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Table 1 Main Constraints to Scaling Up Preterm Birth and Stillbirth Interventions in LMICs

From: Global report on preterm birth and stillbirth (4 of 7): delivery of interventions

Level of Constraint Types of Constraints
Community and • Insufficient demand for effective and available interventions
Household Level • Barriers to use of effective interventions (e.g., physical, financial, and sociocultural)
Health Services Delivery Level • Shortage and distribution of appropriately qualified healthcare providers
  • Weak technical guidance, program management and supervision
  • Inadequate pharmaceutical products and medical supplies
  • Lack of equipment and infrastructure
  • Poor accessibility of health services
Health Sector Policy and • Weak and overly centralized systems for planning and management
Strategic Management Level • Lack of competent district health management teams
  • Weak drug policies and supply system
  • Inadequate regulation of pharmaceutical and private sectors
  • Improper industry practices
  • Poorly functioning health information systems
  • Lack of intersectoral action and partnership for health between government, industry and civil society
  • Weak incentives to use inputs (e.g., medicines and laboratory tests) efficiently and respond to user needs and preferences
  • Difficulty in scaling up successful interventions to the national level
  • Monitoring and evaluating programs
  • Reliance on donor funding that reduces flexibility and ownership
  • Donor practices that damage country policies
Public Policies Cutting • Government bureaucracy (civil service rules and remuneration, centralized management system, civil service reforms)
Across Sectors • Poor availability of communication and transport infrastructure
Visibility of the Problem • Lack of data on the magnitude of preterm birth and stillbirth
     - broad measurement issues (e.g., sources of data)
     - need for better operational definition of stillbirth
     - need to distinguish antepartum and intrapartum deaths
     - need for better measurement of preterm birth (i.e., not based on birth weight)
     - better identification of preterm birth and low birth weight
  • Lack of political visibility of the problem of preterm birth and stillbirth at country and international levels
Environmental and • Governance and overall policy framework
Contextual Characteristics    - corruption, weak government, weak rule of law and enforceability of contracts
     - political instability and insecurity
     - weak ministry of health
     - low priority attached to social sectors
     - weak structures for public-sector accountability
     - lack of free press
  • Physical environment
     - climatic and geographic predisposition to disease
     - physical environment unfavorable to service delivery
  1. Source: Hanson, K., et al., Victora, C.G., et al. [2, 3]