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

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fariba Mirbaha-Hashemi ◽  
Batool Tayefi ◽  
Zahra Rampisheh ◽  
Arash Tehrani-Banihashemi ◽  
Mozhdeh Ramezani ◽  
...  
Keyword(s):  
Action Plan ◽  
Scale Up ◽  
Newborn Care ◽  
Building Blocks ◽  
Neonatal Care ◽  
Patient Transfer ◽  
Analysis Tool ◽  
System Building ◽  
Bottleneck Analysis ◽  
Health System Building Blocks

Abstract Background 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. 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. Methods We 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. Results We 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. Conclusions To 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.

scholarly journals A Bottleneck Analysis of Care and Feeding of the Small and Sick Newborn in Malawi: Findings and Proposed Solutions (P11-100-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Patricia Welch ◽  
Justine Kavle ◽  
Florence Bwanali ◽  
Kanji Nyambo ◽  
Neena Khadka
Keyword(s):  
Health System ◽  
Action Plan ◽  
National Level ◽  
Building Blocks ◽  
Analysis Tool ◽  
Baby Friendly Hospital Initiative ◽  
National Policies ◽  
Bottleneck Analysis ◽  
Sick Newborn ◽  
Provision Of Care

Abstract Objectives The objectives of this bottleneck analysis are to 1) Diagnose bottlenecks at the health facility and health system levels in the provision of care and feeding of the small and sick newborn (SSNB) within the context of the Baby Friendly Hospital Initiative (BFHI) in Malawi, 2) Provide recommendations to address the identified bottlenecks. Methods The Every Newborn Action Plan (ENAP) bottleneck analysis tool was adapted to provide an increased focus on care and feeding of the SSNB. Using the adapted bottleneck analysis tool, we conducted facility-based observations and interviews with clinical and supervisory staff at eight hospitals to assess for bottlenecks at the facility level. To identify health system bottlenecks, interviews were conducted with key district- and national-level Ministry of Health personnel, and a desk review of key national nutrition and child health policies and guidelines was conducted. Information collected from interviews and extracted from national policies and guidelines were collated and analyzed for the presence/absence of significant bottlenecks. Results Significant bottlenecks were similar across the eight hospitals and included: unskilled staff in feeding concerns of the SSNB; overburdened and understaffed hospitals; lack of feeding cups for infants who are unable to suckle; limited space in the maternity ward for mothers and other caregivers to be present and feed their infant; no job aids or supportive supervision protocols or guidelines around care of the SSNB; no national policies in place to ensure monitoring of care of the SSNB. Key actions to address the identified bottlenecks are presented — including task shifting, improving mechanisms for monitoring care of SSNBs, and capacity-building of health providers — with consideration around how they could be implemented through Malawi's existing and scaled Baby-Friendly Hospital Initiative platform. Conclusions This assessment revealed the need to strengthen the provision of care and feeding of the SSNB. Addressing gaps in each of the six ENAP building blocks will be critical for improving newborn nutrition and health outcomes, and Malawi's already existing BFHI platform could provide an ideal platform for addressing the identified bottlenecks. Funding Sources United States Agency for International Development (USAID).

scholarly journals Evaluating and strengthening the health system of Curaҫao to improve its performance for future outbreaks of vector-borne diseases

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Vaitiare Mulderij-Jansen ◽  
Izzy Gerstenbluth ◽  
Ashley Duits ◽  
Adriana Tami ◽  
Ajay Bailey
Keyword(s):  
Qualitative Study ◽  
Health System ◽  
Health Systems ◽  
Building Blocks ◽  
Entomological Surveillance ◽  
Vector Borne Diseases ◽  
System Building ◽  
Vector Borne ◽  
Dutch Caribbean ◽  
Health System Building Blocks

