Situation Analysis of Inpatient Care of Newborns and Young ...

THE AMERICAN PEOPLE

lfaternal and Child

Survival Program

Situation Analysis of Inpatient Care of Newborns and Young Infants in Nepal

Authors Deepak Jha Adhish Dhungana Shraddha Manandhar Sarita Yadav Om Krishna Shrestha Kalyan Lama Lydia Wisner Neena Khadka

wwwmcsprogramorg

The Maternal and Child Survival Program (MCSP) is a global $560 million 5-year cooperative agreement funded by the United States Agency for International Development (USAID) to introduce and support scale-up of high-impact health interventions among USAIDrsquos 25 maternal and child health priority countries as well as other countries MCSP is focused on ensuring that all women newborns and children most in need have equitable access to quality health care services to save lives MCSP supports programming in maternal newborn and child health immunization family planning and reproductive health nutrition health systems strengthening watersanitationhygiene malaria prevention of mother-to-child transmission of HIV and pediatric HIV care and treatment

This study is made possible by the generous support of the American people through USAID under the terms of the Cooperative Agreement AID-OAA-A-14-00028 The contents are the responsibility of MCSP and do not necessarily reflect the views of USAID or the United States Government

Table of Contents Acknowledgments iv

Abbreviations v

Executive Summary vii

Context vii

Key Findings and Recommendations vii

Background 1

Nepal Country Profile 1

Purpose of the Situation Analysis 2

Methodology 3

Objective 3

Study Design 3

Data Analysis 4

Challenges and Limitations 4

Results 5

NYI Units Infrastructure 6

NYI Services 7

Provision of Care Human Resources13

Commodities for Neonatal Services 15

Management Systems 16

Monitoring and Evaluation 17

QOC 18

Infection Prevention 19

Referrals 20

Discharge Planning 21

Parental Support22

Experience of Care23

Recommendations25

Conclusion 27

Appendix 1 Nepalrsquos Expected Standards of Care by Service Level 28

Situation Analysis of Inpatient Care of Newborns and Young Infants in Nepal iii

Acknowledgments Ministry of Health and Population Nepal Dr Dipendra Raman Singh principal investigator Dr Bhim Singh Tinkari director Family Welfare Division

USAID Dr Shilu Adhikari Sabita Tuladhar Dr Lily Kak Dr Susan Niermeyer

Technical Advisory Group Dr Dipendra Raman Singh Bhogendra Dotel Dr Bikash Lamichhane Dr Bhim Singh Tinkari Dr Sudha Basnet Dr Dibeswora Nepal Dr Ashish KC Dr Meera Upadhaya Dr Devi Prasai Deepak Jha Dr KP Bista Dr Kusum Lata Mishra Dr Binod Bajracharya

Data Collectors Dipak Raj Chaulagain Dr Anil Kumar Shrestha Dr Sunil Gajurel Dr Poonam Sharma Aliza Dhanwantary Juni Rokaya Ambika Devkota Syalon Chand Sapanjana Pandey Sangita Sedhai Samikshya Baniya Pinki Kalwar Sabita Lamichhane Mona Giri

Data Managers Sarita Yadav Om Krishna Shrestha Kalyan Lama

Every PreemiendashSCALE Judith Robb-McCord Nancy Fronczak Chelsea Dunning Dawn Greensides

MCSP Dr Adhish Dhungana Dr Neena Khadka Shraddha Manandhar Lydia Wisner Deepak Joshi

Situation Analysis of Inpatient Care of Newborns and Young Infants in Nepal iv

Abbreviations BFHI Baby-Friendly Hospital Initiative

CPAP continuous positive airway pressure

CSF cerebrospinal fluid

ENC essential newborn care

IMNCI integrated management of neonatal and childhood illness

KMC kangaroo mother care

LSHTM London School of Hygiene amp Tropical Medicine

MCSP Maternal and Child Survival Program

MOHP Ministry of Health and Population

NICU neonatal intensive care unit

NYI newborn and young infant

QOC quality of care

SNCU special newborn care unit

USAID United States Agency for International Development

WHO World Health Organization

Situation Analysis of Inpatient Care of Newborns and Young Infants in Nepal v

Situation Analysis of Inpatient Care of Newborns and Young Infants in Nepal vi

Executive Summary Context The Nepal Every Newborn Action Plan aims to reduce newborn mortality to below 11 per 1000 live births by 2035 from the current rate of 21 To achieve this target the Government of Nepal has mainstreamed essential newborn care but the inpatient care of newborns and young infants (NYIs) is still nascent This report presents the findings of assessing policies implementation strategies services readiness and health systems related to the inpatient care of NYIs (0ndash59 days old) in Nepal and presents findings from 17 government and private health facilities within Nepalrsquos seven provinces The results and suggested recommendations are intended to support the Nepal Ministry of Health and Populationrsquos ongoing efforts to identify gaps within the continuum of care and offer links between the needs of small and sick newborns and the capacity of the health system to respond accordingly

Key Findings and Recommendations

Staff shortages and a lack of specialized staff such as pediatricians with neonatal experience are the primary barrier to the provision of inpatient NYI care services Efforts to incentivize and offer professional development opportunities to existing staff may prove effective in motivating and growing the number of providers with experience in the care of small and sick newborns

None of the national-level referral hospitals had separate kangaroo mother care (KMC) units despite KMC being routine This could be attributed to a lack of national-level guidance on the organization of KMC services KMC with a focus on low-birthweightpreterm infants was however the most reported topic included in in-service training for NYI care providers within the previous 12 months

Gaps in the provision of specific NYI services were identified including magnesium sulfate for neuroprotection1 assessment of newborn hearing and screening for retinopathy of prematurity These gaps suggest the need to review the existing national service package

Sepsis management including diagnostic methods and treatment protocol varied among the facilities and should be standardized and scaled up

Shortages of commodities and equipment including NYI commodities and equipment were reported at the provincial level Strengthening district- and provincial-level forecasting systems may minimize errors and delayed orders

The procurement of oxygen is conducted largely at the facility level There were limited reports of shortages in supply Facilities had oxygen piped centrally or stored in tanks on site Crucial supporting equipment for its use including airoxygen blenders were not widely available Equipment for newborns in respiratory distress should therefore be forecast and procured as per national guidance

There are no national or provincial checks for the functionality of NYI equipment at the facility level which leaves NYI units vulnerable to equipment breakdown Maintenance practices should be budgeted and made routine for all NYI equipment at every facility

There is an opportunity to roll out the World Health Organizationrsquos Baby-Friendly Hospital Initiative to increase the number of Baby-Friendly hospitals in Nepal and support the strengthening of national breastfeeding rates

Infection control efforts were largely adequate except for the limited number of waste containers for disposing of contaminated waste Nepal may still benefit from Clean Clinic initiatives that focus on hygiene practice and behaviors since some providers were observed touching different infants without handwashing in between

Very few facilities made use of linages with community-based health workers There is a clear opportunity to build upon such networks in order to strengthen postdischarge care

1 Though there is no national policy in place in Nepal on the use of magnesium sulphate for fetal neuroprotection national guidelines do require its use in treating pre-eclampsia therefore it would be a relatively simple addition to include for newborn interventions

Situation Analysis of Inpatient Care of Newborns and Young Infants in Nepal vii

Over half of the 38 interviewed caregivers of inpatient NYIs (55) reported out-of-pocket payments for the cost of care including expenses for food and accommodation The present incentive scheme should be reviewed to minimize such costs for accompanying parents and family members staying at the hospital to enable family-centered care which requires the presence and close involvement of families during the care of the NYI

