Inpatient care of small and sick newborns: a multi-country analysis of health system bottlenecks and potential solutions

Abstract

BackgroundPreterm birth is the leading cause of child death worldwide. Small and sick newborns require timely, high-quality inpatient care to survive. This includes provision of warmth, feeding support, safe oxygen therapy and effective phototherapy with prevention and treatment of infections. Inpatient care for newborns requires dedicated ward space, staffed by health workers with specialist training and skills. Many of the estimated 2.8 million newborns that die every year do not have access to such specialised care.MethodsThe bottleneck analysis tool was applied in 12 countries in Africa and Asia as part of the Every Newborn Action Plan process. Country workshops involved technical experts to complete the survey tool, which is designed to synthesise and grade health system "bottlenecks" (or factors that hinder the scale up) of maternal-newborn intervention packages. For this paper, we used quantitative and qualitative methods to analyse the bottleneck data, and combined these with literature review, to present priority bottlenecks and actions relevant to different health system building blocks for inpatient care of small and sick newborns.ResultsInpatient care of small and sick newborns is an intervention package highlighted by all country workshop participants as having critical health system challenges. Health system building blocks with the highest graded (significant or major) bottlenecks were health workforce (10 out of 12 countries) and health financing (10 out of 12 countries), followed by community ownership and partnership (9 out of 12 countries). Priority actions based on solution themes for these bottlenecks are discussed.ConclusionsWhilst major bottlenecks to the scale-up of quality inpatient newborn care are present, effective solutions exist. For all countries included, there is a critical need for a neonatal nursing cadre. Small and sick newborns require increased, sustained funding with specific insurance schemes to cover inpatient care and avoid catastrophic out-of-pocket payments. Core competencies, by level of care, should be defined for monitoring of newborn inpatient care, as with emergency obstetric care. Rather than fatalism that small and sick newborns will die, community interventions need to create demand for accessible, high-quality, family-centred inpatient care, including kangaroo mother care, so that every newborn can survive and thrive.

Pulse oximetry values of neonates admitted for care and receiving routine oxygen therapy at a resource‐limited hospital in Kenya

“…While promising, such devices are unlikely to be available in low‐resource settings in the near future. Additional strategies for improved oxygen targeting are needed for these settings, where nurses are few and workload is high 47, 48. Furthermore, wider availability of pulse oximeters in facilities is essential.…”

A hidden burden of neonatal illness? A cross-sectional study of all admissions aged less than one month across twelve Kenyan County hospitals

“…Where research has been conducted within resource-limited healthcare environments, concerns have been raised about the quality of care that neonates receive in this non-specialised paediatric setting where care may focus on the needs of older patient groups 4, 5 . As part of efforts to address the persistently high mortality among newborns in low-income countries, it will be important to ensure that small and sick newborns are receiving care in the most appropriate setting with access to specialised staff and equipment 1, 3 .…”

What does the literature tell us about health workers' experiences of task‐shifting projects in sub‐Saharan Africa? A systematic, qualitative review

“…Recent research suggests that although the provision of rural healthcare interventions is an important part of reducing neonatal mortality, inpatient neonatal care is also a major contributing factor and should be targeted (Moxon et al . ).…”