Table 3.

Space, power, and water functionality across facility levels

Facility Level	Problem
Space
Health post	Only space for immediate assessment and referral
	1-room facilities
	No separate space for mothers, neonates, or preterm, LBW, and sick newborns
	Condition of building compromised (roof caved in)
	Lack of fully equipped rooms
Health center	Size of existing rooms inadequate
	Could not serve multiple preterm, LBW, and sick newborns who arrived simultaneously
	No inpatient or pediatric unit
	Could not accommodate newborn when mother was getting care and unable to care for her newborn
	Necessary to refer cases beyond first aid due to lack of space
	Multiple activities usually combined in 1 or 2 rooms
	L&D shared with postnatal ward; space limited and uncomfortable
	No postnatal room; newborns with mothers in waiting room
	Preterm newborns cared for in delivery room
	No space for parent to rest or sleep when newborn was admitted for care
	Antenatal care, family planning, Integrated Child Illness in 1 room; prenatal and pre-labor in another room
	No separate room for neonates or preterm, LBW, and sick newborns
	Shortage of rooms for delivery
Primary hospital and general hospital	Shortage of space in NICU; had to serve only most critically sick newborns
	No space for newborns in delivery rooms
	The only space for breastfeeding mothers was in a separate building away from the NICU
	Space for doctors and nurses was crowded
	KMC room had no sink and limited beds
	Delivery room lacked beds; mothers on floor mattresses
	Shortage of beds in mini-NICU; preterm, LBW, and sick newborns shared beds “Laying 4 and 5 kids on 1 bed is very difficult. That is how we are using it. I think that’s why our work is not effective. Preterm infants that come [to] us rarely survive because both the septic and the healthy sleep together” (ORO-HOSP).
	KMC babies and mothers in the delivery room with others
	Neonatal room did not meet standards
Specialized hospital	No space for parents in NICU; they had to sleep outdoors or in the latrine
	Sometimes had to refer preterm, LBW, and sick newborns due to shortage of beds
	Multiple babies in 1 incubator
	Neonates put into adult and surgical wards due to lack of space
Power
Health post Health center Primary hospital	Power interrupted and unreliable “There [are times that] the power will be off up to 2 days. Even there was time that we take our patients to other hospital by ambulance due to lack of power” (AA-HOSP)
	Generator and/or solar power do not ensure uninterrupted supply Power/generator failure can also result in water failure
Water
Health post	Only periodic water
Health post Health center	Reliance on river water
	No water of any kind whatsoever
	Only 3 reported that water was continuous/uninterrupted, with 1 due to mountain location
	Collected and used rain water
Health center General hospital and specialized hospital	Collected and used unclean river water “We don’t have clean tap water. We have to get it from the river. Mind you the kinds of infections and other waterborne diseases that may be caused as a result of this” (ORO-HC)
	Collected and used water from a nearby source; not available on-site
	Even in a new health center facility, water pipes had leaks; others reported broken pipes
	Water came only on alternate days
	Mothers not able to clean up after birth “It is difficult for a mother to go home covered in blood after birth. .. For example, if a mother gives birth here on dusty space, then it is no different from giving birth at home” (AMH-HC)
	Shortages for 1 to 2 weeks “We may not get water for 1 or 2 weeks. To eat our food, we have to buy packed water. Even we do not get to wash our hands. We prepared large water container, so we fetch from that. .. We have to carry from the ground [floor] to the second floor” (AA-HOSP)
	Periodic interruptions due to an aged building
	Parents restricted from visiting preterm, LBW, and sick newborns in NICU if there was no water to wash visitor gowns