NICHE International is a small UK-registered medical charity working alongside healthcare professionals and partner organisations to improve the care of newborn babies in resource-scarce settings.

Our work focuses on practical neonatal education. The Neonatal Care Course covers essential aspects of care during the first weeks of a baby’s life, including resuscitation at birth, breastfeeding, skin-to-skin care, keeping babies warm and recognising and managing illness.

The course has been developed for use in settings where resources may be limited, using practical approaches and simple equipment. NICHE International has worked alongside healthcare professionals in Cameroon, Liberia, Zimbabwe, India and Uganda, forming long-term partnerships and adapting training to local circumstances.

But for NICHE, delivering a training course is only part of the story.

Building skills that can continue locally

A central part of NICHE International’s approach is supporting local healthcare professionals to become instructors themselves.

By developing local instructors, encouraging peer-to-peer practice and supporting continuing professional development, skills and knowledge can be shared with more colleagues and become embedded within local healthcare services.

This is important to NICHE because sustainable training is not about arriving, delivering a course and leaving. It is about working alongside local colleagues over time, supporting local ownership and creating the conditions for training to continue independently. NICHE describes this approach as a route towards training self-sufficiency, with local faculties eventually able to deliver both the Neonatal Care Course and instructor development themselves.

A recent journey by Grace in Cameroon shows what that ongoing support can look like in practice.

Returning to Mbam

Last year, Grace delivered neonatal training at the health centre in Mbam, a remote village in the North West Region of Cameroon. You can read about her first trip at Neonatal Care Course in a remote village in Cameroon – NICHE International. This month, she made the long journey back to visit the health centre, see how the team were getting on and take them a baby manikin so that staff can continue practising newborn resuscitation skills.

Reaching Mbam is no straightforward journey. Grace first travelled overnight by bus, followed by four-wheel drive and motorbike. On this visit, difficult road conditions made the journey even more challenging. The vehicle broke down in the mud and Grace continued by motorbike for around eight hours.

The photographs she sent give a glimpse of both the journey and the health centre she was returning to.

Communication presents another challenge. There is no phone network in Mbam, so Grace had to climb a nearby hill to find enough signal to send an update and share the photographs from her visit. Behind those extraordinary practical details is something very important: follow-up.

Training does not end when the course finishes

Clinical skills need to be practised and refreshed. Providing the health centre with a baby manikin means staff have an opportunity to continue practicing newborn resuscitation after formal training has ended. Grace’s return also gives colleagues an opportunity to discuss how things are progressing and to maintain the connection established during the original training.

This reflects NICHE International’s wider approach. The charity aims not only to provide neonatal training, but also to support healthcare professionals to share knowledge, practise together and develop the local teaching capacity needed for training to continue in the longer term. The charity’s Trustees’ Report identifies training local instructors and encouraging peer-to-peer skills practice as central to making its programmes sustainable.

NICHE also recognises that learning is collaborative. Healthcare professionals working in their own communities bring knowledge and experience that visiting instructors do not have. The charity’s approach therefore emphasises partnership, mutual learning and locally led solutions rather than one-way teaching.

Grace’s visit to Mbam is a simple but powerful example of that principle in action: returning, listening, supporting practice and helping locally led neonatal education continue.

Supporting NICHE International

NICHE International is a small charity supported by volunteers, fundraising and charitable donations. Its volunteer instructors include doctors, nurses and resuscitation officers with clinical and teaching experience, who give their time to support neonatal education and instructor development. Donations help NICHE continue working alongside healthcare professionals and partner organisations, supporting training, instructor development and the practical resources needed to maintain skills.

If you would like to support NICHE International, you can donate, fundraise for the charity, share its work with others or help raise awareness of its approach to sustainable newborn care education.

Find out more about donating to NICHE International here:

Support NICHE International

Thank you to Grace and to the healthcare team in Mbam for sharing this update and for their continuing commitment to newborn care.

NICHE collects feedback on increased confidence levels in certain skills taught on the Neonatal Care Course. Proving that neonatal mortality is falling as a result of our project is our long-term aim but measuring this outcome is a challenge.  There are so many confounding factors in any clean data that is actually collected that it is almost impossible to prove that one intervention like this has any statistically significant effect on neonatal mortality. 

It is more productive to measure shorter term outcomes which are known to correlate positively with an improvement in neonatal survival.  We gather feedback from our learners on the usefulness of the course, their prior experience, suggestions for the future etc. but also on their increase in confidence levels in the practice of various skills taught on the course.  The template for our feedback forms is based on one promoted by the UK’s Royal College of Paediatrics and Child Health for use on training courses.

Variations in self-confidence are known to influence motivation and tend to predict performance success. Research has shown that health professionals with confidence are more likely to “have a go” at things they have learnt about and, with this attitude and an appropriate level of supervision, will come increasing competence over time.

