This analysis documents the impact of implementing the NEST Model at the Saint Jean de Dieu Hospital in Tanguiéta, Benin, between 2022 and 2024. It presents evidence of measurable improvements in neonatal survival, quality of care, governance, and continuity between hospital and community services. The publication is available in English and French.
The Paolo Chiesi Foundation is publishing a new impact evaluation on the implementation of its NEST Model (Neonatal Essentials for Survival and Thriving) at the Saint Jean de Dieu Hospital in Tanguiéta, northern Benin. Available in both English and French, the publication documents how a district hospital, operating in a resource-limited context, has achieved measurable and sustained improvements in the quality of neonatal care.
Covering the period from 2022 to 2024, with additional analysis also of the first quarter of 2025 to assess the trends, this analysis examines the evolution of clinical practices, infrastructure, governance, and outcomes, drawing on hospital data, external evaluations, and feedback from healthcare professionals and families.
A systemic approach to neonatal care
The NEST Model is built on a systemic vision of quality, structured around four interdependent pillars: Place, Products, People, and Power. Rather than focusing on isolated interventions, the model addresses neonatal care as a coordinated system, where infrastructure, equipment, competencies, and leadership progress together.
At Tanguiéta, this approach has guided both the consolidation of an existing neonatology unit and its progressive transformation into a regional reference center serving northern Benin and neighboring countries, including Togo, Burkina Faso, and Niger. The program aligns with Benin’s National Health Plan (2018–2030) and the global objectives of Sustainable Development Goals and Every Woman Every Newborn Everywhere.
From consolidation towards maturity
Following a strategic relaunch in 2022, the partnership between the Paolo Chiesi Foundation and the Saint Jean de Dieu Hospital focused on stabilizing core functions and addressing critical gaps. Priority actions included reinforcing infection prevention and control, restructuring Kangaroo Care, upgrading essential equipment, and re‑establishing regular mortality audits supported by clinical data.
Between 2023 and 2024, the NEST Model entered a phase of expansion and systemic integration. Equipment availability improved, staff training intensified, and post‑discharge home visits were formally introduced to strengthen continuity of care beyond hospital discharge.
By early 2025, the model had reached a level of operational maturity characterized by consolidated practices, full integration of digital data management, and consistent use of quality indicators to guide decision‑making.
Measurable improvement in care and survival
Between 2022 and 2024, the Saint Jean de Dieu Hospital in Tanguiéta recorded 3,229 neonatal admissions, with more than 1,000 newborns admitted each year (1,075 in 2022, 1,076 in 2023 and 1,078 in 2024). This confirms the hospital’s role as a key referral center for northern Benin and neighboring countries, including Togo, Burkina Faso and Niger.
Over the same period, overall neonatal mortality decreased significantly, from 33.2% in 2022 to 19.9% in 2024, with a positive downward trend also observed in the first quarter of 2025. Mortality fell from 25.4% to 17.8% among inborn newborns and from 42% to 22.7% among outborn newborns. The marked reduction among outborn newborns may be partly attributable to the decrease in the number of outborn infants weighing less than 1,500 grams. Nevertheless, despite being on average heavier than inborn newborns, outborn newborns continued to show higher mortality in 2024, at 22.7% compared with 17.8% among inborn newborns.
Among infants weighing less than 1,500 grams, mortality also decreased, although it remained high. It fell from 71.4% to 45.5% among inborn newborns and from 71.6% to 39% among outborn newborns.
The analysis suggests that this trend may be associated with several combined factors, including a reduction in cases of asphyxia and infection, as well as improvements in clinical management during hospitalization.
Clinical progress, with persistent challenges
Looking at clinical conditions at admission, hypothermia rates remained low and stable over time. Asphyxia decreased from 33.3% to 23.7%, with reductions observed among both inborn and outborn newborns, and particularly among outborn newborns. This trend may partly reflect the lower number of outborn infants weighing less than 1,500 grams. Infection rates remained high, although they decreased from 71.3% to 61.5%, with a similar downward trend among both inborn and outborn newborns. Jaundice also decreased, while respiratory distress increased slightly, particularly among inborn newborns; this may be linked to the higher proportion of very low birthweight infants among inborn admissions.
Deaths occurring within the first seven days of life — the most critical period for a newborn — also decreased over the period analysed. This points to stronger early clinical management and improved capacity to care for newborns during the most fragile phase of hospitalization
Strengthening life-saving care and continuity after discharge
The improvement in neonatal outcomes was accompanied by greater use of life-saving interventions, including CPAP ventilation, and by the development of a continuum of care linking the hospital and the community through post-discharge home visits.
Kangaroo Care has become a central component of the model in Tanguiéta, promoting zero separation between newborns and caregivers, breastfeeding support and thermal stability, particularly for the most vulnerable newborns. Structured home visits, introduced progressively from 2023, have further strengthened the connection between hospital and community, helping reduce loss to follow-up and support the early identification of complications after discharge.
Overall, the results show an improvement in neonatal outcomes within an evolving care system, while also pointing to persistent challenges, especially the high burden of infections and the complexity of the cases treated.
Building skills, governance, and local ownership
Data‑driven governance has played a central role. The use of a dedicated neonatal database, combined with regular mortality audits and infection control reviews, has enabled teams to identify gaps, adapt practices, and document progress over time. This culture of accountability underpins the sustainability of results.
Federica Cassera, Neonatal Health Program Manager at the Foundation, observed: “After years of dedicated effort in the region, we are now seeing the tangible outcomes of our commitment. Tanguiéta stands as compelling evidence that the Model is effective, with clear, measurable improvements in neonatal care and survival. These results are a testament to the professionalism and perseverance of our teams and partners, and to the power of pursuing quality through a systems-based approach. Importantly, behind every statistic is a real child—a newborn whose life has been allowed not only to survive, but to thrive. It is this human dimension, the hope and transformation experienced by families, that truly defines the significance of our work.”
A model for replication
The Tanguiéta experience demonstrates that a district hospital can achieve high standards of neonatal care when quality is addressed as a system. The NEST Model’s modular structure allows for adaptation to different contexts and progressive scaling, starting from essential functions and building toward comprehensive care.
The evaluation outlines opportunities for replication at national and regional levels, positioning Tanguiéta as a demonstration and learning site within the wider NEST network. Its results confirm that targeted investments, aligned with strong local leadership and rigorous monitoring, can translate global commitments into measurable improvements for newborns and families.
The full document is available in English and French and offers detailed insights for health authorities, practitioners, and partners committed to improving neonatal survival and care quality in low‑resource settings.
