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Table 3 Summary of bottlenecks and solution themes

From: Understanding health systems to improve community and facility level newborn care among displaced populations in South Sudan: a mixed methods case study

Health system building block Subcategory Common bottlenecks Solution themes
Leadership & governance Policy and planning Absence of strategies to address premature babies and neonatal sepsis • Review and improve existing policies, and sensitize health officials and donors on newborn care
Supervision Non-local staff had restricted access to sites during acute conflict or evening hours • Increase hiring of local staff who can provide continuous newborn care
Health financing Policy Newborn-specific interventions are outside of humanitarian response • Advocate for donors to include newborn care in humanitarian funding opportunities • Increase knowledge among program managers to integrate newborn interventions in maternity programs
Health workforce Skilled care Shortage of skilled health workers to continuously provide comprehensive package of interventions • Authorize task-shifting where appropriate and invest in training institutions
Training Lack of training for recent graduates from national institutions on newborn care • Integrate comprehensive curricula on newborn care into national institutions
Number and distribution of CHWs Limited coverage and wide scope of work to conduct home visits in first 48 h after birth • Increase number of CHWs to meet Sphere standards or dedicate cadre for maternal and newborn activities by transitioning TBAs to CHWs
Essential medical commodities Integration Lack of newborn supplies in Inter-agency Reproductive Health Kits • Coordinate with UN agencies to integrate newborn commodities into existing supply chains
Supply chain management Stock out of supplies in facilities over time • Improve tracking of supplies and improve forecast of newborn supply needs to buffer for times of acute crisis
Health service delivery Infrastructure Limited space for neonatal admissions • Prioritize standards to allocate hygienic areas for newborn care
Clinical protocols Unavailability of higher-level health workers to care for small and sick newborns • Adopt simpler protocols for mid-level cadre to take on additional responsibilities
Referral system Poor quality of care for small and sick newborns at referral facilities Lack of access to referral facilities (transport and distance) • Strengthen newborn care at primary care level • Partner with security personnel (e.g. UN peacekeepers) to plan for referrals during insecurity
Health information system Quality Incomplete registers and limited data on neonatal admissions • Integrate critical newborn health indicators in donor reporting • Introduce pictorial registers for illiterate health workers
Community engagement Personal beliefs Barriers to handling newborns by CHWs • Increase awareness and engagement of community leaders