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Table 1 Summary of solution themes and proposed actions for inpatient care for small and sick newborns.

From: Inpatient care of small and sick newborns: a multi-country analysis of health system bottlenecks and potential solutions

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