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Table 2 Summary of solution themes and proposed actions for treatment of neonatal infections (continued).

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

Health system building block Solution themes Proposed actions
Health service delivery Mobile outreach MNH services/ post-discharge counselling
Community/home-based maternal and newborn care
Two way referral system for sick newborns
Quality assurance/ improvement mechanisms
• Ensure post-discharge counselling on danger signs for newborns;
• Scale-up newborn care at the lower level of care: Strengthen the provision of newborn care, especially sepsis case management at outpatient/primary health centre level where referral is not possible, institutionalise home visits / domiciliary care by trained personnel; Expand mobile outreach MNH services to make newborn services closer to the community
• Strengthen two way referral system for sick newborns;
• Establish quality assurance mechanisms: a quality assurance cell at the state/national level with regular quality assessments with emphasis on supportive supervision and mentoring by medical colleges and private hospitals; national scale-up of clinical audits and perinatal death reviews; Periodic critical review of appropriate management of newborn infections; Regular review and dissemination of quality of care check lists
Health information system Electronic reporting systems
Processes and evidence-based decision -making
• Develop electronic reporting system: software apps for record keeping on newborn interventions including neonatal sepsis management and establishing linkages from facility to community
• Strengthen data collection and reporting for newborn care: disaggregate the data in the health management information system to include newborn health interventions, especially management of severe neonatal infections; add community data and postnatal consultations; develop neonatal registers; and set up a monitoring system for hospital infection prevention
• Establish review processes; analyse and use data on management of neonatal infections to inform performance review meetings and for quality improvement processes
• Enhance research in newborn care: conduct bacterial surveillance and antibiotics resistance studies; conduct newborn survival analysis to inform programme managers
Community ownership and participation Development/review of local IEC materials
Fee exemption for newborn care
Community-based education for behaviour change
Male involvement
• Development/review of local IEC materials: emphasize benefits of newborn care services, mainly within the first week of life
• Fee exemption for newborn care and functional referral system as well as for maternity care.
• Strengthen community-based activities: education on hand washing and personal hygiene, behaviour change communication activities for educating caretakers on identification and prompt care seeking and to tackle harmful cultural beliefs, awareness campaigns using multiple channels to increase knowledge, demand for postnatal and community-based newborn care, and empower women.
• Engage male partners in MNH care: Encourage male participation in ANC, labour, delivery and post natal visit.