Table 1 Category of health system building blocks assessed, and assessment criteria

Availability of services

• Twenty-four hours delivery services, immediate newborn care services, KMC, breastfeeding support, and sick newborn care services

Referral services

• Functional ambulance or other vehicles on-site for referrals, availability of fuel in the vehicle, mechanism or system to make phone calls available all the time, and availability of mobile phone/landline numbers on-site for communication during the referral

Training on neonatal resuscitation

• Number of health workers who received training on neonatal resuscitation before

Availability of human resource for newborn care services

• Availability of duty roster (24-hour clock), availability of staffs on their designated shifts, availability of a skilled person in conducting deliveries present at the hospital or on-call round the clock, including weekends and public holidays to provide delivery service, availability of obstetrician to respond to complicated deliveries 24 h a day, and availability of pediatrician to respond to complicated deliveries 24 h a day

Availability of essential equipment

• Monitoring equipment (stethoscope with neonatal chest piece, non-invasive BP monitors, heart rate/apnea monitor, pulse oximeter, low reading clinical thermometer, room thermometer, electronic baby weighing scale, mechanical baby weighing scale)

• Equipment for management (radiant warmer, phototherapy unit, CPAP, ventilator, glucometer)

• Resuscitation equipment (self-inflating bags, foot-operated suction pumps/ mucus traps, penguin suction, bag and mask)

Infrastructure (electricity, water supply)

• Designated area for; labor room, operating theatre, postnatal ward, newborn corner, KMC corner/unit, SNCU/NICU, breastfeeding corner, hand-washing space (labor ward), hand-washing space (SNCU/NICU), boiling and autoclaving, laundry, clean utility room, soiled utility room, store, laboratory room, doctor’s room, nurses room

• Any in-patient in the maternity ward shared beds at any time before or after delivery in the last three months

• Any patients in the maternity ward slept on the floor in the last three months

• Any maternity patient delivered on the floor in a corridor or bathroom due to lack of beds in the last three months

Information system

• Routine audits or case reviews on maternal deaths

• Routine audits or case reviews on newborn deaths/stillbirths

• System in place to regularly collect maternal and neonatal health service data

• Display of newborn care related data

Governance

• Availability of hospital governance committee

• Frequency of the meetings of hospital governance committee in a year

• Number of work/action plans created by hospital governance committee