Implementation Lessons from a Multifaceted National Newborn Program in Solomon Islands: A Mixed-Methods Study

Abstract

Multifaceted interventions are important in improving neonatal quality of care and health outcomes. This study describes the implementation of an intervention to improve the quality of newborn care in Solomon Islands, a small island developing state and lower middle-income country in the Western Pacific. Inputs included training, equipment provision, and healthcare system organizational changes. For evaluation, we used a mixed-methods design, using quantitative (audits of health facility equipment, structure, and organization) and qualitative (semi-structured interviews and focused group discussions with healthcare workers) methods. Participants highlighted the practical, interactive, coaching style of training and its short duration as positive features in establishing skills. Training had indirect impacts through improving culture of the workplace, and the evaluation provided a valuable opportunity for reflection of the implementation process for healthcare workers. Facility limitations from equipment deficits and poor condition of clinical areas had implications by limiting the provision of quality care, as well as contributing to healthcare workers feeling undervalued. Resuscitation of a nonbreathing baby was a stressful experience for many health workers, compounded by geographic isolation and feeling unsupported. Our findings highlight the importance of training methodology, impact from structural limitations, and experience of resuscitation for the healthcare worker. Attention to these factors may help the design and implementation of newborn care programs in similar contexts.

Quality newborn care in East New Britain, Papua New Guinea: measuring early newborn care practices and identifying opportunities for improvement

“…A study which assessed the quality of newborn care in five facilities in a neighbouring Pacific island country, the Solomon Islands, found that whilst essential medicines were generally available [ 56 ], other barriers to quality newborn quality care were consistent with those identified in our study including workforce limitations, equipment supply, and lack of infection control measures. A subsequent study by the same research team involved implementation of an intervention to improve the quality of newborn care, specifically through training, equipment provision and health system organisation changes, finding enhanced skills and an improved workplace culture as a result of the training [ 57 ].…”

A narrative review of course evaluation methods for continuing professional development: The case of paediatric and neonatal acute-care in-service courses in low and lower-middle income countries: BEME Guide No. 76

“…Equipment such as bag-valve-mask availability can be audited pre-and post-course, including after an Early Essential Newborn course in Solomon Islands (Tosif et al 2020) and a Service Availability and Readiness Assessment pre-and post-HBB in Rwanda (Umunyana et al 2020). A large study involving 13,169 participants at HBB courses in Tanzania performed 335 facility and equipment checklists to determine whether, for example, a bag-valve-mask and suction devices were present in every delivery area (Arlington et al 2017).…”