Table 1 Five-pronged framework for understanding and preventing Maternal-Neonatal morbidity and mortality in low income countries

• Prevention of vertical transmission of infections

• Prediction and Preventing intra-partum related neonatal morbidity and mortality

• Vaccines against causes of early neonatal sepsis especially Group B

Streptococcus and other diseases including HIV|AIDS

• Chemoprophylaxis against GBS

• Effective prevention of mother to child transmission of congenital infections including HIV|AIDS

• Barrier preventions e.g provisions of LLITNS^a

• Family planning, education and economic empowerment of women

• Specific focus on adolescent girls

❖ Addressing delays in decision to seek care

• Education on danger signs during pregnancy and early neonatal life

• Community engagement through behavioral change and communication strategies

• Demand of care creation

❖ Addressing delays in reaching point of care once decision is made

• financial incentives e.g. transport refunds

• facility output-based financing approaches

• referral systems that can help minimize delays that contribute to HIE^b

• use of community cadres

❖ Addressing delays in provision of quality services at point of care

• point of care quality improvement approaches

• continuous investment in in-service skills development

• operational research on how to best offer care at point of service delivery

• More research on the role of facility improvement teams

• Continuous direct investments in health systems building blocks

• Exploring adjunct treatment options for infections and HIE

❖ Post-discharge follow up and rehabilitation

• expanding of human resource for health cadres with rehabilitation skills (occupational, physiotherapy,& psyscho-social support) in LICS

• surveillance systems for post-discharge complications and or sequelea

• specific follow up and treatment of obstetrics complications including obstetric fistulas

• Ongoing support where long-term impairments are anticipated