Only 58 of caregivers felt the NYI unit was quiet during the day Key elements of nurturing care including privacy management of infant pain and sound and light levels in NYI inpatient care facilities should be incorporated within national policy and nationally endorsed curricula to protect the optimal environment for NYIs Staff could also be mentored on simple measures to support nurturing care on the job

Situation Analysis of Inpatient Care of Newborns and Young Infants in Nepal viii

Background An integrated health systems approach along the continuum of care enables the identification of high-risk newborns and provision of timely high-quality inpatient care thereby saving newborn lives and preventing morbidity2 It is a global priority to increase coverage and quality of key routine practices (essential newborn care or ENC) at the time of birth and during the first hours of life whether in the health facility or at home It has been estimated that optimal supportive care in a hospitalrsquos Special Newborn Care Unit (SNCU) could avert 70 of neonatal deaths due to preterm birth complications and a hospitalrsquos neonatal intensive care units (NICUs)3 could avert 90 Strengthening inpatient and postdischarge nurturing care for small and sick newborns is essential to meet country-level commitments to Every Newborn Action Plan and Sustainable Development Goal targets

A first step in the process of improving inpatient care for newborns and young infants (NYIs ages 0ndash59 days old) is to understand the landscape of care Nepalrsquos Ministry of Health and Population (MOHP) with support from the United States Agency for International Development (USAID)rsquos flagship Maternal and Child Survival Program (MCSP) conducted a situation analysis of inpatient care of NYIs in Nepal The situation analysis adapted protocol and tools developed jointly by USAID the USAID-funded Every PreemiendashSCALE project MCSP UNICEF the World Health Organization (WHO) USAIDrsquos Applying Science to Strengthen and Improve Systems project Save the Childrenrsquos Saving Newborn Lives Program the London School of Hygiene amp Tropical Medicine (LSHTM) and the USAID Global Health Supply Chain Program

Nepal Country Profile In Nepal under-5 child mortality rates fell dramatically from 118 per 1000 live births in 1996 to 39 per 1000 live births in 2016 The infant mortality rate also declined from 78 per 1000 live births in 1996 to 32 per 1000 live births in 2016 but the reduction in neonatal mortality was slower falling from 50 per 1000 live births to 21 per 1000 live births during the same period with almost a decade of stagnation in between Neonatal mortality comprised 61 of all under-5 mortality in 2011 and now accounts for a slightly reduced 544

Nepalrsquos top causes of neonatal death (preterm birth [31] birth asphyxia [31] neonatal infection [19] and acute respiratory infection [4])5 can each be prevented by cost-effective ENC interventions Nepalrsquos MOHP and partners coordinated a bottleneck analysis of newborn care in 2013 to inform the development of Nepalrsquos Every Newborn Action Plan which was formally endorsed in 2016 The plan includes nine strategies that aim to reduce newborn mortality to below 11 per 1000 live births by 2035 from the current rate of 21 Activities to date have prioritized the implementation and streamlining of ENC within Nepalrsquos newborn health programming and national health policy

Efforts are already underway by Nepalrsquos government and partners to improve care for small and sick babies The MOHP has formalized relevant national policies documents standards and protocols while scaling up

2 Bhutta ZA Das JK Bahl R et al 2014 Can available interventions end preventable deaths in mothers newborn babies and stillbirths and at what cost Lancet 384(9940)347ndash70 doi 101016S0140-6736(14)60792-3 3 Moxon S Lawn J Dickson KE et al 2015 Inpatient care of small and sick newborns a multi-country analysis of health system bottlenecks and potential solutions BMC Pregnancy Childbirth 15 Suppl 2S7 doi 1011861471-2393-15-S2-S7 4 Nepal Ministry of Health (MOH) New ERA ICF 2017 Nepal Demographic and Health Survey 2016 Key Indicators Kathmandu Nepal Nepal MOH 5 Nepal Ministry of Health (MOH) New ERA ICF 2017 Nepal Demographic and Health Survey 2016 Key Indicators Kathmandu Nepal Nepal MOH

Box 1 Nepal Birth Statistics

Annual births 577000 57 facility birth rate 58 of births with a skilled birth attendant Preterm birth rate (babies born lt 37 weeks) 14 Low-birthweight rate (babies born lt 2500 g) 18 Initiation of breastfeeding within 1 hour 49 Exclusive breastfeeding for 6 months 66 Sources Nepal Demographic and Health Survey 2016 Every PreemiendashSCALE Nepal Profile

Situation Analysis of Inpatient Care of Newborns and Young Infants in Nepal 1

training on newborn services and procuring the necessary equipment for neonatal services The national facility-based integrated management of neonatal and childhood illness (IMNCI) program and protocols the establishment of district-level SNCUs and improved national curricula for doctors and nurses providing inpatient care to newborns evidence the increased focus on improving coverage and quality of care (QOC) for NYIs

A 2017 report6 conducted by the Nepal Pediatric Society indicated that inpatient care of small and sick NYIs is still nascent in Nepal The report identified issues with human resources recording and reporting systems inadequate standard treatment protocols and a lack of standardization across various levels of care all of which compromise the QOC available

Purpose of the Situation Analysis The current situation analysis builds upon the Nepal Pediatric Society 2017 report It provides an overview of the status of inpatient care of NYIs in Nepal and includes current trends practices and the landscape of inpatient care It analyzes components of policy implementation strategy and health systems to support high-quality services clinical practices and perceptions of provision of care as experienced by mothers and family members with NYIs in inpatient care By supporting efforts to define and standardize QOC across all levels of the health system this report further intends to inform service delivery for improved inpatient care of NYIs

Nepalrsquos MOHP has initiated impressive efforts to enhance services for the inpatient care of small and sick newborns Following the 2016 endorsement of the Nepal Every Newborn Action Plan the Government of Nepal launched an ambitious plan in 2017 to establish SNCUs and NICUs in strategic locations to address accessibility gaps in NYI services The plan designated birthing centers and primary health centers for the provision of primary-level newborn care (Level I) and approved the establishment of SNCUs7 (Level II) at district hospitals and NICUs8 (Level III) at zonal provincial and central hospitals This initiative created the momentum to reinvent Nepalrsquos system from one where inpatient Level I NYI care was centrally based and where there were no formally planned Level II facilities to one that is more accessible throughout the country Since 2017 11 NICUs (out of a target of 14 [79]) and 21 SNCUs (out of a target of 65 [32]) have been successfully established Within the next 2 years all of Nepalrsquos district hospitals will have fully standardized SNCUs In addition in 2017 the MOHP rolled out the National Free Newborn Service Guidelines which describe the human resources and equipment needs as well as the expected service standards at the three defined levels of NYI care (Levels I II and III) as well as monitoring indicators and data collection formats for use at the facility level The service standards by facility level are included in Appendix I

Despite the MOHPrsquos efforts to work with national and international partners to build a strong foundation for successful newborn programming the context in Nepal is challenging Specifically in order to meet the requirements of existing and expanding inpatient services Nepalrsquos human resources needs must be clearly forecast The MOHPrsquos Human Resource Information System (HuRIS) was designed to track national human resources in order to better inform staffing strategies but the system has not yet been fully integrated within the national health system and is considered redundant by national level stakeholders As a result there are no functional systems in place to keep track of existing specialist human resources such as neonatologists nurses with neonatal care specialization or pediatric ophthalmologists In addition national and provincial guidance on the basic education qualifications required for NYI inpatient care staffing is required This situation analysis helps to identify gaps within the continuum of care and the links between the needs of small and sick newborns and the capacity of the health system to respond accordingly