Abstract Background Vector-borne diseases (VBDs) such as dengue, chikungunya, and Zika pose a significant challenge to health systems in countries they affect, especially countries with less developed healthcare systems. Therefore, countries are encouraged to work towards more resilient health systems. This qualitative study aims to examine the performance of the health system of the Dutch Caribbean island of Curaҫao regarding the prevention and control of VBDs in the last decade by using the WHO health system building blocks. Methods From November 2018 to December 2020, a multi-method qualitative study was performed in Curaçao, applying content analysis of documents (n = 50), five focus group discussions (n = 30), interviews with experts (n = 11) and 15 observation sessions. The study was designed based on the WHO framework: health system building blocks. Two cycles of inductive and deductive coding were employed, and Nvivo software was used to analyse the data. Results This study’s data highlighted the challenges (e.g. insufficient oversight, coordination, leadership skills, structure and communication) that the departments of the health system of Curaҫao faced during the last three epidemics of VBDs (2010–2020). Furthermore, low levels of collaboration between governmental and non-governmental organisations (e.g. semi-governmental and private laboratories) and insufficient capacity building to improve skills (e.g. entomological, surveillance skills) were also observed. Lastly, we observed how bottlenecks in one building block negatively influenced other building blocks (e.g. inadequate leadership/governance obstructed the workforce's performance). Conclusions This study uncovers potential organisational bottlenecks that have affected the performance of the health system of Curaҫao negatively. We recommend starting with the reinforcement of oversight of the integrated vector management programme to ensure the development, implementation and evaluation of related legislation, policies and interventions. Also, we recommend evaluating and reforming the existing administrative and organisational structure of the health system by considering the cultural style, challenges and barriers of the current health system. More efforts are needed to improve the documentation of agreements, recruitment and evaluation of the workforce's performance. Based on our findings, we conceptualised actions to strengthen the health system's building blocks to improve its performance for future outbreaks of infectious diseases. Graphical abstract

scholarly journals Health System Building Blocks and Organ Transplantation in India

2021 ◽  
Vol 105 (8) ◽  
pp. 1631-1634
Author(s):  
Smita Divyaveer ◽  
Sanjay Nagral ◽  
K.T. Prasad ◽  
Ashish Sharma ◽  
Vivekanand Jha
Keyword(s):  
Health System ◽  
Organ Transplantation ◽  
Building Blocks ◽  
System Building ◽  
Health System Building Blocks

scholarly journals Evaluating and Strengthening the Health System of Curaҫao to Improve its Performance for Future Outbreaks of Infectious Diseases.

2021 ◽  
Author(s):  
Vaitiare Mulderij-Jansen ◽  
Izzy Gerstenbluth ◽  
Ashley Duits ◽  
Adriana Tami ◽  
Ajay Bailey
Keyword(s):  
Qualitative Study ◽  
Infectious Diseases ◽  
Health System ◽  
Building Blocks ◽  
Healthcare Systems ◽  
Management Program ◽  
Entomological Surveillance ◽  
Vector Borne Diseases ◽  
System Building ◽  
Health System Building Blocks

Abstract BackgroundVector-borne diseases (VBDs) such as dengue, chikungunya, and Zika pose a significant challenge to health systems in countries they affect, especially countries with less developed healthcare systems. Therefore countries are encouraged to strengthen their healthcare systems to achieve more resilient systems. This qualitative study aims to examine the performance of the health system of the Dutch Caribbean island of Curaҫao with regards to the prevention and control of VBDs in the last decennium by using the WHO health system building blocks.MethodsFrom January 2019 to February 2020, a multi-method qualitative study was performed in Curaçao., applying content analysis of documents (n = 50), five focus group discussions (n = 30), interviews with experts (n = 11), and fifteen observation sessions. The study was designed based on the WHO framework: health system building blocks. Two cycles of inductive and deductive coding were employed, and Nvivo software was used to analyse the data.ResultsThis study’s data highlighted the challenges (e.g., insufficient oversight, coordination, leadership skills, structure, and communication) that the departments of the health system of Curaҫao faced during the last three epidemics of VBDs (2010–2020). Furthermore, low levels of collaboration between governmental and non-governmental organisations (e.g., semi-governmental and private laboratories) and insufficient capacity building to improve skills (e.g., entomological, surveillance skills) were also observed. Lastly, we observed how bottlenecks in one building block negatively influenced other building blocks (e.g., inadequate leadership/governance obstructed the workforce's performance).ConclusionsThis study uncovers potential organisational bottlenecks that have affected the performance of the health system of Curaҫao negatively. We recommend starting with the reinforcement of oversight of the integrated vector management program to ensure the development, implementation, and evaluation of related legislation, policies, and interventions. Also, we recommend evaluating and reform the existing administrative and organisational structure of the health system by taking the cultural style, challenges, and barriers of the current health system into account. More efforts are needed to improve the documentation of agreements, the recruitment, and evaluation of the workforce's performance. Based on our findings, we conceptualised actions to strengthen the health system's building blocks to improve its performance for future outbreaks of infectious diseases.

