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. 2015;15 Suppl 2(Suppl 2):S4.
doi: 10.1186/1471-2393-15-S2-S4. Epub 2015 Sep 11.

Basic newborn care and neonatal resuscitation: a multi-country analysis of health system bottlenecks and potential solutions

Christabel Enweronu-Laryea, Kim E Dickson, Sarah G Moxon, Aline Simen-Kapeu, Christabel Nyange, Susan Niermeyer, France Bégin, Howard L Sobel, Anne C C Lee, Severin von Xylander, Joy E Lawn

Basic newborn care and neonatal resuscitation: a multi-country analysis of health system bottlenecks and potential solutions

Christabel Enweronu-Laryea et al. BMC Pregnancy Childbirth. 2015.

Abstract

Background: An estimated two-thirds of the world's 2.7 million newborn deaths could be prevented with quality care at birth and during the postnatal period. Basic Newborn Care (BNC) is part of the solution and includes hygienic birth and newborn care practices including cord care, thermal care, and early and exclusive breastfeeding. Timely provision of resuscitation if needed is also critical to newborn survival. This paper describes health system barriers to BNC and neonatal resuscitation and proposes solutions to scale up evidence-based strategies.

Methods: The maternal and newborn bottleneck analysis tool was applied by 12 countries in Africa and Asia as part of the Every Newborn Action Plan process. Country workshops engaged technical experts to complete the survey tool, which is designed to synthesise and grade health system "bottlenecks" that hinder the scale up of maternal-newborn intervention packages. We used quantitative and qualitative methods to analyse the bottleneck data, combined with literature review, to present priority bottlenecks and actions relevant to different health system building blocks for BNC and neonatal resuscitation.

Results: Eleven of the 12 countries provided grading data. Overall, bottlenecks were graded more severely for resuscitation. The most severely graded bottlenecks for BNC were health workforce (8 of 11 countries), health financing (9 out of 11) and service delivery (7 out of 9); and for neonatal resuscitation, workforce (9 out of 10), essential commodities (9 out of 10) and service delivery (8 out of 10). Country teams from Africa graded bottlenecks overall more severely. Improving workforce performance, availability of essential commodities, and well-integrated health service delivery were the key solutions proposed.

Conclusions: BNC was perceived to have the least health system challenges among the seven maternal and newborn intervention packages assessed. Although neonatal resuscitation bottlenecks were graded more severe than for BNC, similarities particularly in the workforce and service delivery building blocks highlight the inextricable link between the two interventions and the need to equip birth attendants with requisite skills and commodities to assess and care for every newborn. Solutions highlighted by country teams include ensuring more investment to improve workforce performance and distribution, especially numbers of skilled birth attendants, incentives for placement in challenging settings, and skills-based training particularly for neonatal resuscitation.

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Figures

Figure 1
Figure 1
Definitions and tracer interventions. Texts in italics are tracer interventions selected for the bottleneck analysis.
Figure 2
Figure 2
Basic newborn care and basic neonatal resuscitation, showing health system requirements by level of care. Hospital level image source: Christena Dowsett/Save the Children. Primary facility image source: Karen Kasmauski/MCSP. Home birth/community level image source: Michael Bisceglie/Save the Children.
Figure 3
Figure 3
Very major or significant health system bottlenecks for basic newborn care and neonatal resuscitation. NMR: Neonatal Mortality Rate. *Cameroon, Kenya, Malawi, Uganda, Bangladesh, Nepal, Vietnam. **Democratic Republic of Congo, Nigeria, Afghanistan, India, Pakistan. See additional file 2 for more details. Part A: Grading according to very major or significant health system bottlenecks for basic newborn care as reported by eleven countries combined. Part B: Grading according to very major or significant health system bottlenecks for neonatal resuscitation as reported by eleven countries combined.
Figure 4
Figure 4
Individual country grading of health system bottlenecks for basic newborn care and neonatal resuscitation. DRC: Democratic Republic of the Congo. Part A: Heat map showing individual country grading of health system bottlenecks for basic newborn care and table showing total number of countries grading significant or major bottleneck for calculating priority building blocks. Part B: Heat map showing individual country grading of health system bottlenecks for neonatal resuscitation and table showing total number of countries grading significant or major bottleneck for calculating priority building blocks.
Figure 5
Figure 5
Implementing chlorhexidine use for cord care. NMR: Neonatal Mortality Rate. DRC: Democratic Republic of the Congo.
Figure 6
Figure 6
Scaling up universal access to neonatal resuscitation. HBB: helping babies breathe. LMIC: low and middle income countries
Figure 7
Figure 7
Early and exclusive breastfeeding for every newborn. IYCF: infant and young child feeding. UNICEF: United Nations International Children's Emergency Fund. WHO: World Health Organization
Figure 8
Figure 8
Key messages and action points for basic newborn care and neonatal resuscitation. BNC: basic newborn care
See this image and copyright information in PMC

References

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