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Table 1 Summary of solution themes and proposed actions for treatment of neonatal infections.

From: Treatment of neonatal infections: a multi-country analysis of health system bottlenecks and potential solutions

Health system building block Solution themes Proposed actions
Leadership and governance Policy/guidelines review, harmonisation and dissemination
Task shifting policy
Harmonisation and dissemination of guidelines
• Review / formulation of policies and strategies: integration of neonatal care within integrated management of childhood illnesses (IMCI) and scale up of this at primary care level;
• Shifting care and treatment at the outpatient level where referral is not possible- Expansion/implementation of community-based MNH programmes
• Harmonise guidelines for management of neonatal infections at all level of care: engage professional bodies and private health care institutions
• Ensure effective dissemination of guidelines (workshops, websites)
Health financing Funding for newborn health
National insurance schemes expansion
• Increase budget allocated for newborn health: ensure adequate resources for trainings of health workers, laboratory services, and commodities including injectable antibiotics
• Expand health insurance schemes to address out-of-pocket payments: expansion of community-based health insurance schemes (e.g.: inclusion of fees required at teaching hospitals and for laboratory tests into insurance schemes
Health workforce Local recruitment of health workers
Institutionalisation of incentives
Competency-based skilled based pre-service and in-service training
• Recruit local staff residing in the community to expand the availability of health care workers in all areas
• Motivate health providers through institutionalisation of incentives to improve their retention in rural and hard to reach areas such as improved welfare packages or wages, hardship allowances, pay for performance
• Conduct large scale pre-service and in-service trainings of health care workers in newborn care including management of neonatal infections; enhance the quality of trainings provided through supervision, mentoring and certification systems; involve medical colleges and institutions; train community-based health care workers in newborn care for home visits and identification of sick young infants
Essential medical products and technologies Procurement and supply chain management system
Quality control mechanisms
• Strengthen the national procurement and supply system: Forecast adequate amount of injectable antibiotics according to the needs for treatment and based on the buffer to be kept; Streamline the procurement process including fast tracking of essential commodities; Special equipment like, Continuous positive airway pressure, portable x-ray, and arterial blood gas analyser should made available for tertiary care centres;
• Establish quality control mechanisms: Auditing of medical stores; facility assessments of those reporting frequent stock-outs; assessment of the quality of antibiotics in the bidding process; ensure the delivery of quality products; Develop an electronic logistic management system