Table 3.

Barriers to ENC delivery and strategies for improvement, by level.

Level	Barriers	Strategies for improvement
Patient	•Insufficient maternal knowledge of newborn danger signs •Transportation barriers (e.g., distance, security checkpoints) •Cost (e.g., referral, medicines)	•Initiatives designed to improve maternal education and build trust within communities •Community-based strategies (e.g., community midwives)
Staff	•Inadequately trained staff •Pay differentials between public sector and international NGOs •Time constraints from administrative duties and splitting time between clinical settings	•Dedicated trainings for HCWs •Mentorship by supervisors •Incentives such as promotion and pay-for-performance
Facility	•Variable service availability or coverage •Inadequate infrastructure and supplies •Lack of interfacility referral mechanisms	•Mother-baby-friendly spaces •Up-to-date clinical guidelines and standard operating procedures (SOPs) •Adoption of neonatal signal functions •Improvements in health information systems
Humanitarian setting	•Insecurity •Donor-driven prioritization •Breakdown in governance •Attacks against healthcare	•“Strategic” governance •Negotiated access to populations in need