Scaling up quality care for mothers and newborns around the time of birth: an overview of methods and analyses of intervention-specific bottlenecks and solutions.

Kim E Dickson,Sarah G Moxon,Bernadette Daelmans,Matthews Mathai,Christabel Nyange,Gaurav Sharma,A Metin Gülmezoglu,Nabila Zaka,Joy E Lawn,Joanne Ashton,Aline Simen-Kapeu,Kate J Kerber,Martina Baye,Mary V Kinney

doi:10.1186/1471-2393-15-s2-s1

Abstract

BackgroundThe Every Newborn Action Plan (ENAP) and Ending Preventable Maternal Mortality targets cannot be achieved without high quality, equitable coverage of interventions at and around the time of birth. This paper provides an overview of the methodology and findings of a nine paper series of in-depth analyses which focus on the specific challenges to scaling up high-impact interventions and improving quality of care for mothers and newborns around the time of birth, including babies born small and sick.MethodsThe bottleneck analysis tool was applied in 12 countries in Africa and Asia as part of the ENAP process. Country workshops engaged technical experts to complete a tool designed to synthesise "bottlenecks" hindering the scale up of maternal-newborn intervention packages across seven health system building blocks. We used quantitative and qualitative methods and literature review to analyse the data and present priority actions relevant to different health system building blocks for skilled birth attendance, emergency obstetric care, antenatal corticosteroids (ACS), basic newborn care, kangaroo mother care (KMC), treatment of neonatal infections and inpatient care of small and sick newborns.ResultsThe 12 countries included in our analysis account for the majority of global maternal (48%) and newborn (58%) deaths and stillbirths (57%). Our findings confirm previously published results that the interventions with the most perceived bottlenecks are facility-based where rapid emergency care is needed, notably inpatient care of small and sick newborns, ACS, treatment of neonatal infections and KMC. Health systems building blocks with the highest rated bottlenecks varied for different interventions. Attention needs to be paid to the context specific bottlenecks for each intervention to scale up quality care. Crosscutting findings on health information gaps inform two final papers on a roadmap for improvement of coverage data for newborns and indicate the need for leadership for effective audit systems.ConclusionsAchieving the Sustainable Development Goal targets for ending preventable mortality and provision of universal health coverage will require large-scale approaches to improving quality of care. These analyses inform the development of systematic, targeted approaches to strengthening of health systems, with a focus on overcoming specific bottlenecks for the highest impact interventions.

Highlights

The Every Newborn Action Plan (ENAP) and Ending Preventable Maternal Mortality targets cannot be achieved without high quality, equitable coverage of interventions at and around the time of birth
Intervention-specific bottlenecks across the health systems building blocks Table 2 provides an overview of which health system building blocks are ranked the most severely for each intervention package by all countries
Community ownership and partnership Our analysis identified community ownership and partnership as a priority area for sick newborns including the treatment of neonatal infections, kangaroo mother care (KMC) and inpatient care for sick newborns

Summary

Introduction

The Every Newborn Action Plan (ENAP) and Ending Preventable Maternal Mortality targets cannot be achieved without high quality, equitable coverage of interventions at and around the time of birth. This paper provides an overview of the methodology and findings of a nine paper series of in-depth analyses which focus on the specific challenges to scaling up high-impact interventions and improving quality of care for mothers and newborns around the time of birth, including babies born small and sick. Available interventions can prevent many of these deaths [5], but interventions often face challenges to scale up, many of which are specific to context or the intervention [4] Understanding these specific challenges is critical to aid countries to intentionally focus their efforts and resources to achieve the effective, high quality coverage of interventions that are needed to save women and newborns, and to prevent stillbirths. Achieving the targets requires functioning health systems, integrated planning and delivery to ensure efficient, high quality and effective health services for women and children [4]

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