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 |