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

Abstract

BackgroundAn 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.MethodsThe 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.ResultsEleven 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.ConclusionsBNC 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.

Using quality improvement to decrease birth asphyxia rates after ‘Helping Babies Breathe’ training in Kenya

“…Globally, facility deliveries are not associated with a subsequent reduction in perinatal mortality due to key quality gaps, including inadequate staffing, widespread use of inexperienced trainees as front line workers and overcrowded facilities (12)(13)(14)(15)(16)(17)(18).…”

An Assessment of High Delivery Load Facilities under the Dakshata Program

“…There are no clear guidelines from the government to decide from the state level regarding the rational distribution of human resources on the basis of the delivery load. Under the every newborn action plan, A study was conducted in 12 countries of Asia and Africa that also suggested that newborn resuscitation bottleneck is more severe than for essential newborn care [5]. The study also stated that neonatal resuscitation services are more critical at the district level.…”

“…India is also facing the problem regarding lack of availability of trained and skilled health workers in terms of ANMs, SNs and doctors [4]. Redistribution of human resources in the facilities at the district level has a critical role thereafter [5]. Availability of human resources and its distribution in a country has great impact.…”

“…Demand for health services in countries depends upon various characteristics such as economic factors, sociodemographic characteristics, etc. [5,6]. There are no clear guidelines from the government to decide from the state level regarding the rational distribution of human resources on the basis of the delivery load.…”

“…Many models have been adopted worldwide to increase the efficiency of the health system for example outsourcing, contractual, etc. [5,6]. Filler et al [7] also found that critical steps of resuscitation have not being followed and improved education and further training on resuscitation need to be imparted in labor room team [6].…”