Factors affecting survival:  Mortality varies by state, urban and rural areas, and wealth. Education: Coverage of postnatal care varies by maternal education. Access to health care: Only one in three babies in Nigeria are delivered in a health center. There has been no measurable reduction in the average national neonatal mortality rate in the last decade. The poorest families have more than twice the risk of neonatal death as the richest families.

By LMIC: Nigeria is well-known for its extremely high neonatal mortality rate, putting the country at the top of the list of neediest LMICs. Daily, over 846 babies die from preventable reasons across the constituent States in Nigeria. The Niger State, located at the northwest of the middle belt, had one of the highest neonatal mortality rates prior to 2017. All Nigerian States habitually rely on federal government health centers for the special care of their growing population of needy neonates. Only one such center is in the State of Niger, yet there has been no significant progress in the entire State. This resulted in the State government taking on an extraordinary step of independently trialing the new concept of a Neonatal Rescue Scheme (NRS), powered by LMIC-compatible frugal neonatal devices and procedures.

The Amina-center, so-commissioned in 2017, has sustainably used indigenous basic medical officers and nurses who received prior short-term training on the applications of the NRS to deliver impactful services to neonates. This 6-year impact and comparative assessment study explored how the services of the Amina-center have radically transformed the Niger State’s desperate situation by reducing the facility mortality from 90/100 neonates to 4/100 neonates. This innovative program also attracted and increased the average neonatal traffic from 20 neonates/month to an astronomical 264 neonates/month. The Amina-center represents a typical transformation that could alleviate many precarious neonatal healthcare problems in every LMIC setting.

For many years, the Niger State of Nigeria has remained one of the states with the highest neonatal mortality rate in the country. Unlike most other states, Niger has the largest landmass with only one tertiary referral centre – the Federal Medical Centre (FMC) located in the town of Bida, far away from the State’s most cosmopolitan city of Minna (Fig. 1). This is a disadvantage to neonates and families who need to travel the longest distance in Nigeria to access their tertiary referral centre for any care and interventions. Therefore, Niger neonates remain the most disadvantaged newborns in Nigeria, especially when the poorly-equipped FMC-Bida is lacking in modern intervention techniques. Consequently, for many years, the Niger neonatal care providers have had to make difficult choices when sending a fragile or sick neonate on the ever-treacherous journey to facilities in neighbouring states, often without proper neonatal transport. The Niger neonates were, hence, put at the odds of high neonatal mortality – a situation of great concern to successive recent administrations that governed the State. A demographic survey of the Nigerian population commission (NPC) of 2015 identified the Niger State as a high contributor to the death of infants and children under the age of five years in Nigeria (UNICEF WHO World Bank UN Pop Div, 2015).

The inherent frustration of delivering a neonate whose probable needs could be untenable in the State precipitated a standard of practice whereby obstetricians and midwives resorted to referring high-risk pregnancies to faraway cities, often outside the State. Abject poverty and the stress for those who would attempt such journeys soon led to ever-poor outcomes. Evidently, available patient records of high-risk neonates such as preterm and low birthweight (LBW) newborns at notable General Hospitals in the State show that these classes of neonates were never fully documented. The regionally located General Hospitals in the State, by standard, are the closest medical intervention centres for needy town and rural village neonates; hence, hospital records were expected to capture their demographic data. These neonates were missing from records because they were either referred intrauterine, soon after they were born, or they never showed up because they died at home. 

All of these high-risk neonates who were not admitted due to a lack of medical expertise contribute to the number of premature and LBW neonates who may have died without documentation. A typical Niger parent was unsure of maintaining a desired family size due to the uncertainties of the survival of its young babies; therefore, family planning techniques were not an option amidst the obvious soaring newborn mortality in the State. The State seemed to be left with the only option of creating the most efficient system for neonatal survival that they could offer mothers in the State. Such an intervention system was, however, unknown in Nigeria as the national corporate neonatal situation was equally poor, having no good education to offer a State Government that is desirous of independently helping its people.

Techniques used must be robust and capable of a high success rate with a visible impact. An enduring hope for the Niger neonate would be such that a befitting approach would be sustainable. The great landmass of Niger State could make it hard to provide multiple specialised care centres near every community within the short tenure of the office of the state executive governor. However, the highly populated Minna metropolis was the best area to begin creating such hope for Niger neonates. The project was a daunting one to achieve since the absence of a medical university made the State very unattractive to specialists in the field of paediatrics and neonatology. It was obvious that some radical steps would be required if the governor was to deliver on the promise of creating better opportunities for the survival of the Niger neonate.

Therefore, the aims of the project diversified into (1) the creation of an easily accessible neonatal centre where some unique intervention techniques could be deployed with the potential of using available medical officers to drastically reduce the neonatal mortality rate within the State and (2) to conduct a milestone assessment of the impact of the technique in the State.

The initial vision was to create a special care baby unit (SCBU) at the General Hospital Minna which is located around the centre of the highly populated Niger State capital territory, Minna. The idea was that this centre could be easily accessible to many needy Niger neonates. However, the collaborative inquiries of the executives of the State government demanded to know if there were some other untried approaches for tackling the high neonatal mortality problems, other than what the corporate Nigerian healthcare system has been doing unsuccessfully for many years. The executives of the State believed that no difference might be achieved by adopting the same techniques that had failed for over thirty years since the United Nations’ Millennium Development Goals, target No.4 (MDG4) began in Nigeria, and which are still being applied unsuccessfully across the nation. Hence, the administration hoped for a potential game-changing intervention technique that could be trialed in the State, and if need be, upturn the current situation to give Niger neonates a good chance of survival. The executive governor was resolute on this but did not know how or where to find such an untried novel approach. Therefore, the patronage of all medically informed citizens of the State were solicited, including members of the State executives and their families within the rank and file of medical practice, and all the directors of the Niger State Ministry of Health (NSMOH) in searching for a novel solution.