Table 8.

Recommendations and actions to improve health system readiness for preterm, LBW, and sick newborns

Health System Building Blocks	Recommendations	Suggested Actions
Service delivery/ infrastructure Supplies/ equipment	• Consideration of critical infrastructure (space, power, water) and equipment to meet the specific needs of preterm, LBW, and sick newborn care	• Create separate building/rooms specially designed for preterm, LBW, and sick newborn care with space for mothers/caretakers • Have backup power source (generator) • Have a water reservoir • Prioritize procurement and maintenance of critical supplies and equipment
Workforce	• Continuous training, motivation, and support for the workforce are necessary to boost skills and commitment in a highly demanding environment of intensive and advance newborn care • Addressing health care workforce shortages within facilities to meet adequate staffing levels for labor-intensive inpatient care for newborns	• Train adequate number of doctors and nurses with neonatal care skills • Conduct refresher training for health workers working in neonatal units • Develop strategies to appropriately remunerate and incentivize neonatal health workers • Provide regular supportive supervision • Recognize the role of health extension workers
Governance/ leadership	• Evidence-based, up-to-date guidelines and protocols specific to the care of preterm, LBW, and sick newborns should be developed and communicated across the system tiers with appropriate supervision	• Develop guidelines and protocols that are specific to preterm, LBW, and sick newborn care and that match skill levels of health workers • Update the guidelines in a timely manner • Disseminate the guidelines to all facilities caring for preterm, LBW, and sick newborns
Health financing	• A program specifically supporting and funding preterm, LBW, and sick newborn care at the facility level may help to alleviate the challenges and ultimately improve the available care	• Develop sustainable source of funding earmarked for preterm, LBW, and sick newborn care at the facility level • Develop mechanisms for incorporating baby food and clothing in medical supplies
Data M&E/ health information system	• Improve the consistency and quality of data collection and use at all levels of health system	• Improve data collection and storage through continuous training and supervision • Monitor data quality through regular feedback and follow-up • Improve data usage at all levels of health system
Community engagement	• Increase community engagement through awareness creation	• Improve awareness through health education, peer modeling, and dissemination of positive experience • Improve family experience at health facilities • Create culture-responsive health care environment

Abbreviations: LBW low birth weight, M&E monitoring and evaluation