Abstract
<title>Abstract</title> <p>Background Neonatal mortality remains a significant global public health challenge, with 2.5 million newborns dying in their first 28 days. In low- and middle-income countries (LMICs), including Rwanda there is disparities in readiness to provide neonatal care. This study assessed neonatal care readiness in JHPIEGO-supported hospitals in the Northern Province of Rwanda, focusing on three key domains: human resources and training, infrastructure, equipment and medicines, and the availability of clinical guidelines and protocols. Methods An observational cross-sectional study design was used to assess seven hospitals, including both urban and rural facilities. Data was collected using a structured checklist based on the WHO Service Availability and Readiness Assessment (SARA) framework. Descriptive statistics were used to summarize findings, while bivariate analysis with independent t-tests and one-way ANOVA were conducted to identify the association between readiness and hospital characteristics. Results The overall readiness of each hospital was categorized as “ready” if its score was greater than or equal to 75%, and “Not ready” if the score was less than 75%. The mean readiness for the seven hospitals was 78.50% (SD ± 7.34). The hospitals had a higher score in terms of infrastructure, which was equal to 86.1% (SD ± 5.8), followed by medicines, 80% (SD ± 5.7), compared to equipment of 68.32% (SD ± 6.6). Despite the strength in infrastructure and medicine availability, equipment readiness remained a persistent weakness, averaging only 68.32%. In terms of human resources, the average number of staff assigned to the neonatal unit was 11.86(SD ± 4), with an average of only 5.86(SD ± 6) trained. The Mann–Whitney test indicated no statistically significant difference in overall readiness between urban and rural hospitals (p = 0.053). A similar pattern was observed in the human resources and training component (p = 0.053), guidelines and protocols domain (p = 0.629), and in infrastructure, equipment, and medicine readiness (p = 0.329). The Kruskal–Wallis test also revealed no statistically significant differences in overall readiness among the three types of hospitals (p = 0.134). Similarly, no statistically significant differences were observed across hospital types in relation to human resources and training readiness (p = 0.134), guideline availability (p = 0.779), or infrastructure readiness (p = 0.600). Conclusion This study highlights notable disparities in neonatal care readiness across the hospitals. While overall readiness was moderately high, critical gaps remain particularly in the availability of essential neonatal equipment and staff training. Urban and higher-level hospitals showed stronger readiness trends, though differences were not statistically significant. These findings underscore the need for targeted investments in workforce development and essential neonatal equipment to ensure equitable and quality newborn care across all facility levels.</p>