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Bottleneck analysis approach to accelerate newborn care services in two regions in Ghana: implications for national newborn care.

Abstract：

OBJECTIVE:The aim of this work is to describe application of a data-driven approach (bottleneck analysis [BNA] approach process) to accelerate newborn care services in two regions and what effect it had on national-level newborn care interventions in Ghana. STUDY DESIGN:A mixed-method approach was used for the study. The BNA tool generated quantitative data and group discussions provided phenomenological explanations to identified service gaps. METHODS:Regional newborn care health service assessments were conducted in November 2013 through desk reviews, field and health facility visits and coaching/mentorship. The BNA tool (an excel-based tool) directly utilized service coverage data and programme monitoring and review reports in Ghana. Outputs were generated based on service coverage indicators: supply side/health system factors (commodities, human resource and access), demand side (service utilization) and quality/effective coverage. National targets were used as benchmarks to assess gaps in coverage indicators. RESULTS:Key health system bottlenecks included absence/stock-out of essential newborn care commodities/resuscitation kits and absence of updated policies at services delivery points. In both regions, less than 55% of health facilities had at least 80% of midwives trained to provide essential obstetric and newborn care, management of preterm babies, resuscitation and inpatient paediatric care. In addition, less than 35% of pregnant women were assisted by a skilled birth attendant (midwife) and monitored with a partograph in the two regions. Demand-side bottlenecks included cultural preference for home deliveries, limited knowledge on importance of postnatal care and poor community involvement.The BNA approach in the two regions resulted in the development of national and other regional operational plans and monitoring and evaluation framework for newborn care services in Ghana over the period 2012-2016, and a relative improvement in neonatal mortality at the regional and national level. CONCLUSION:The BNA tool and approach provided data-driven planning for newborn care service delivery in a low-income setting. It identified gaps in service coverage based on empirical data at lower levels of the health system and garnered strategies in addressing bottlenecks to newborn care services at the national level.

journal_name

Public Health

journal_title

Public health

authors

Yawson AE,Awoonor-Williams JK,Sagoe-Moses I,Aboagye PK,Yawson AO,Senaya LK,Bonsu G,Eleeza JB,Agongo EE,Banskota HK

doi

10.1016/j.puhe.2016.09.026

subject

Has Abstract

pub_date

2016-12-01 00:00:00

pages

245-254

eissn

0033-3506

issn

1476-5616

pii

S0033-3506(16)30257-8

journal_volume

141

pub_type

杂志文章

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Bottleneck analysis approach to accelerate newborn care services in two regions in Ghana: implications for national newborn care.