6 Nepal Pediatric Society 2017 Readiness and Availability of Newborn Services in 30 Hospitals of Nepal Kathmandu Nepal Nepal Pediatric Society 7 SNCU provides various services for moderately sick infants with less intensive monitoring than in a NICU In many facilities this will be the highest-level unit available for NYIs 8 NICU provides higher level of service with continuous monitoring of sick infants who are considered in critical condition A neonatologist is ideally available 24 hours a day

Methodology This assessment uses a framework based on six building blocks defined by WHO for well-functioning health systems9 to assess the health system as it relates to care for the small and sick newborn at national and subnational levels The framework for assessing information at the facility level is based on the WHO Standards for Improving Quality of Maternal and Newborn Care in Health Facilities10 including evidence-based interventions

Tools and methods for the assessment build on international experiences in collecting information on availability and readiness to provide services systems to support high-quality services and quality of services provided These include the Service Provision Assessment the Service Availability and Readiness Assessment comprehensive emergency obstetric care survey tools and the Every Mother Every Newborn facility assessment (UNICEF) In addition the content of the tools and analysis plan are informed by multiple stakeholders particularly by recent assessments and lessons learned by Every PreemiendashSCALE MCSP LSHTM and the Applying Science to Strengthen and Improve Systems project

Objective The objective of the situation analysis is to assess policies implementation strategies services readiness and health systems related to the inpatient care of NYIs (0ndash59 days old) in Nepal

Study Design The health facility-based situation analysis employed qualitative and quantitative data collection methods including

Document review Key informant interviews at the national provincial and facility levels Facility assessments using interviews with facility in-charge and service providers observations of facility

structures and interviews with parents of NYIs

The sample of 17 public facilities offering inpatient care for NYIs (0ndash59 days old) was not nationally representative but each facility was selected by the MOHP in consultation with the technical advisory group Public facilities were prioritized for inclusion with an attempt to sample at least one hospital at each service level along the referral continuum The 17 selected facilities include one of Nepalrsquos tertiary hospitals and three private medical college hospitals (categorized as ldquoNational Referral HospitalOtherrdquo) which were selected by the technical advisory group as the referral hospitals In addition six provincial hospitals and seven district hospitals were chosen by the technical advisory group to present the range of standards that exist along the referral continuum

Ethical reviews were conducted and approved by the Nepal Health and Research Council (NHRC) in Nepal and by the Western Institutional Review Board (WIRB) and Save the Childrenrsquos Ethical Review Board in the United States In early 2018 the assessment team reviewed and adapted tools designed for multicountry use to fit the Nepalese context This involved editing the tools to include the Nepalese terminology for various cadres of health care workers involved in the provision of NYI services and the names of NYI equipment used in Nepal and to correctly represent the structure of the Nepalese health service system For example

9 (1) Health services (2) health workforce (3) health information system (4) medical products vaccines and technologies (5) health financing (6) leadership and governance and (7) community engagement 10 (1) Evidence-based management of complications (2) actionable information systems (3) functional referral systems (4) effective communication with women and families (5) patientscaretakers treated with respect (6) emotional support for parentscaretakers of newborn (7) competent motivated staff and (8) infrastructure environment and resources to provide care

the assessment tools were adapted to represent the structure and Box 2 List of tools leadership of the newly formed provincial health system since

the new federal democratic state system favors the provincial National profile management of health care The adapted tools were translated National guidelines into Nepali and the translations were reviewed and certified by Interview with national-level personnel WIRB A formal back-translation did not take place however Interview with district-level personnel the translations were confirmed during the data collector

Health facility assessment training Patient record review

A week of training took place in Kathmandu (March 10ndash14 Health information reports 2019) during which four adapted tools (health facility Interview with health care providers assessment structured interview guide for health care workers Interview with parentscaregivers structured interview guide for caregivers and structured interview guide for provincial-level personnel) were field-tested at a local hospital that was not included in the sample The data collection took place from March 18ndashJune 7 2019 During this time enumerators conducted key informant interviews at the national and provincial levels with individuals informed in national- and provincial-level policies and programs related to inpatient care for NYIs Three teams of four trained data collectors each consisting of pediatricians and nursemidwives traveled to five to six sites to conduct the 17 facility assessments

Data Analysis Data were collected using electronic devices Quantitative data were entered into an electronic form using the Kobo Toolbox platform after which data were extracted into Microsoft Excel and exported into Statistical Package for Social Scientists for cleaning and analysis A descriptive summary of variables that describe facility readiness factors was performed

Descriptive analysis (frequencies means and cross-tabulations) was conducted for all variables by tool When appropriate scores or indices were created and are described in table footnotes All data were aggregated but stratified by site type of facility and province

Qualitative data from the key informant interviews were noted in field diaries edited translated into English and entered into Microsoft Excel Texts were coded and clustered along the developed themes and subthemes for subsequent analysis

Challenges and Limitations As the facilities were not randomly selected the results are not generalizable to all facilities providing care for small and sick NYIs in Nepal They do however provide evidence on the range of facility-level service availability and readiness for NYI care This information is expected to be useful for program planning

While 17 facilities were selected for the assessment not all were able to provide inputs to each of the nine tools Two facilities for example though equipped to provide NYI services had no inpatient NYIs admitted on the day of assessment whilst others were not able to share past case records at the time of assessment These SNCUs were not replaced in the sample since they were still able to offer valuable data for example through the service provider interviews This did however affect the analysis leading to differing denominators for several of the variables across the results

Results Across the 17 facilities (7 district hospitals 6 provincial hospitals and 4 national referral or private hospitals) 38 caregivers (33 mothers and 5 fathers) and 34 NYI service providers (5 pediatricians 10 medical officers 14 nurses and 5 auxiliary nurse midwives (ANM)) were interviewed as described in Table 1

Table 1 Numbers of parents and providers interviewed by province and facility type

Facility Type Parents Interviewed Providers Interviewed

Mother Father Medical Officer Pediatrician Nurse ANM

Province 1

1 Provincial Hospital 2 0 1 0 1 0

2 National Referral HospitalOther 3 0 1 0 1 0

3 District Hospital 3 0 1 0 1 0

Province 2

Province 3

Province 4

Province 5

Province 6

Province 7

TOTAL 33 5 10 5 14 5

TOTAL 38 34

The report presents a concise analysis of key results from Nepalrsquos situation assessment of inpatient care of NYIs and is presented according to the assessed themes

NYI Units Infrastructure This assessment included SNCUs (Level II) and NICUs (Level III) at district provincial and national referral facilities

Since there are no international standards for the categorization of inpatient levels of newborn care the level of service and level of care are determined by assessing criteria such as nursemidwife-to-patient ratio equipment availability and staff skills

Interviews with NYI care providers established how services for NYIs were organized at the facility level and whether there were separate units with dedicated nursing staff during any given shift

Key findings include

The highest level of infant care unit reported in the 17-facility sample was the NICU which was reported at seven of the 17 facilities (all four of the national referralother hospitals and threeprovincial hospitals)

All seven district hospitals in the sample had SNCUs as did three of the six provincial hospitals Five provincial and district hospitals reported having kangaroo mother care (KMC) units but none of the national referralother hospitals had KMC units according to the national level interview respondent this may be because of the lack of national-level guidance on the organization of KMC services

