Table 3 Summary of bottlenecks and solution themes

Leadership & governance

Policy and planning

Absence of strategies to address premature babies and neonatal sepsis

• Review and improve existing policies, and sensitize health officials and donors on newborn care

Supervision

Non-local staff had restricted access to sites during acute conflict or evening hours

• Increase hiring of local staff who can provide continuous newborn care

Health financing

Policy

Newborn-specific interventions are outside of humanitarian response

• Advocate for donors to include newborn care in humanitarian funding opportunities

• Increase knowledge among program managers to integrate newborn interventions in maternity programs

Health workforce

Skilled care

Shortage of skilled health workers to continuously provide comprehensive package of interventions

• Authorize task-shifting where appropriate and invest in training institutions

Training

Lack of training for recent graduates from national institutions on newborn care

• Integrate comprehensive curricula on newborn care into national institutions

Number and distribution of CHWs

Limited coverage and wide scope of work to conduct home visits in first 48 h after birth

• Increase number of CHWs to meet Sphere standards or dedicate cadre for maternal and newborn activities by transitioning TBAs to CHWs

Essential medical commodities

Integration

Lack of newborn supplies in Inter-agency Reproductive Health Kits

• Coordinate with UN agencies to integrate newborn commodities into existing supply chains

Supply chain management

Stock out of supplies in facilities over time

• Improve tracking of supplies and improve forecast of newborn supply needs to buffer for times of acute crisis

Health service delivery

Infrastructure

Limited space for neonatal admissions

• Prioritize standards to allocate hygienic areas for newborn care

Clinical protocols

Unavailability of higher-level health workers to care for small and sick newborns

• Adopt simpler protocols for mid-level cadre to take on additional responsibilities

Referral system

Poor quality of care for small and sick newborns at referral facilities

Lack of access to referral facilities (transport and distance)

• Strengthen newborn care at primary care level

• Partner with security personnel (e.g. UN peacekeepers) to plan for referrals during insecurity

Health information system

Quality

Incomplete registers and limited data on neonatal admissions

• Integrate critical newborn health indicators in donor reporting

• Introduce pictorial registers for illiterate health workers

Community engagement

Personal beliefs

Barriers to handling newborns by CHWs

• Increase awareness and engagement of community leaders