Table 2 Priority actions for country implementation of the Every Newborn Action Plan (ENAP) to improve quality of care by health system building block.
Health Systems Building Blocks | Priority actions | Interventions (n = 9) where >75% of countries identified health system building block as a priority | Milestone for 2020 |
|---|---|---|---|
Leadership and Governance | • Develop national newborn action plans or strategies that could be standalone plans or an integral part of reproductive, maternal, newborn, child and adolescent health or broader health sector plans. • Clearly define targets for maternal mortality ratio and neonatal mortality and stillbirth rates in national plans in line with the global Every Newborn Action Plan (ENAP) and Ending Preventable Maternal Mortality strategy. | 1 (KMC) | National plans and targets for reducing newborn mortality rate, stillbirth rate and maternal mortality ratio. |
Health Financing | • Allocate specific line items for newborn care in national and subnational health budgets. • Ensure financial health protection schemes cover the costs of care for newborns. | 6 (SBA, CEmOC, BNC, KMC, Treatment of infections, Inpatient care of small and sick newborns) | Budget lines and insurance schemes outlining care for newborns especially the small and sick newborns included in national plans. |
Health Workforce | • Develop and implement long term (5 and 10 year) costed human resource plans that outline country strategies for the training, distribution and retention of health workers particularly midwives, neonatal nurses and neonatologists. | 5 (SBA, Neonatal Resuscitation, KMC, Treatment of neonatal infections, Inpatient care of small and sick newborns) | Train and retain the health workforce to provide quality care around the time of birth. |
Essential Medical Products and Commodities | • Ensure that national essential drugs and commodity lists include the maternal newborn drugs and commodities identified by the United Nations Commission on Life Saving Commodities. • Strengthen procurement and supply systems to improve availability of supplies. | 2 (ACS, Neonatal resuscitation) | Essential drugs for maternal newborn interventions included in national drugs lists and strengthen procurement and supply systems. |
Health Service Delivery | • Establish global standards for quality care around the time of birth and implement through adaptation to country specific models to ensure sustainability. | 6 (BEmOC, CEmOC, ACS, BNC, neonatal resuscitation, KMC) | Establish and implement quality standards of care. |
Health Information Systems | • Include ENAP core indicators in country-led health management information systems. • Establish audit mechanisms in countries ensuring a minimum perinatal dataset is defined. • Strengthen civil and vital registration systems (CVRS) in countries to ensure that every newborn receives a birth certificate. | 2 (ACS, Treatment of infections) | ENAP core metrics in country Health Management Information System and establish perinatal audit mechanisms. |
Community ownership and partnership | • Transform social norms to improve care seeking for mothers and newborns, and reduce perceptions of fatalism that all small and sick newborns will die. • Engage with communities to demand quality care for every woman and every newborn as a basic human right. | 3 (KMC, Treatment of infections, Inpatient care of small and sick newborns) | Transform social norms to demand quality care for every mother and newborn. |