Appropriate infrastructure as identified in WHOs Standards for improving quality of maternal and newborn care in health facilities is critical to provide high-quality inpatient services for NYIs This includes regular electricity supply along with backup sources for critical equipment water from an improved source adequate means of external communication and functional toilets that parentsvisitors to the NYI unit consider usable and in good condition (since prolonged admission is common for small and sick NYIs)

NYI equipment requires a constant and continuous electricity supply but this was not noted to be an issue in the assessed facilities As described in Figure 1 all of the referral hospitals (one national and three private hospitals) had a 247 electricity supply as did almost all of the provincial hospitals (83) and district hospitals (83) All sampled facilities had a backup source of electricity available that met the needs of the facility including the NYI units should the regular electricity supply fail As such specific equipment does not require its own individual backup supply

I

Figure 1 Infrastructure in newborn and young infant units

Per

cent

age

100 90 80 70 60 50 40 30 20 10 0

Regular electricity Back-up electricity Water from Access to external Functional toilet supply source improved source communication for parents

visitors Infrastructure

National Referral Others Provincial District facilities

The data collection team assessed the main source of water used for the NYI units Water from an improved source (piped water supply piped water onto facility grounds public tapstandpipe tube wellborehole protected dug well protected sprint and rainwater collection) was confirmed in 81 of the facilities Surprisingly the improved water sources were more common in the provincial and district hospitals than the national referralother hospitals

Eligible means of external communication that are accessible for staff to use to receive or transfer NYIs include landline phone cellphone supported by facility or shortwave radio All facilities demonstrated full access to external communications

The functionality of toilets for patientsvisitors to the NYI units is defined as toilets that can be used and if flushing is required those with water available to flush the toilet Functional toilets specifically for parentsvisitors were available in just 56 of facilities and were found in more district facilities than national referralother and provincial facilities

NYI Services This section discusses high-impact evidence-based interventions proven to improve outcomes for small and sick newborns

In Nepal the following nine key national documents guide the implementation of newborn health

National Neonatal Health Strategy 2004 Community-Based IMNCI 2014 Nepal Every Newborn Action Plan 2016 National Neonatal Clinical Protocol 2016 Quality Improvement of Perinatal Care Guideline for Implementation in Hospitals 2016 Facility-Based IMNCI package 2017 Level II Newborn Care Package 2017 National Free Newborn Care Service Guideline 2017

Equity and Access Guideline 2018

A desk review assessed the above documents for inclusion of expected NYI care topics The results are shown in Table 2 The minimal reference to prenatal intervention (6) is due to its inclusion in Nepalrsquos national maternal health guidelines though it is important to note the significance of aligning national maternal and newborn care guidance

One significant identified gap was the presentation of human resource requirements (11) within theNYI guidelines Another gap was the lack of guidance on specific congenital anomalies (8)

Table 2 Inclusion of expected topics related to newborn and young infant (NYI) care within available national NYI guidelines (number of nationally available NYI guidelines that include each expected NYI topic total number of available national NYI guidelines assessed)

Topic Percentage of Guidelines

National plansandor strategies for inpatient care of NYIs 91

Staffing numbers and skills development 11

Specific strategies for improving inpatient care of NYIs 39

Service standards for each level of inpatient care for NYIs 53

Prenatal interventions 6

Essential newborn care 85

Newborn assessment 33

Specific congenital anomalies to be assessed at birth 8

Identification of at-risk newborn and action to be taken 21

Promoting beneficial practices 29

Routine monitoring of newborn (for routine recording) 32

Guidelinesprotocols for specific newborn conditionsinterventions 60

The desk review identified the following missing aspects of NYI care from the nine reviewed documents

Service standards for the physical layout and infrastructure requirements for each defined ward (eg separate rooms partitions positioning with respect to each other)

Newborn assessment (measurement of head circumference) specific congenital abnormalities (esophageal patency or obstruction of the esophagus) respiratory distress due to hernia or pneumothorax clubfoot hip dislocation and screening for hypothyroidism

Identification of at-risk newborns and necessary action management of hypothyroidism Rh incompatibility

Nurturing care practices promoting exclusive human milk feeding for inpatient NYIs minimizing separation (promoting rooming-ingiving caregiver access to infants too sick for rooming-in) and maintaining low-stimulation environment (low lightnoise)

Nepalrsquos National Free Newborn Service Guidelines describe the expected standards per facility type (Levels I II and III) The more sophisticated neonatal interventions are only expected to be available at the NICULevel III facilities but the following results provide an overview of the services available at all levels of facility providing inpatient care

Figure 2 provides the summary of the percentage of relevant services that are available for the sickest NYIs in the sampled facilities by facility type Table 3 presents the specific services for NYIs available at the sampled

bull

facilities Almost all facilities reported providing services for the diagnoses and treatment of severe neonatal illnesses but screening for congenital conditions was less common

Figure 2 Percentage of assessed NICUs and SNCUs providing NYI services and interventions for indicated areas

ion Interventions for sick newborn5

vent Practices for infant safety4

NY

I Ser

vice

In

ter

Routine newborn screening for congenital conditions3

Severe neonatal illness diagnosed and treated2 SNCU

NICU

Intrapartum interventions for fetus1

0 10 20 30 40 50 60 70 80 90 100

Percentage

1 Antenatal corticosteroids magnesium sulfate for premature labor magnesium sulfate for fetal neuroprotection antibiotics to prevent fetal infections and ultrasound to determine gestational age 2 Diagnosetreat severe neonatal infections provide antibiotics diagnosetreat neonatal respiratory distressdisorders detectmanage hypothermia detectmanagement hyperbilirubinemia and diagnosetreat seizures 3 Birth defects surgical repair blood tests (eg hypothyroid phenylketonuria cystic fibrosis hypoglycemia) assess hearing and screen for retinopathy 4 Thermal management feeding and lactation support wash hands between infants and one infant per cot 5 Oxygen administration fluid management alternative feeding and exchange transfusion

While 15 facilities noted conducting assessment for congenital birth defects only half of them provided any routine blood test for congenital disorders such as hypothyroidism phenylketonuria and cystic fibrosis This may be because no national guidelines for the screening of congenital abnormalities are yet in place and the service is not routinely available

Of the intrapartum interventions for the fetus while all of the 16 assessed facilities provide magnesium sulfate for eclampsia staff at only three facilities reported they used it for the purpose of fetal neuroprotection (see Table 3) Antenatal corticosteroids are not part of government-endorsed protocols yet 14 of the 16 facilities reported providing this service Nepal has no national policy regarding neonatal hearing loss and as such the assessment of newborn hearing was limited to five facilities Similarly screening for retinopathy of prematurity which is not included in the National Free Newborn Service Guidelines was rarely offered (four facilities) According to the provider interviews interventions such as thermal management feeding and lactation support and handwashing between infants were practiced by all facilities Only two facilities reported having more than one infant per cot

Table 3 Number of facilities with practices for providing specific services for newborns and young infants (NYI n = 16)

NYI service Number of assessed facilities providing service

Antepartumintrapartum services

Antenatal corticosteroids 14

Ultrasound to determine gestational age 14

Magnesium sulfate for eclampsia 16

Magnesium sulfate for neuroprotection 3

Antibiotic for premature rupture of membranes 15

Diagnosis and treatment for specific conditions

Diagnose sepsissevere bacterial infection 16

Provide antibiotics for neonatal infections 16

Diagnose neonatal respiratory distressdisorders 16

Treat neonatal respiratory distress 15

Detect and manage hypothermia 16

Detect hyperbilirubinemia 16

Manage hyperbilirubinemia 16

Diagnoseinvestigate cause of seizures 14

Treat seizures 14

Assessment of newborn hearing 5

Screening for retinopathy of prematurity 4

Provide basic interventions for NYI

Thermal management 16

Feeding and lactation support 16

Handwashing between infants 16

Only one infant in cot 14

Advanced interventions for NYI

Administer oxygen 16

Provide IV fluids 16

Provide alternatives to breastfeeding 15

Exchange transfusion 10

Almost all facilities reported providing advanced interventions for NYIs Exchange transfusion was the only advanced intervention provided by a limited number of facilities (10 of 16) but this result in in fact positive showing that an intervention described by the National Free Newborn Service Guidelines as a Level III service is also being provided at Level II facilities

