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

BACKGROUND: Preterm 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. Inp...

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Autores principales: Moxon, Sarah G, Lawn, Joy E, Dickson, Kim E, Simen-Kapeu, Aline, Gupta, Gagan, Deorari, Ashok, Singhal, Nalini, New, Karen, Kenner, Carole, Bhutani, Vinod, Kumar, Rakesh, Molyneux, Elizabeth, Blencowe, Hannah
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4577807/
https://www.ncbi.nlm.nih.gov/pubmed/26391335
http://dx.doi.org/10.1186/1471-2393-15-S2-S7
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author Moxon, Sarah G
Lawn, Joy E
Dickson, Kim E
Simen-Kapeu, Aline
Gupta, Gagan
Deorari, Ashok
Singhal, Nalini
New, Karen
Kenner, Carole
Bhutani, Vinod
Kumar, Rakesh
Molyneux, Elizabeth
Blencowe, Hannah
author_facet Moxon, Sarah G
Lawn, Joy E
Dickson, Kim E
Simen-Kapeu, Aline
Gupta, Gagan
Deorari, Ashok
Singhal, Nalini
New, Karen
Kenner, Carole
Bhutani, Vinod
Kumar, Rakesh
Molyneux, Elizabeth
Blencowe, Hannah
author_sort Moxon, Sarah G
collection PubMed
description BACKGROUND: Preterm 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. METHODS: The 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. RESULTS: Inpatient 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. CONCLUSIONS: Whilst 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.
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spelling pubmed-45778072015-09-23 Inpatient care of small and sick newborns: a multi-country analysis of health system bottlenecks and potential solutions Moxon, Sarah G Lawn, Joy E Dickson, Kim E Simen-Kapeu, Aline Gupta, Gagan Deorari, Ashok Singhal, Nalini New, Karen Kenner, Carole Bhutani, Vinod Kumar, Rakesh Molyneux, Elizabeth Blencowe, Hannah BMC Pregnancy Childbirth Research BACKGROUND: Preterm 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. METHODS: The 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. RESULTS: Inpatient 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. CONCLUSIONS: Whilst 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. BioMed Central 2015-09-11 /pmc/articles/PMC4577807/ /pubmed/26391335 http://dx.doi.org/10.1186/1471-2393-15-S2-S7 Text en Copyright © 2015 Moxon et al. http://creativecommons.org/licenses/by/4.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Moxon, Sarah G
Lawn, Joy E
Dickson, Kim E
Simen-Kapeu, Aline
Gupta, Gagan
Deorari, Ashok
Singhal, Nalini
New, Karen
Kenner, Carole
Bhutani, Vinod
Kumar, Rakesh
Molyneux, Elizabeth
Blencowe, Hannah
Inpatient care of small and sick newborns: a multi-country analysis of health system bottlenecks and potential solutions
title Inpatient care of small and sick newborns: a multi-country analysis of health system bottlenecks and potential solutions
title_full Inpatient care of small and sick newborns: a multi-country analysis of health system bottlenecks and potential solutions
title_fullStr Inpatient care of small and sick newborns: a multi-country analysis of health system bottlenecks and potential solutions
title_full_unstemmed Inpatient care of small and sick newborns: a multi-country analysis of health system bottlenecks and potential solutions
title_short Inpatient care of small and sick newborns: a multi-country analysis of health system bottlenecks and potential solutions
title_sort inpatient care of small and sick newborns: a multi-country analysis of health system bottlenecks and potential solutions
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4577807/
https://www.ncbi.nlm.nih.gov/pubmed/26391335
http://dx.doi.org/10.1186/1471-2393-15-S2-S7
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