engagement & Refinement

  • Community of Practice: The toolkit was linked to a global community through:
    • Monthly Webinars: Featuring multi-disciplinary speakers and live translation (English/French).
    • Social Media & Newsletters: Targeted campaigns on LinkedIn, X, and Facebook.
    • Expert Advisory Team: Quarterly meetings to guide strategy.
    • Crowdsourcing: An annual essay contest to engage grassroots implementers.
  • Data-Driven Iteration: Monthly analytics (user demographics, device types, engagement time) and direct feedback were used to refine content and engagement strategies.

3. Key Contributions

• The Newborn Toolkit Platform: A centralized, open-access web platform (www.newborntoolkit.org) hosting 585 tools and 524 readings (as of Dec 2025) in 15 languages.
• Implementation Action Pathways: A novel feature introduced in 2024 to simplify complex systems change. These are step-wise guides for specific clinical challenges (e.g., Pain Management, Kangaroo Mother Care, Outbreak Response) that link evidence directly to actionable steps.
• Co-Design Model: A scalable model for knowledge management that integrates diverse stakeholders (from policymakers to caregivers) in the curation and refinement of evidence.
• Bridging the Language Divide: Significant effort in translating content and hosting bilingual webinars to serve Francophone Africa, a region with high neonatal mortality.

4. Key Results

• Reach & Engagement:
  • Users: Between 2021 and 2025, the platform recorded 157,452 unique users from 198 countries/territories.
  • Growth: Unique users grew from 10,273 (2022) to 62,561 (2025).
  • Geographic Distribution: High engagement in high-burden LMICs (India, Kenya, Nigeria, Tanzania, Ethiopia) as well as high-income countries (USA, UK, Australia).
• Content Utilization:
  • Most accessed resources include WHO guidelines, neonatal unit floor plans, and the ABC Neonatal Devices Planning and Costing Tool.
  • Top accessed core components: Data Systems, Equipment, Infrastructure, Human Resources, and IPC.
• Community Building:
  • 45 webinars were hosted (2022–2025), reaching nearly 3,500 viewers in 2024 alone.
  • Speakers represented a wide range of sectors (WHO, UNICEF, NGOs, government, private sector).
• Operational Success: The addition of technical staff (a neonatal doctor and bilingual nurse) in 2023 correlated with a significant spike in user engagement.

5. Significance and Future Directions

• Accelerating Implementation: The Toolkit provides a mechanism to prevent "reinventing the wheel" by offering standardized, context-adapted action pathways. This is crucial for meeting 2030 SDG targets.
• Scalability: The co-design approach demonstrates how global partnerships can operationalize complex health systems frameworks into practical digital tools.
• Challenges Identified:
  • Language Barriers: English remains the dominant language of science; while French translation is a success, further translation (Portuguese, Spanish, local dialects) is needed.
  • Infrastructure: Power shortages and limited internet in some target regions still hinder access.
  • Impact Measurement: While user engagement is high, directly measuring the impact on facility-level clinical outcomes remains a challenge.
• Conclusion: The Newborn Toolkit represents a successful shift from static evidence repositories to dynamic, community-driven implementation platforms. Future work must focus on expanding language offerings, securing sustainable funding, and developing metrics to track the translation of digital engagement into tangible improvements in newborn survival.