By facility type the district hospitals which are Level II scored the lowest on providing the services in Table 3

KMC KMC is an evidence-based approach to reducing mortality and morbidity in preterm infants WHO defines KMC as prolonged skin-to-skin contact between mother and infant exclusive breastfeeding and early discharge with follow-up and support As shown in Figure 3 respondents working in the sick newborn units reported that KMC services are routine in 14 facilities and five provincial and district hospitals reported having KMC units However only three of these 14 facilities reported having a separate unit withbeds for KMC

Three facilities offer mothers opportunities to intermittently provide skin-to-skin contact with newborns who are separated in incubators or cots because of treatment needs The observed conditions for KMC identified areas for improvement such as building staff capacity job aids to guide the practice supply of appropriate infant clothing (such as wrapbinder) culturally appropriate privacy standards (eg when the baby is placed skin to skin on the motherrsquos bare chest) and monitoring tools and registers (which are typically incorporated within NICUSNCU registers rather than separate KMC registers) to capture KMC practices

Figure 3 Kangaroo mother care (KMC) resources and service conditions

16 14

Num

ber

of fa

cilit

ies

14

12

10 8

8 6

6 4

4 3 3

2 1

0 KMC routine Separate unit Visual privacy Job aids Infant clothing KMC register Trained staff

Resources and service conditions

Breast Milk Feeding WHO recommends exclusive breast milk feeding for all infants including small and sick newborns requiring specialized inpatient care As such facility policies should promote breast milk feeding preferably on the breast Small and sick NYIs may need alternate sources for the provision of breast milk such as expressed milk from the mother or donor breast milk fed by nasogastric tubespooncupPaladai11 which should be available in all NYI units All 16 facilities noted they had policies in place to encourage exclusive breastmilk feeding and 15 offered alternative feeding opportunities for infants unable to breastfeedAmong facilities that reported supporting alternate feeding practices only three had guidelinesjob aids to support the practice None of the facilities offered donor breast milk services Eighty-eight percent of the 15 facilities offering alternative feeding opportunities for infants had infant weight scales but under half had feeding sources including cup and spoon (44) and Paladai cups (38) Nasogastric tubes were available in less than 50 of facilities Functional manual breast pumps were available in 8 of the facilities but none of the facilities had functional electronic breast pumps

None of the facilities had refrigerators or containers dedicated for storing breast milk

Respondents who were mothers of the infants were asked if they were currently breastfeeding Of 38 respondents mothers currently breastfeeding were questioned about their experience of supportive breastfeeding practices in the facility Eighty-seven percent of currently breastfeeding mothers had been offered support for breastfeeding by facility staff Of these 63 reported having a comfortable location to breastfeed but only 31 reported having sufficient privacy Ninety-two percent of mothers interviewed were currently breastfeeding or expressing milk yet all caregivers including mothers surveyed reported out-of-pocket costs for breast milk substitute This suggests that while breast milk feeding is promoted it is not exclusive over the course of inpatient care

Severe Bacterial Infection WHO recommends hospitalization and treatment with injectable antibiotics for all NYIs with severe bacterial infection

11 The Paladai is a cuplike utensil with a narrow tip that has been used traditionally to feed babies in India

As seen in Table 4 only nine of the 13 assessed NICU and SNCU facilities reported seeing NYIs with symptoms of severe bacterial infection Diagnosis of severe infection was most commonly made by clinical assessment (77) Confirmatory blood cultures or cerebrospinal fluid (CSF) analysis were not available in all facilities Each sampled facility would provide further assessment or treatment before referring NYIs with symptoms of severe infection All facilities that reported seeing NYIs with sepsis provide at least one dose of injectable antibiotic administered intravenously (nine) or intramuscularly (four) Only five facilities prescribe the full antibiotic regimen with follow-up

Table 4 Services for infants with symptoms of sepsissevere bacterial infections

Facilities seeing

infants with symptoms of severe infection

Facilities reporting the indicated diagnostic and treatment practices are followed always or sometimes

Upon identification of infant with suspect sepsis

Antibiotics administered Diagnostic methods reported

Imm

edia

tely

ref

erpa

tien

t w

itho

ut fu

rthe

ras

sess

men

t or

tre

atm

ent

Pro

vide

one

dos

ein

ject

able

ant

ibio

tic

th

en r

efer

Pre

scri

be fu

ll an

tibi

otic

re

gim

en a

nd fo

llow

-up

IV IM

Clin

ical

ass

essm

ent

only

Blo

od c

ultu

re

Lum

bar

punc

ture

and

se

nses

exa

min

atio

n

NICU 3 0 3 2 3 1 2 3 3

SNCU 6 0 6 3 6 3 5 3 2

Total 9 0 9 5 9 4 7 6 5

Most (73) facilities providing services for severe bacterial infection in NYIs (which is included within Nepalrsquos IMNCI program) had at least two antibiotics available Sixty-four percent of all sampled facilities reported having the available equipment to conduct laboratory diagnostic tests using blood urine or CSF cultures but since national guidelines do not require level II facilities to offer it only 36 of the sampled facilities had lumbar puncture kits and just 18 had available Cryptococcal antigen testing services

Respiratory Distress All 16 assessed facilities reported seeing infants with respiratory distress and many had the essential equipment to manage such cases As noted in Table 5 other than apnea monitors most facilities were well equipped to diagnose and monitor respiratory status Five of the NICUs could administer continuous positive airway pressure (CPAP) a form of ventilator intubate and use ventilators if needed as per national guidance documents Surprisingly one of the SNCUs also had a ventilator which is not normally a requirement for Level II care in Nepal

Table 5 Services for infants with symptoms of respiratory distress

Facility Type

Among facilities reporting that they provide services for suspect respiratory distress in sick newbornsyoung infants facilities with the indicated items available and functional

(observed)

Equipment for diagnosing and monitoring respiratory status

Equipment for treating respiratory distress

Steth oscop

e

Pulse oximet

er

Respirati on

monitor

Apnea monit

or

X-ray (report

ed)

Sucti on

Neona te

chest tubes

CPAP equipm

ent

Ventilat or

Percentage with indicated items by facility level types

NICU 6 6 6 2 6 6 0 5 5

SNCU 6 5 6 1 7 5 0 4 1

Percentage with indicated items by private and public facility types

Private 3 3 3 0 3 3 0 2 3

Public 12 11 11 4 13 11 1 7 3

All facilities relied primarily upon clinical assessment using signs and symptoms (eg grunting or chest inspiration) to diagnose suspected respiratory distress Most (83) of the facilities had functional pulse oximeters but only 50 of the 16 facilities reported using oxygen saturation to diagnose respiratory distress

Seizures Sixty-nine percent of facilities reported seeing infants with seizures of these all facilities provide one dose of injectable drugs for seizure control and either refer or provide treatment for underlying cause Despite 71 of facilities reporting having diagnostic methods available for tests using blood urine and CSF cultures the most commonly reported diagnostic method was clinical assessment (56) followed by blood culture (38) CSF examination (31) and radiologic or ultrasound test (25)

