Table 1 Summary of solution themes and proposed actions for inpatient care for small and sick newborns.
Health system building blocks | Solution Themes | Proposed actions |
|---|---|---|
Leadership and Governance | Advocacy and political will Improve organisation structures Review and disseminate guidelines | • Active involvement of national advocates (professional bodies, academic, policy makers) for care of sick newborns • Increase number of special care units and spaces in facilities for newborns • Develop national policies and guidelines for referral systems, organisational standards for sick newborn care |
Health Financing | Budget allocation Innovative funding and removal of user fees | • Increase and sustain funding for sick newborns, earmark funds within facilities caring for newborns • Expand existing maternal health schemes (end-user incentives, insurance schemes, voucher schemes) to cover inpatient care of newborns • Long term vision and health systems approach towards universal coverage for healthcare |
Health Workforce | Recruitment and Retention Competency based training Task shifting | • Develop neonatal nursing cadre with agreed standards and benchmarks • Strategies to incentivise neonatal health workers • Develop job descriptions, appropriate remuneration and career development pathways for health workers caring for newborns • Scale up of simplified, skilled based training programmes on infection prevention, feeding, provision of warmth and family centred care for newborns • Maximising existing resources, including nurses, lower level health workers and communities |
Essential Medical Products and Technologies | Essential medical list Logistic system strengthening and forecasting | • Update and implement the essential medical list to include oxygen • Inclusion of neonatal equipment and drugs in logistics systems • Strengthen oxygen systems at national and local level |
Health Service Delivery | Increase service delivery and rationalise service distribution Quality improvement and assurance Improve working conditions | • Special care baby units (or dedicated area) in every district hospital • Decentralisation of inpatient neonatal care, stable babies cared for in KMC units • Develop and harmonise quality assurance tools and carry out quality assessment of neonatal units • Provide supportive supervision and mentoring • Improve remuneration and incentives (see also, health workforce), working hours, food provision and facilities to stay |
Health Information System | Strengthening and integration of HMIS Development of indicator definitions, reporting systems, tools and Scale up audits and registers | • Integrate newborn indicators into national health information systems • Define and harmonise newborn indicators, especially care of sick newborns • Regular mortality audits in all special care and neonatal intensive care units. |
Community Ownership and Participation | Accessibility of information and community awareness Improve care seeking and linkages Male involvement | • Sensitisation on importance of newborn inpatient care and entitlements to care • Use of community volunteers, local champions and leaders • Develop local transportation solutions for families, improve patient experience in facilities and develop family-centred guidelines • Male role models in the community, inclusive policies and frameworks in facilities • Education on maternal and newborn health targeted at men |