Table 3.

Summary of main gaps emerging from the baseline assessments: provision of effective, safe and respectful care to newborn babies (compared with WHO standards 1 and 5) [7]

WHO quality standards	Areas where serious gaps were identified in at least 1/3 of the health facilities	Examples of gaps
Standard 1: Every woman and newborn receives routine, evidence-based care and management of complications during labour, childbirth and the early postnatal period, according to WHO guidelines	Early mother-baby contact and immediate initiation of breastfeeding	Early skin-to-skin contact not ensured.
		Initiation of breastfeeding within the first hour not ensured.
	Resuscitation preparedness and procedures	Preparedness for newborn resuscitation (skills and equipment) insufficient.
		Apgar score not applied properly.
		Newborn resuscitation not started according to the recommended algorithm.
	Care for premature/Low Birth Weight Babies	Kangaroo care not implemented.
		Inadequate nutrition of prems/LBW/sick babies, feeding needs not calculated.
	Excess and/or inappropriate interventions	Unnecessary nasogastric aspiration..
		Unjustified use of drugs based on inappropriate diagnosis of perinatal asphyxia
	Early identification and monitoring of risk conditions and complications	Poor recording of vital signs.
		Poor recognition of signs of infection.
		Monitoring of women and baby in delivery room (first 2 h) not ensured.
	Management of complications	Delayed diagnosis of infection.
		Over-diagnosis of infection.
Standard 5: Women and newborns receive care with respect and preservation of their dignity	Mother-baby bonding	Unjustified separation at birth.
		Babies kept separated from mothers without medical reasons for most of the time.
	Pain prevention and relief	Excess of painful diagnostic procedures with no attention to pain prevention.
		No attention paid to guarantee a quiet silent environment
		Mothers not involved in care of sick newborn babies.

WHO – World Health Organization