Newborn care in Indonesia, Lao People’s Democratic Republic and the Philippines: a comprehensive needs assessment

Abstract

BackgroundBetween 1990 and 2011, global neonatal mortality decline was slower than that of under-five mortality. As a result, the proportion of under-five deaths due to neonatal mortality increased. This increase is primarily a consequence of decreasing post-neonatal and child under-five mortality as a result of the typical focus of child survival programmes of the past two decades on diseases affecting children over four weeks of age. Newborns are lagging behind in improved child health outcomes. The aim of this study was to conduct a comprehensive, equity-focussed newborn care assessment and to explore options to improve newborn survival in Indonesia, Lao People’s Democratic Republic (PDR) and the Philippines.MethodsWe assessed newborn health policies, services and care in the three countries through document review, interviews and health facility visits. Findings were triangulated to describe newborns’ health status, the health policy and the health system context for newborn care and the equity situation regarding newborn survival.ResultsMain findings: (1) In the three countries, decline of neonatal mortality is lagging behind compared to that of under-five mortality. (2) Comprehensive newborn policies in line with international standards exist, although implementation remains poor. An important factor hampering implementation is decentralisation of the health sector, which created confusion regarding roles and responsibilities. Management capacity and skills at decentralised level were often found to be limited. (3) Quality of newborn care provided at primary healthcare and referral level is generally substandard. Limited knowledge and skills among providers of newborn care are contributing to poor quality of care. (4) Socio-economic and geographic inequities in newborn care are considerable.ConclusionsSimilar important challenges for newborn care have been identified in Indonesia, Lao PDR and the Philippines. There is an urgent need to address weak leadership and governance regarding newborn care, quality of newborn care provided and inequities in newborn care. Child survival programmes focussed on children over four weeks of age have shown to have positive outcomes. Similar efforts as those used in these programmes should be considered in newborn care.

Successes, Challenges and Opportunities Towards Universal Health Coverage for Maternal and Child Health in South East Asian Countries: A Systematic Review

“…Among studies included in the review, a majority was from India (n=30, 48 %) . There were 11 studies from Nepal (42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52) , 10 from Bangladesh (53)(54)(55)(56)(57)(58)(59)(60)(61)(62) , six from Indonesia (63)(64)(65)(66)(67)(68) and two from Timor-Leste 69,70 . From Bhutan 71 , Thailand 72 , and Myanmar 73 one from each was identi ed.…”

“…With regard to equity on access of maternal services, inequity was detected in service delivery to migrant women working in brick kilns 33 and SC women in India 27 . There are considerable socio-economic and geographic inequities in newborn care in Indonesia 65 . In Nepal, inequity persists in care seeking for childhood diarrhea and respiratory symptoms among poor, less educated mothers over 15 years 48 .…”

“…When considering the quality of MCH care, facility readiness was detected as poor for emergency obstetric care and newborn care in public and private health facilities including primary care facilities both rural and urban areas in India, Nepal and Bangladesh 21,31,47,56 . Several studies detected inadequate infrastructure leads to poor quality in maternal and child care including family planning services in the region 12,[22][23][24]26,28,38,45,51,52,56,60,65,73 . In addition to those problems, irregular supply of water and electricity, lessfunctioning of blood bank 12 , inadequate laboratory facilities 12,56,61 were detected as challenges.…”

“…In two rural districts of Uttar Pradesh, India, process gaps are observed during delivery and post-delivery stages compromising mothers' safety and quality care 30 . Few other studies pointed out the problems with referral system for the contribution of poor quality 12,36,38,65 . According to Puett et al, referrals by community health worker of childhood conditions are treated with low quality in Southern Bangladesh institutions 60 .…”

Turning Disaster into an Opportunity for Quality Improvement in Essential Intrapartum and Newborn Care Services in the Philippines: Pre- to Posttraining Assessments

“…Prior to typhoon Haiyan, implementation of the EINC Protocol was being undertaken only in selected government hospitals and primary level facilities (rural health units and district hospitals). Inequity and system barriers to bring implementation to scale persisted despite national health policies being in place [9]. Neonatal mortality rate (NMR) reported in the National Demographic and Health Survey (NDHS 2013) [10] was 13 per 1000 live births nationally and 15, 18, and 10 per 1000 live births in Western, Central, and Eastern Visayas regions, respectively.…”