Hyperbilirubinemia All of the 16 assessed facilities provide services for hyperbilirubinemia Of these 87 have available and functional phototherapy lights and 80 have masks for infantsrsquo eyes Methods available for bilirubin assessment included quantitative serum bilirubin (87) and transcutaneous bilirubin (73) All levels of facilities included in the assessment reported providing exchange transfusion services when required However only 56 reported having access to blood from a blood bank

Provision of Care Human Resources Interviews with national- and provincial-level respondents noted that the MOHP does not have sufficient NYI expertise Technical assistance has been provided in the past 3 years through seconded experts including short-term technical assistance targeting provincial and local government planning efforts and capacity development However additional technical assistance is needed to improve NYI inpatient services to supplement existing expertise and to build specifically upon the MOHPrsquos provincial and local governmentsrsquo planning and capacity-building efforts both in-service and pre-service

National- and provincial-level respondents also reported a lack of skilled providers due to inadequate numbers of clinical staff (doctors nurses and midwives) insufficient skills among existing staff and staff unwillingness to be posted where needed A widespread lack of specialized staff such as neonatologists was of particular concern The lack of skilled NYI service providers reported as a challenge by national-

and provincial-level respondents is considered to be the primary barrier in the provision of care forNYIs admitted for inpatient services However the National Free Newborn Care Service Guidelines specifications for HR requirements do not reflect the number of staff needed by level of care listing only the type of provider by level of care

The units caring for the sickest infants in 15 visited facilities12 did not reflect the national and provincial reports of staff shortages These facilities were well staffed and had in total 97 nurses experienced in newborn care and 51 nursesmidwives scheduled to work a 24-hour shift (an average of 99 staff per facility) The average number of unit patients on the day of assessment was just 24 The ratio of patients to 24-hour nursemidwives was an average of 48-to-1 ranging from 29-to-1 at the district hospital to 103-to-1 at the national referral hospital Other specialized staff were also available The four national referralother hospitals in the sample had in total five neonatologists and 31 pediatricians on staff Three of the four same hospitals had six ophthalmologists able to manage NYI retinal conditions Two of the national referralother hospitals had five pediatric surgeons Though there were no available dedicated neonatal nurses there were eight nurses from the 16 facilities who had some form of neonatal nursing training There were 19 pediatricians who provide neonatal care in the assessed provincial hospitals None of the district hospitals had any specialized staff for NYI services but this is appropriate according to the National Free Newborn Care Service Guidelines which require nursing staff paramedics and medical officers as necessary staff for Level II facilities and nursing staff paramedics medical officers and pediatricians as necessary staff at Level III facilities with no mention of neonatologists at all

When staff are newly hired or rotated to work in the NYI units routine practice (defined as at least half of the time) includes assigning new staff to work with experienced staff (93) providing training while working in the unit (86) not assigning new staff to the sickest patients (71) and providing refresher trainings (43) though the topic of the refresher training was not confirmed

Despite having the recommended staff in place 71 of facilities reported occasional unexpectedstaff shortages of which 21 took place four or more times in the past month This result suggests that though positions are filled the sanctioned numbers may not be adequate to respond to unexpected shortages or high turnover Routine practice to fill unexpected gaps included calling in off-duty staff (89) ldquomaking dordquo with those present (78) or pulling staff from other units (44) Forty-four percent of interviewed health care providers reported experiencing being pulled to work in other units or other staff being pulled into their units which 53 felt was good practice Interviewed health care providers reported that a formal process exists to ensure formal handover during shift changes (91) Seventy-nine percent of the respondents found this process to be helpful Forty-four percent of 34 interviewed health care providers reported experiencing stress when caring for sick NYIs during the past 3 months and 35 reported stress or difficulty dealing with the NYI parent or caregiver

Of the 34 interviewed NYI service providers 50 nursemidwives and 41 doctors indicated patient care as their primary responsibility while 6 of them reported it to be NYI unit managers Most had worked at any NYI for more than 2 years (44) 1ndash2 years (18) or less than 1 year (38) Most respondents (41) had worked for less than 1 year at the facility where they were interviewed

Most of the reported in-service training received by the interviewed NYI care providers took place within the previous 12 months and focused on general topics (38) provision of interventions for smallpremature infants (41) interventions for sick NYIs (38) diagnosing andor managing specific illnesses (32) immediate postpartum care of the newborn (35) diagnosing and managing risky conditions or illnesses for the infant (32) counseling the parent on general infant care (29) counseling the parent of a critically ill infant (29) or counseling the parent of an infant who died (29) Very few providers (3 to 15) reported receiving trainings 13ndash23 months earlier in comparison Skin-to-skin contactKMC with a focuson low-birthweightpreterm infants was the most reported topic included in the in-service training(41)

12 Two of the 17 sampled facilities were not considered functional and were subsequently excluded from the analysis

All NYI service providers should receive periodic refresher training in neonatal resuscitation including practice on a manikin Forty-seven percent of staff reported having received training on neonatal resuscitation in the past year of whom 73 reported practice on a manikin No respondents reported that all facilitystaff had received training on advanced care for small and sick newborns 33 reported that some but not all staff had received such training Thirteen percent of staff had received training in the past year on how to counsel parents on infant death

NYI service providers were asked about the working conditions experienced during the past 3 months and 3 months before the facility assessment As described in Figure 4 staff reported drug shortages (29) and equipment breakdown (32) over the past 3 months Over the past month staff reported shortages of nursing staff (35) lack of medical staff (24) complex patient beyond staff skills (44) and difficulties with parentcaregiver of NYI (38)

Figure 4 Working conditions reported by newborn and young infant (NYI) staff over previous 1ndash3 months

Per

cent

age

44 38 35 32 29

24

Drug shortage Equipment Shortage nursing Lack of medical Complex patient Difficulties with (lt3 months) breakdown (lt3 staff (any shift) staff (any shift) beyond staff skills parentcaregiver

months) (lt1 month) (lt1 month) (lt1 month) of infant (lt1 month)

Working conditions reported by NYI staff

Commodities for Neonatal Services Drug Procurement Nepalrsquos government system includes all essential NYI drugs and commodities Procurement takes place according to a standard procurement policy endorsed by the government A national monitoring system is in place to validate the quality of procured drugs The introduction of the federal system has recently led local governments to initiate efforts to establish decentralized procurement systems and quality control measures

Equipment The national equipment procurement policy also includes equipment for NYI care Equipment specifications exist for major pieces of equipment including incubators radiation heaters and newborn resuscitation bags Bidding guidelines for equipment are also observed at the national level National respondents reported no shortages or problems with supplies of essential commodities for NYIs during the past year However shortages of all essential commodities including NYI commodities were reported in 43 of the provinces The reasons for the provincial shortages included district- and provincial-level forecasting errors or delayed orders (29) lack of funds for transportation (14) and lack of funds to fill funding gaps (43)

Nepal does not have a national or provincial oxygen policy in place The responsibility for procurement and supply of oxygen rests at the provincial (14) and facility (86) levels Only one facility reported shortages in oxygen in the past 3 months All four national referralother hospitals and 67 of the provincial hospitals had centrally piped oxygen Eighty-one percent of all facilities had oxygen tanks stored on site

Nepalrsquos National Free Newborn Service Guidelines describe CPAP and oxygen provision through concentratorcylinder as a necessary intervention in both Level II and Level III facilities The equipment necessary for providing oxygen was largely available however airoxygen blenders which are critical for the safe provision of oxygen which were only available in 25 of facilities Of the 16 assessed facilities 56 had CPAP equipment but only 38 had ventilators

