Table 4 Major problems and root causes for immediate newborn care and neonatal resuscitation (based on the presentation from health workers during bottleneck analysis workshop)
Major Problems | Root Cause |
|---|---|
1. All health workers not being able to perform appropriate neonatal resuscitation | 1. Many health workers not trained in neonatal resuscitation 2. Lack of positive attitude 3. Lack of initiation from health workers 4. Overburden of duty due to inadequate number 5. Low level of interest/ motivation |
2. Inadequate equipment for neonatal resuscitation service | 1. Unavailability of equipment needed for resuscitation 2. Equipment not functioning (radiant warmer, pulse oximeter) 3. Equipment not available (CPAP, neonatal ventilator) |
3. Inadequate hand-washing practice by health workers | 1. Sink not available 2. Inadequate space 3. Old/ improper infrastructure 4. Negligence of service providers |
4. Low quality of neonatal resuscitation services | 1. Adequate space to practice neonatal resuscitation unavailable 2. No supervision and monitoring of resuscitation practice 3. Improper sterilization of Ambu- bag |
5. Poor referral mechanisms | 1. Lack of training for health workers 2. Inadequate communication with higher-level health facilities |
6. Lack of routine reviews | 1. Maternal and Perinatal Death Review Committee not functioning 2. Lack of hospital governance committee |
7. Poor recording and reporting system | 1. Inadequate coordination problem between record department and others 2. Resources are not enough for a health information system 3. Training is not given to all staff according to need for recording reporting |