Scaling up newborn care in Afghanistan: opportunities and challenges for the health sector

Abstract

Newborn health in Afghanistan is receiving increased attention, but reduction in newborn deaths there has not kept pace with declines in maternal and child mortality. Using the continuum of care and health systems building block frameworks, this article identifies, organizes and provides a synthesis of the available evidence on and gaps in coverage of care and health systems, programmes, policies and practices related to newborn health in Afghanistan. Newborn mortality in Afghanistan is related to the nation's weak health system, itself associated with decades of conflict, low and uneven coverage of essential interventions, demand-side and cultural specificities, and compromised quality. A majority of deliveries still take place at home. Birth asphyxia, low birth weight, perinatal infections and poor post-natal care are responsible for many preventable newborn deaths. Though the situation has improved, there remain many opportunities to accelerate progress. Analyses conducted using the Lives Saved Tools suggest that an additional 10 405 newborn lives could be saved in Afghanistan in 5 years (2015-20), through reasonable increases in coverage of these high-impact interventions. A long-term vision and strong leadership are essential for the Ministry of Public Health to play an effective stewardship role in formulating related policy and strategy, setting standards and monitoring maternal and newborn services. Promotion of equitable access to health services, including health workforce planning, development and management, and the coordination of much-needed donor support are also imperative.

Facility level factors that determine consistent delivery of essential newborn care at health centers in Ethiopia

“…The working environment at health facilities (32) and negative attitudes of health workers towards pregnant women directly affects the quality of care (29). Regularly monitoring these and striving for improvement is an in uencing factor on the likelihood of success for any facility.…”

Quality of essential newborn care and neonatal resuscitation at health facilities in Afghanistan: a cross-sectional assessment

“…Despite substantial improvements, the Islamic Republic of Afghanistan still has unacceptably high newborn mortality, estimated at 40 per 1000 live births 1 2. Addressing maternal and newborn mortality is among the highest priorities of the Government of Afghanistan 3 4. The leadership of the Ministry of Public Health (MoPH) has emphasised the need to improve quality, access and ensure equitable delivery of life-saving maternal and child health interventions in the community and health facilities 4…”

“…Assessing quality of care requires an understanding of the national programme and policies, facility readiness, health worker competencies, health worker–patient interactions, user experiences and the environment in which services are provided 13–15. Although there have been many assessments of facility readiness and health service capacity in Afghanistan, including a 2010 National Emergency Obstetric and Newborn Care needs assessment at first-line referral facilities and annual assessments of BPHS and EPHS facilities, there have been no large-scale facility assessments in documenting the quality of essential newborn care and compliance with global clinical practice standards 3 16 17…”

Getting health information to internally displaced youth in Afghanistan: can mobile phone technology bridge the gap?

“…Child and maternal mortality remain critical public health issues, with higher rates in rural settings compared to urban 3 . Though some newborn and child health statistics have improved, immunization and nutrition indicators lag behind other countries regionally and vary markedly 3 – 5 between provinces and urban and rural settings. Total fertility rate (TFR) among Afghan women, which contributes to maternal mortality, is also high at 5.3 children per woman, and age at first birth is low (median 20.1 years) with 12% of girls ages 15–19 years initiating childbearing 3 .…”