The facilitiesrsquo ability to process equipment for reuse varies but each had at least one method 86 had an electric autoclave for sterilizing equipment 29 had nonelectric autoclaves with a heat source 36 had electric dry heat sterilizers and 86 used chemicals for sterilization Reuse of resuscitation masks and of oxygen administration tubes and masks was done by sterilization (50 and 57 respectively) washing with soap and water (both 29) or washing with soap and water and high-level disinfecting (14 and 7 respectively)

Maintenance and Repair Maintenance plans including funding for parts are bought along with critical neonatal equipment for a limited period of time National equipment maintenance practices which are part of the governmentrsquos overall maintenance plan were reported These plans include the maintenance of incubators radiant warmers and CPAP equipment The national government is responsible for building the capacity of a pool of maintenance staff who are deployed at the national and provincial levels Each province is assigned a biomedical engineer but there are no maintenance staff at the district level Districts therefore receive support from the provincial level when required

Maintenance guidelines have established standards for routine maintenance but it is unclear how well such guidance is followed No national- or provincial-level routine checks for equipment functionality takeplace at the facility level Nonetheless 71 of the 16 assessed facilities reported routine maintenance practices for any equipment and 88 reported having budget line items to conduct routine maintenance and purchase parts for repair

Management Systems Health facilities in Nepal have Hospital Development Committees that support the management of the facility In the assessed facilities management activities within the previous 3 months included external supervision of neonatal care (100) management team meetings (76) interdisciplinary team meetings (71) and budget management (eg budgeting approving procurements or reporting on accountability of funds) (65)

External supervision helps to ensure that standards are followed across facilities and external supervisors often ensure that systemic issues are brought to the attention of higher-level decision-makers

Each facility confirmed that it had received external supervision relevant to NYI care within the past6 months 18 reported supervision the month of the assessment 29 within the past 2ndash3 months and 24 in the past 3ndash6 months Components of the discussions during such external supervision over the past 3 months are described in Figure 5

Figure 5 Content of external supervision in past 3 months (N = 17)

Com

pone

nt o

f dis

cuss

ion Service dataindicators for QOC

Guidelinesprotocolson-the-job training

Communications with parents

Solutions to QOC problems

Staff availabilitytraining

Managementservice problems

Gaps in QOC

0 20 40 60 80 100

Percentage

External supervision visits also provide an opportunity to review records relevant to NYI services While supervision visits included discussions on the above-noted topics the assessment results showed that records were rarely reviewed on staff attendanceleave (29) staff training (18) health worker activity reports (0) financial records (18) and data for completeness quality and timely reporting by reviewing submitted reports or data in registers (24)

Nineteen (55) of the 34 interviewed providers of clinical services confirmed they had been personally supervised during the previous 3 months In most cases supervision was external (63) but 37 of supervisions were from within the facility Supervision includes observation of work (74) use of a checklist (37) discussion of communication with the parent of the NYI (21) recordkeeping (21) equipment maintenanceadequate supplies (53) patient care (53) and staff motivational issues (47)

All 17 facilities reported having an NYI management team either at the facility level (76) or at the unitdepartment level (24) Most had met within the past month (71) and the remainder within the past 2ndash3 months Discussions at the meeting included cases resulting in deaths (92) clinical care (100) nursing care (92) staffing numbers or skills (92) consumable resources (92) equipmentdiagnostics (100) and finances (92)

Interdisciplinary team meetings are expected to improve coordination identify needs and aim to result in better planning and teamwork for individual patient care In addition to clinical and nursing care other disciplines are included because of their support coordinating immediate service needs and follow-up services after discharge Interdisciplinary management teams were in place at 76 of the facilities composed of clinicians including medical staff (100) nursesmidwives (92) nutritional (15) and other technical staff (eg laboratory staff) (69) The nonclinical participants included social services (46) managers (77) community-based workers (8) and family representatives (15)

Of the 17 facilities 65 reported that the NYI unit has authority over some aspect of the facility budget Of these 47 reported being able to contribute to budget preparation and 65 to procurements (requests for drugs commodities and equipment) 59 could request additional funds 53 could negotiate the budget 65 prepared reports on funds and 41 were able to authorize procurement

Monitoring and Evaluation Facility-level neonatal indicators are reported and monitored at the national level and in some cases at the provincial level (86) However evidence of such monitoring was half of that reported at 43

=

All facilities routinely submit compiled reports to the local authorities and submit births to relevant entities as per national guidelines Although all facilities are required to monitor nationally endorsed newborn indicators only 94 of the assessed facilities reported monitoring newborn indicators The facilities report monitoring very low-birthweight and low-birthweight (82) very preterm live births (lt 32 weeks gestation) (76) live births with birth asphyxia requiring resuscitation (53) facility births with neonatal sepsis (47) and inpatient infant deaths by cause (82)

Data collectors reviewed individual registers and registers for aggregate data Sixty-three percent of the facilities that maintained records use standardized sets of forms to record patientsrsquo medical records Of 84 NYI patients encountered on the day of assessment 94 had individual case sheet records

All inpatients should have a diagnosis made by the doctor to guide the management of each NYIrsquos treatment The three most common diagnoses were respiratory distress severe bacterial infection andhyperbilirubinemiajaundice

Every newborn should have a full physical assessment to identify conditions requiring immediate management

Table 6 shows the findings from five randomly selected records of NYI patients and 59 charts of newborns born in the same facility Routine monitoring was less adhered to

Table 6 Documentation of newborn assessment and routine monitoring of newborn and young infant

Reported aspect of newborn assessment Percentage of reviewed records (N 59)

Birthweight 78

Gestational age 75

Temperature 86

Respiratory rate 86

Congenital abnormalities 44

Notes on danger signs 44

Respiratory rate recorded three times a day or more 48

Temperature recorded three times a day or more 11

Facilities providing record saturation rate daily 0

Respiratory rate 86

Daily progress notes on patient condition 20

Record of medicines to be received and medicines administered 23

Daily note on times infant urinated 20

Daily note on times infant passed stool 20

Daily note on times infant was fed 17

QOC Ninety-four percent of facilities routinely monitor the QOC indicators described in Figure 6 but only 65 hold routine meetings to review the findings The monitored indicators were reported most consistently at

the provincial hospitals (100) followed by the district hospitals (90) and national referralother hospitals (88) despite all facilities being required to report to the MOHP

Figure 6 Quality of care (QOC) indicators reported by facilities (N = 17)

100

Per

cent

age 80

60

40

20

0 Perinatal mortality rates Neonatal mortality rates Case fatality rates (CFR) CFR by weight and

gestational age

Monitored QOC indicators

Seventy-one percent of facilities monitor nosocomial infections but of these only 29 monitor nosocomial infections in infant care units and only 18 have written guidelines to do so

Nepal has a national policy for perinatal death audits and neonatal death audits Though national guidelines for maternal perinatal and neonatal death audit processesmdashincluding the review and use of resultsmdashwere reported these were not observed during the assessment Eighty-six percent of provinces reportedconducting perinatal death audits and 57 reported conducting neonatal death audits Fifty-seven percent of provinces reported plans to expand death audits Data gathered over an average of 27 months recorded in facility-compiled reports showed that on average each month facilities record 3288 live births 1771 perinatal deaths and 606 neonatal deaths

