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Table 9 Facility-Based Strategies and Constraints

From: Global report on preterm birth and stillbirth (7 of 7): mobilizing resources to accelerate innovative solutions (Global Action Agenda)

Overarching Goal: By 2015 all community members will have timely access to effective, affordable and high-quality facility-based MNCH care provided by informed and responsive HWs as part of an integrated and equitable system to reduce perinatal mortality and morbidity
  Milestones*  
Output Post-Conference (by 2010) Short-Term (by 2012) Intermediate (by 2015) Long-Term (beyond 2015) Success Metrics
A. Obtain funding dedicated to a prioritized research agenda 1. Develop a comprehensive conceptual framework: accountability, referral, organization, regulatory interventions
2. Develop a complete set of research questions and submit these to the CHNRI process, producing a manuscript with priorities for research
3. Develop protocols answering top questions
4. Obtain funding for priority research studies
5. Build in-country research capacity
6. Conduct research and disseminate results
7. Research findings aredisseminated and effectively incorporated into health policy 8. Research agenda is regularly updated to incorporate changes in technology, demographics, burden of disease and costs • Priority research items receive funding
• Manuscript developed for publication
B. Provide quality care for all community members attending health facilities 1. Define packages and integrate with existing ones
2. Set standards
3. Increase the availability of existing packages
4. Get stakeholder buy-in
5. Develop capacity to implement in-country
6. Conduct situation analysis at country level
7. Create district map of availability of interventions (2010)
8. Choose and estimate the cost of solutions
9. Identify constraints (e.g., capacity, political will)
10. Create intervention plan (2011)
11. Implementation and scale up of facility interventions in a large number of countries 12. Ongoing: Evaluate, monitor indicators • Defined country-level packages
• Mapped gaps in facility- based care
• Strategy implementation
• Monitoring and evaluation of quality indicators
C. All facilities provide core packages of MNCH services at first and referral levels; Quality facility-based care is accessible to all mothers, newborns and children in a timely manner 1. Complete GAPPS review of prioritized facility-based interventions 2. Define package for each level
3. Conduct situation analysis
4. Identify measurable targets
5. Establish clear policy for no point-of-care payment
6. Use public-private partnership to make private MNC services available to all at no cost to families (e.g., vouchers)
7. Provide community support in using services and community ownership of facilities
8. Secure funding
9. Engage civil society to ensure accountability
10. Existing facilities provide the appropriate package of care in all countries: 1) policy on the importance of facilities for achieving MDGs 4 and 5; 2) human resources - task shifting, capacity building, deployment motivation; equipment, supplies, maintenance, infrastructure; managerial - 24/7 services; funding
11. Government covers family costs in accessing care (e.g., transport)
12. Establish new facilities to ensure adherence to benchmarks (population/ facility ratio) Note: All 5 components from intermediate-term milestones apply here as well
13. Improve transportation where needed
14. Facilities establish close communities in excess of population-facility ratio benchmarks
• Proportion of facilities meeting defined standards
• Facility to population ratio (overall, by geographic regions and disaggregated by underserved populations)
• Proportion of facilities where there is no point of care fee
• Proportion of facilities where the governing body has adequate community leadership
  1. *Milestones are to be reached by no later than December of the year indicated.
A GLOBAL ACTION AGENDA ON PRETERM BIRTH AND STILLBIRTH