scholarly journals Neonatal care practices in Buikwe District, Uganda: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Marte Bodil Roed ◽  
Ingunn Marie Stadskleiv Engebretsen ◽  
Robert Mangeni
Keyword(s):  
Health Workers ◽  
Post Partum ◽  
Newborn Care ◽  
Neonatal Care ◽  
Sub Saharan Africa ◽  
Cord Clamping ◽  
Care Practices ◽  
Sub Saharan ◽  
Skin To Skin ◽  
User Perspectives

Abstract Background Sub-Saharan Africa is the region with the highest neonatal mortality rate, with Uganda reporting 20 deaths per 1000 live births. The Uganda Clinical Guidelines (UCG) from 2016 have detailed descriptions on care for mothers and their newborns during pregnancy, delivery and the post-partum period. The objective of the study was to identify provider and user perspectives regarding the knowledge of and adherence to the UCG recommendations in aspects of delivery and newborn care, both in cases of normal as well as complicated births. Methods The study used qualitative methods with data collection from participant observations, interviews with key-informants and focus group discussions. Malterud’s Systematic Text Condensation (STC) was used for analysis. Results The study found low knowledge about the UCG among the health workers. Various discrepancies between performed hands-on-procedures and the UCG were found related to neonatal care practices, including low use of partograms, uncertainty around timing for cord clamping, routine oronasopharyngeal suction of newborns and inadequate implementation of skin-to-skin care. Conclusions Continued focus on systemic strategies for further implementation of the UCG is recommended.

scholarly journals Diagnostics and monitoring tools for noncommunicable diseases: a missing component in the global response

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Antonio Bernabé-Ortiz ◽  
Jessica H. Zafra-Tanaka ◽  
Miguel Moscoso-Porras ◽  
Rangarajan Sampath ◽  
Beatrice Vetter ◽  
...  
Keyword(s):  
Health System ◽  
New Technologies ◽  
Action Plan ◽  
Building Blocks ◽  
Communicable Diseases ◽  
Noncommunicable Disease ◽  
World Health ◽  
Noncommunicable Diseases ◽  
Diagnostic Tools ◽  
Monitoring Tools

AbstractA key component of any health system is the capacity to accurately diagnose individuals. One of the six building blocks of a health system as defined by the World Health Organization (WHO) includes diagnostic tools. The WHO’s Noncommunicable Disease Global Action Plan includes addressing the lack of diagnostics for noncommunicable diseases, through multi-stakeholder collaborations to develop new technologies that are affordable, safe, effective and quality controlled, and improving laboratory and diagnostic capacity and human resources. Many challenges exist beyond price and availability for the current tools included in the Package of Essential Noncommunicable Disease Interventions (PEN) for cardiovascular disease, diabetes and chronic respiratory diseases. These include temperature stability, adaptability to various settings (e.g. at high altitude), need for training in order to perform and interpret the test, the need for maintenance and calibration, and for Blood Glucose Meters non-compatible meters and test strips. To date the issues surrounding access to diagnostic and monitoring tools for noncommunicable diseases have not been addressed in much detail. The aim of this Commentary is to present the current landscape and challenges with regards to guidance from the WHO on diagnostic tools using the WHO REASSURED criteria, which define a set of key characteristics for diagnostic tests and tools. These criteria have been used for communicable diseases, but so far have not been used for noncommunicable diseases. Diagnostic tools have played an important role in addressing many communicable diseases, such as HIV, TB and neglected tropical diseases. Clearly more attention with regards to diagnostics for noncommunicable diseases as a key component of the health system is needed.

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