Health system readiness to support facilities for care of preterm, low birth weight, and sick newborns in Ethiopia: a qualitative assessment

Abubeker Kedir Usman,Kirsten Senturia,Abraham Tariku,Abate Yeshidinber,Eskinder Wolka,James A Litch,Alula M Teklu,Yared Tadesse,Wendemaghen Gezahegn

doi:10.1186/s12913-019-4672-2

Abstract

BackgroundPreterm birth is a worldwide challenge with the highest burden in low- and middle-income countries. Despite availability of low-cost interventions to decrease mortality of preterm, low birth weight, and sick newborns, these interventions are not well integrated in the health systems of low- and middle-income countries. The aim of this study was to assess, from the perspective of key stakeholders comprising leaders in the public health system, the health system readiness to support health care facilities in the care provided to preterm, low birth weight, and sick newborns in different regions of Ethiopia.MethodsA qualitative assessment using in-depth interviews with health facility leaders was conducted in health facilities in 3 regions of Ethiopia from December 2017 to February 2018. The interview guide was developed using a modified version of the World Health Organization health system building blocks.ResultsAcross the public health system, adequate and reliable space, power, and water were problematic. Human resource issues (training, staffing, and retention) were critical to being able to properly care for preterm, low birth weight, and sick newborns. Problems with functional equipment and equipment distribution systems were widespread. Funds were lacking to support preterm, low birth weight, and sick newborn needs in facilities. Data collection practices, data quality, and data utilization were all problematic. There were gaps in the availability of guidelines and protocols, specifically targeting preterm, low birth weight, and sick newborn care. Key facilitators, information disseminators, and influencers identified in the study were the Health Development Army, community and religious leaders, and mothers and families who had had positive experiences or outcomes of care.ConclusionsThe Ethiopian health system has opportunities across all 7 World Health Organization health system building blocks to strengthen readiness to support health facilities to provide quality care and improve outcomes for preterm, low birth weight, and sick newborns.

Highlights

Preterm birth is a worldwide challenge with the highest burden in low- and middle-income countries
This study used a modified version of the health systems building block framework to guide our assessment of the current context of services for preterm, low birth weight (LBW), and sick newborns in Ethiopia [15]
Clinical leaders were proportionally divided across all 3 regions; 50% were 26 to 30 years of age; and all were employed as midwives, nurses, health officers, heath extension workers (HEWs), or neonatologists (Table 2)

Summary

Introduction

Preterm birth is a worldwide challenge with the highest burden in low- and middle-income countries. Despite availability of low-cost interventions to decrease mortality of preterm, low birth weight, and sick newborns, these interventions are not well integrated in the health systems of low- and middle-income countries. Preterm birth is a worldwide challenge, with the highest burden in low- and middle-income countries (LMICs). Despite the availability of low-cost interventions to reduce mortality of preterm, low birth weight (LBW), and sick newborns, these interventions are not well integrated in the health systems of LMICs. Neonatal deaths are the leading cause of under-5 mortality [2], and complications of prematurity is the leading cause of neonatal mortality [3, 4]. The most common causes of death among newborns in Ethiopia are prematurity (37%), infection (28%), and asphyxia or other intrapartum events (24%) [6]

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