Progress towards Every Newborn Action Plan (ENAP) implementation in Iran: obstacles and bottlenecks

Fariba Mirbaha-Hashemi,Zahra Rampisheh,Batool Tayefi,Omid Pournik,Arash Tehrani-Banihashemi,Mohammad Heidarzadeh,Abbas Habibelahi,Rahim Taghizadeh-Asl,Mozhdeh Ramezani,Narjes Khalili,Maziar Moradi-Lakeh

doi:10.1186/s12884-021-03800-x

Abstract

BackgroundNeonatal mortality accounts for more than 47% of deaths among children under five globally but proper care at and around the time of birth could prevent about two-thirds of these deaths. The Every Newborn Action Plan (ENAP) offers a plan and vision to improve and achieve equitable and high-quality care for mothers and newborns. We applied the bottleneck analysis tool offered by ENAP to identify obstacles and bottlenecks hindering the scale-up of newborn care across seven health system building blocks.MethodsWe applied the every newborn bottleneck analysis tool to identify obstacles hindering the scale-up of newborn care across seven health system building blocks. We used qualitative methods to collect data from five medical universities and their corresponding hospitals in three provinces. We also interviewed other national experts, key informants, and stakeholders in neonatal care. In addition, we reviewed and qualitatively analyzed the performance report of neonatal care and services from 16 medical universities around the country.ResultsWe identified many challenges and bottlenecks in the scale-up of newborn care in Iran. The major obstacles included but were not limited to the lack of a single leading and governing entity for newborn care, insufficient financial resources for neonatal care services, insufficient number of skilled health professionals, and inadequate patient transfer.ConclusionsTo address identified bottlenecks in neonatal health care in Iran, some of our recommendations were as follows: establishing a single national authorizing and leading entity, allocating specific budget to newborn care, matching high-quality neonatal health care providers to the needs of all urban and rural areas, maintaining clear policies on the distribution of NICUs to minimize the need for patient transfer, and using the available and reliable private sector NICU ambulances for safe patient transfer.

Highlights

We interviewed national experts and key informants including the head of Iranian Society of Neonatology in Tehran, the director and experts at the national office of neonatal care at Ministry of Health and Medical Education (MoHME) in Tehran, relevant key informants from the United Nations Children’s Fund (UNICEF)
The main identified bottlenecks for scaling-up neonatal care in Iran were as follows: Leadership and governance Participants in this study pointed out many challenges in the leadership and governance of neonatal care in the country
It was indicated that many decisions are made by politicians who are focused on their political short-term goals

Summary

Introduction

Neonatal mortality accounts for more than 47% of deaths among children under five globally but proper care at and around the time of birth could prevent about two-thirds of these deaths. The Every Newborn Action Plan (ENAP) offers a plan and vision to improve and achieve equitable and high-quality care for mothers and newborns. The Every Newborn Action Plan (ENAP) was launched in 2014 as a global roadmap that provides a strategic plan to achieve equitable and high-quality care for mothers and newborns. It offers a clear vision of how to improve newborn health by 2035. This roadmap helps eliminate preventable newborn mortality through global and national plans, evaluation, and accountability frameworks [3, 4]. All startegic goals and dimensions of ENAP have been integrated with a special focus on “reducing inequties”, “improving quality” and “counting everynewborn through measurement, programme-tracking and accountability”

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