Objective: Providing quality health care is what all health facilities seek to achieve. Accreditation of health services are used to assess and improve the quality of health care in different settings. This study describes experiences of developing and conducting accreditation for excellence in newborn care in district hospitals in KwaZulu-Natal (KZN), South Africa following a 3-year programme of support to all nurseries in KZN. Methods: A facility review was conducted in district hospitals in KZN to evaluate the quality of care provided to newborn babies to accredit hospitals in newborn care. Multiple tools were used to assess different components of care from different perspectives, including record reviews, assessment of staff skills and interviews with mothers. Awarding accreditation was based on scores achieved in various domains, which contributed to an overall score. Compliance with key priority indicators was required for accreditation to be awarded. Results: Overall scores for accreditation ranged between 57%-93%. Mothers reported high levels of satisfaction with care received. Record reviews identified shortfalls in care provided, and skills assessments showed poor resuscitation skills in labour wards in some hospitals. Of 39 district hospitals, eight were awarded silver and five were awarded gold accreditation status. Conclusions: This accreditation of newborn care provides a workable model for undertaking accreditation in district hospitals and can be used by managers to identify and address shortfalls in care. Regular accreditation would support ongoing quality improvement (QI) in neonatal care and such a process could be applied to other aspects of care in health facilities.

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Midwives are, and have always been, the backbone of maternity services care. By virtue of this position, midwives should take the lead in restructuring maternity care, with special focus on provision of women-centred postnatal care. Postnatal care is one of the most important maternal healthcare services, not only for prevention of mortality but also for the reduction of impairment and disabilities associated with childbirth. The postnatal period is described as a critical period for both the mother and the baby, and numerous research studies have shown that maternal mortality is higher during the postnatal period than during antenatal and intrapartum periods. In South African as in many other settings, significant breastfeeding challenges have also been cited particularly in HIV positive women. Utilization of postnatal care by women influences their own and their children's lives, in terms of reducing repeat pregnancies and increasing effective contraceptive use. Midwives have a vital role to recognize the strengths of the community and families and establish working partnerships to improve health seeking behaviours, which will strengthen postnatal care after discharge from health facilities. This continued support will result in improved health care for women and their newborn babies that will ultimately contribute towards the reduction of mortality and morbidity.

Loosely defined, stakeholders are "users" or "implementers" of the guidelines and consisted of district medical officers, primary health care nurses, district MCWH coordinators , midwives, advanced midwives, nurse educators, and representatives from program management. This group also included parties who had an interest in the outcome of the project. Key informants are subject experts who helped to inform and guide the process, particularly with regard to specific technical areas. Stakeholders and key informants also helped to identify relevant provincial and district staff who formed several task teams arranged according to a number of themes identified for special consideration and planning. Despite their busy schedules and the concomitant challenges, meetings were well attended and all districts were represented. Key Informants Key informants are subject experts who helped to inform and guide the process, particularly with regard to specific technical areas. Key informants consisted of 15 academics and researchers. These experts included individuals who were conducting research in the field of antenatal and postnatal care, including conducting trials on PMTCT, individuals with experience in