Table 2 Summary of innovative approaches to maternal and newborn health care by building block

Health service delivery

Quality improvement

• Management and leadership skills development activities

• Safe childbirth checklist, a standardized protocol for MNH care

• Implementation of redesigned care model/protocol based on selected evidence-based recommendations and women’s views

• Collaborative quality improvement of a network of sites working together

• Comprehensive intervention packages based on quality improvement approaches (including certifications, delivery of services, incentives, promotion, etc.)

• UNICEF Safe motherhood programme

• Special care newborn units to provide high quality care

• Infection control programme to reduce nosocomial infections

• Package of MNH interventions at institutional level

• Mental health care for pregnant women using existing primary care resources

• Provision of equipment and training to facilities

• Community education on maternal health

• Application of quality of care model from family planning to EmOC

Skin-to-skin care / kangaroo mother care

• Community-based kangaroo mother care

• Kangaroo mother care implementation tool to monitor progress

• Implementation of kangaroo mother care in government hospitals

• Use of facilitation to implement kangaroo mother care in hospitals

MNH nutrition

• New micronutrient supplementation programs (e.g. zinc, iron, calcium)

• Positive deviance approach to improve antenatal nutrition

Breastfeeding

• Innovative promotion strategies (e.g. postnatal visits, counselling by community volunteers, mass media) and delivery systems (e.g. baby-friendly hospitals, peer facilitators) including mainstreaming breastfeeding into the scale-up of MNH

Prenatal care

• Maternity waiting homes, some combined with MCH services and income generation activities

• Yoga for high risk pregnancies

• Education for first time childbearing women

• Group prenatal care

Medical products and health technologies

Maternal

• Non-pneumatic anti-shock garment to stabilize and resuscitate hypovolemic shock

• Automated blood pressure devices for low resource settings

• Single use obstetric emergency kits

• Misoprostol for community-based use, storage and application system for oxytocin delivery and balloon condom catheter to treat intractable uterine bleeding

• Foilized polyethylene pouch to store neviparine

• Low-cost, low-tech devices: portable OB ultrasound and Doppler, simplified partograph, vacuum delivery/EmOC devices, birth simulator, cell-phone-based malaria diagnostics, hemoglobinmeter, EmOC transporter (eRanger)

• Clean delivery kits

Neonatal

• Low-cost devices: ventilator support, temperature measurement, pulse oximeter and phototherapy

• Devices to prevent PMTCT (e.g. breastfeeding shields)

• Application of chlorhexidine for umbilical cord care

• Topical application of emollients to reduce nosocomial infections and mortality

• Thermoprotection mechanisms: cot-nursing using heated water-filled mattress, infant warmers, wraps and foils

Health workforce

Training

• E-learning via internet and phone text messages

• Training of community health worker cadres in tasks previously not assigned: antenatal care, safe delivery, neonatal resuscitation, essential newborn care and PMTCT care, IMNCI

• Low-technology obstetric and neonatal resuscitation simulation training (e.g. Helping Babies Breathe Programme)

• Training programs/courses for trainers and providers in antenatal care, EmOC, essential newborn care and neonatal resuscitation: Making Pregnancy Safer, Promoting Effective Perinatal Care, WHO Essential Newborn Care, acute care of at-risk newborns, Perinatal Continuing Education Programme, Essential Surgical Skills Emergency MCH Programme

• Partnering international professional organizations for training of providers

• Training TBAs in antenatal care, safe delivery, neonatal resuscitation and essential newborn care, use of delivery mat and misoprostol

• Training of nurses: quality improvement tools, oxytocin use

Task-shifting to non-physicians

• Non-physician clinicans to provide EmOC

• Anaesthesia services provided by mid-level cadres

• NICU newborn aides to help staffing problems

• Pictorial job aids used by providers

Health financing

Enhancing demand for MNH services

• Conditional cash transfers

• Cash incentives for skilled delivery at facility

• Vouchers for maternal health services and related costs (e.g. transport costs and cash payment for delivery at facility)

• Community-based health or obstetric insurance

• Abolition or reduction of user fees

Incentives for health workers to increase supply and quality of services

• Performance-based payment

• Free reimbursement for training and costs

Community ownership and participation

Women’s groups and community-based intervention packages

• Women’s groups convened by female facilitators to identify problems and formulate solutions

• Female community health worker outreach

• Community/home-based intervention packages including pregnancy, delivery and ENC components

Linkage between community and facility

• Integration of newborn care into existing community-based package and national health system

• Creating a network of providers/CHWs

Community mobilisation

• Community-based quality improvement process involving learning and problem-solving cycle

• Home-based care and linkages to facility based services including distribution and use of misoprostol, recognition of danger signs, improvements in transport

• Community participatory learning activities

• Positive deviance behavior change activities

Leadership and governance

Partnerships

• Public-private partnerships, international/regional partnerships and inter-agency task teams to create capacity for MNH care

National MNH policies

• Health system reforms

• Use of research, data and policies to develop community-based newborn care package/national newborn strategy and influence high-profile champions to act

• Integration of skilled birth attendance into national plan/policy

• Increase in political commitment

• Rights-based programming and micro-planning strategy to increase access, coverage and quality of MNH care

• Use of situation analysis to develop newborn action plan