The increase in confidence in managing premature babies is particularly important in Zimbabwe where preterm births make up a higher percentage of neonatal deaths than in other comparable countries for reasons which are not immediately clear.

Some of the free text comments:

The course was empowering and I feel confident to handle any neonatal cases also teach the practical skills as this is part of my work.  I liked the unique practical sessions with a lot of activity and practise.  Thanksyou!

I liked the use of CPAP and cleaning of filters. I also liked the delay to remove baby on skin to skin for baby to find its mother’s breast. Thank you for teaching us and giving us knowledge.  Call again.

I liked that the course was very interactive.  The small groups are really useful in boosting confidence. I enjoyed the simulations & a safe environment for learning, not testing/examining.

The course taught a lot abnout management of neonates and how to identify problems associated with newborns.  i suggest the course continue to be done to more health care workers conry wide to promote neborn care and reduce neonatal mortaity.

The facilittors explaained really well and were really knowledgeable aand encouraging.  Gained a vast amount of practical skills and my confidence has improved greatly.  Maybe if the course could be longer to gsin more skills.

the course was very informative and educative empowering me to care for the baby preterm, unwell and how to improvise CPAP machine using the oxygen concentrator very good to know about it. I was well equipped with the information and like to meet the whole group.  You were excellent teachers

Very educative, felt empowered. God bless you all.

Feedback is always good about the method of teaching and content and it is rewarding to see that people felt supported and safe. We always receive comments about the course needing to be longer (but can’t do much about that). We removed the assessment element this time round and we were pleased to see a positive comment on that. I personally am delighted to see the word “empower” appear throughout the feedback because – for me – that is what it is all about: empowering the frontline healthcare workers (including ourselves) to change practices for the good of the babies we are all so motivated to help.

“Good evening team, I would to express my sincere gratitude to all of you. Your dedication and commitment to the program will always be cherished. We learned a lot in the past 2 days. The knowledge and skills you have impacted in each and every one of us will go a long way in the reduction of neonatal deaths here at Murambinda . May the Mighty Lord bless you and your families. I wish you a safe travel.” Matron

45 healthcare staff have been trained on the Neonatal Care Course and 12-15 people were identified as having instructor potential. We were incredibly well looked after in Murambinda and none of us wanted to leave! All team members are now safely back in our respective countries (Uganda, UK and Cameroon) and hoping to be part of the instructor training faculty who returns to Zimbabwe later this year or early in 2027.

We’ve had another good day today – very keen learners including some senior nurses and midwives from the hospital and nurse tutors from the on site nursing training school. We were shown around the hospital afterwards and were delighted to see the space being set up as a neonatal unit in the maternity department. And, of course, the Kangaroo Mother Care (KMC) facility with a very happy new mother and baby snuggled up under a blanket together.

We always invite people to come early on Day 2 of the Neonatal Care Course to practice their bag-valve-mask skills. We weren’t necessarily expecting all of them! They are a very keen group.

Course number 2 starts tomorrow here in Murambinda, Zimbabwe.

It is an appropriate day to say that nurses from 4 different countries are together teaching and learning on a Neonatal Care Course in Zimbabwe run by NICHE International.

In many countries, nurses with extended skills are critical in caring for newborn babies.   They are sometimes working in places where there are no doctors with specialist skills, so their ability to manage vulnerable neonates is invaluable.  They also help to train colleagues to improve the standards of care in neonatal units.

Elizabeth, who comes from Uganda, is one of the NICHE trainers currently in the Queen of Peace Mission Hospital, Murambinda running Neonatal Care Courses. 

At home in Uganda, Elizabeth is head of paediatric nursing at the Bwindi Community Hospital in South -West Uganda.

The Kampala International University Surgical Society photographed Elizabeth with a sick baby when they visited Bwindi,  and have published the photo to mark International Nurse’s day.

“Joining the NICHE Team to Zimbabwe this time was one of the most exciting moments in my life. Knowing how much the knowledge from NCC has saved lives of our babies in Cameroon gives me the zeal to be part of the team to teach NCC in New communities. My desire is that all Sub Saharan African (SSA) countries should receive this basic knowledge of NCC before 2030 so that we in SSA countries can be able to meet the Sustainable Development Goal of reducing the neonatal mortality to 12/1000 live births.”

Elizabeth and Grace are particularly good at their “ice breakers”, little activities to break up a run of lectures and keep people awake. Here is this morning’s:

Men have to sit down if the word begins with “M” and women have to sit down if it begins with “F” (for female). Amazing how difficult it is to remember if one is a man or a woman!

Day 1 was a great success overall. The learners were very well engaged and seemed to enjoy the day. There was much discussion in the workshops about how to best support mothers and babies here in Murambinda.

We’re ready for the off. We are expecting 24 learners – nurses, midwives and doctors – on the course starting tomorrow and 24 more for course 2. It’s a privilege to be here and we are looking forward to sharing our skills this week.