Twelve of the 17 sampled facilities reported conducting perinatal or neonatal death reviews Among these facilities 92 use structured forms to conduct neonatal death reviews13 and perinatal death review (though only 83 of perinatal death reviews include stillbirths) 82 conduct patient case reviews14 and 88 conduct special care reviews Only 42 of facilities could offer an example of action resulting from a deathreview suggesting further work is required to appropriately discuss review and act on the audit results

Facility-to-facility learning is systematically practiced in 50 of sampled facilities which involves joint classroom training (50) mentoring in their own facility (43) or in another facility (50) and joint case reviews (21)

Nepal promotes WHOrsquos Baby-Friendly Hospital Initiative (BFHI) accreditation but only two (12)of the sampled facilities were designated Baby-Friendly This underlines an opportunity for thewide-scale rollout of WHOrsquos Baby-Friendly Hospital Initiative (BFHI) and other accreditationprograms or certifications

The majority of facilities encouraged feedback from clients and parents with 94 of facilities using a system to invite opinions on their experience at the facilities including suggestion boxes (76) exit interviews (18) and contacting clients after discharge (18)

Infection Prevention

13 Neonatal death reviews include infants born alive who die within the first 28 days 14 A case review is a formal meeting where information about a current or discharged patient is presented usually by the primary doctor for that patient and issues related to diagnosing treating and improving the outcome are discussed Suggestions from peers are sought

-

The availability of infection control supplies in the service areas where NYIs are treated (or immediately adjacent such that the service provider could be reasonably expected to use them with or in between seeing patients) was largely positive As described in Figure 7 there is a need to ensure that facilities have waste containers available for disposing of contaminated waste

Figure 7 Available infection control items per facility (N = 16)

100

Per

cent

age

90 80 70 60 50 40 30 20 10 0

Hand washing Waste container Sharps container Environmental Latex gloves materials for contaminated disinfectant

waste Infection control items

Efforts to prevent transmission of infection among patients include arranging cots in systematic fashion (94) and keeping hand-cleaning sites beside each infant cot in every unit During the assessment visit however 31 of providers were observed touching different infants without cleaning their hands in between

Ninety-three percent of facilities had functional equipment for high-level disinfecting Cleaning reported in between infants is conducted by unit auxiliary staff (75) or cleaning staff (19) and includes wiping the cotincubator with disinfectant (100) and washing blankets and bedding (94) for which 81 of facilities have laundry available for daily washing Floors are mopped more than once daily (88) or once daily (18) by unit auxiliary staff (75) or cleaning staff (25) who also empty diaper disposal containers more than once daily (94)

Referrals Nepal has a national plan for emergency transportation and a special plan for transportation of maternal and NYI patients Only 71 of provinces have a more specific local emergency transportation plan

Most provinces (86) have government-owned emergency transportation vehicles for which fuel is financed by the provinciallocal government budget (29) the facility (14) or the patient (29) Maintenance and repairs are financed by the provinciallocal government budget (29) or the facility budget (29)

Out-Referrals All 17 facilities refer NYIs out when necessary using registers to record out-referrals (94) and accompanying the patient with information on printed referral forms (82) Eighty-eight percent of facilities had an ambulance for patient transport Of these 100 had fuel available for its use Twelve percent used a vehicle from another facility within 30 minutes that can be called to transport patients

During out-referrals family members always accompany the infant None of the facilities use transporterincubators but 44 of facilities transfer the patient in skin-to-skin position

In-Referrals All of the 17 facilities accept in-referrals and 88 of facilities had units to receive NYI in-referrals The fragility of NYI patients requires a rapid assessment (within 15 minutes of arrival) to enable a prompt start to treatment but two facilities (13) confirmed that infants were sometimes not assessed within this window (eg if sicker infants had to be prioritized)

Sixty-three percent of staff working in the intake units had received training in any aspect of diagnosing or treating infants over the past 2 years and 69 had received training on neonatal resuscitation using bag and mask in the past 12 months

Thirty-three reviewed records showed that the documented admission history was inadequate including transferreferral note (18) admission diagnosissymptom (20) patient history (7) maternal pregnancy history (21) and mode of delivery (8) The recorded physical information was also lacking including infant age (24) temperature (23) respiratory rate (23) note on danger signs (20) heart rate (23) muscle tone (13) color (14) breathing (23) and responsiveness (11)

Discharge Planning Systems for planning NYI discharges were observed in 88 of the facilities but only 12 of facilities had any linkages with community-based health workers Reported methods for sharing information with community-based health workers included preprinted discharge forms (12) phone calls (6) and routine meetings at the facility (12)

Facilities had guidelines related to discharge criteria (71) maternal vulnerability (35) socioeconomic status (41) parental competence to provide infant care (59) aids for parents to use at home (59) and lists of community resources to support infant care postdischarge (24)

Table 7 presents the 38 interviewed caregiversrsquo description of discharge planning and their knowledge of postdischarge care

Table 7 Discharge planning with infant caregivers (N = 38) (mothers [81] or fathers [18])

Among caregiver who assume infant will be discharged home those reporting Percentage

Staff discussed taking care of infant at home 38

Staff discussed riskdanger signs to watch for at home 43

Feel comfortable they can care for infant at home 97

Know they can seek help at a local facility postdischarge 51

Know they can benefit from home visits by health workers 51

Know that facility staff can call to check on the infant 41

Know of available postdischarge financial support 32

Know of emergency telephone numbers to call for help 32

Twenty-nine percent of facilities used methods such as appointment systems to improve adherence to infant follow-up care However of 29 reviewed records of infants 3ndash59 days old just 3 recorded that parents were counseled on available community-based support or other resources to support households

Though there is a foundation of discharge planning follow-up care and high recognition of risk signs by caregivers (as described in Figure 8) there is a need to scale up and standardize services

-

across facilities particularly to increase the number of facilities coordinating with community-basedhealth workers to provide postdischarge support and follow-up

Figure 8 Postdischarge risk signs identified by caregivers (N = 37)

Other

Infant yellow

Seizures

Diarrhea

Vomiting

Difficulty feeding

Difficulty breathing

Decreased movement

Fever

Ris

k si

gn

0 10 20 30 40 50 60 70 80 90 100 Percentage

Spontaneously With prompting

Parental Support NYI best practice encourages the close involvement of parents (particularly the mother) with infant care This sometimes involves prolonged stay at the facility and associated costs of living Though the MOHP has made inpatient care of NYIs free across the country and though other assistance to cover costs that support inpatient NYIs also existmdashfor example through government insurance and facility petty cashmdashsuch services are to help with infant costs rather than to support accompanying parents

Of the 17 facilities most offer space where accompanying parents can sleep (93) and cook (33) and 80 have funds to support parents of NYIs though 60 of these only support parents with financial needs Even with this support over half of the 38 interviewed caregivers of inpatient NYIs (55) reported out-of-pocket payments for the cost of care including expenses for food and accommodation

Figure 9 describes which out-of-pocket expenses were considered most expensive Transport tofrom the facility was the expense considered to be large by the most respondents Transportation used to bring the infant to the facility was by ambulance (33) private car (13) or public transportation (27)

Figure 9 Out-of-pocket expenditure considered large by interviewed caregivers (N = 38)

Tips for staff O

ut-o

f-po

cket

pay

men

t Additional items for infant Formula Diapers

Medicine Bringing infant to facility

Transport back home Transport to facility

Food Overnight accommodation

0 10 20 30 40 50 60 70 80 90 100

Percentage

Opinion was almost evenly divided on whether the cost of care is too expensive (52 think it is 48 think it is not)

Caregivers staying at the facility with their infant did not rate the amenities favorably Except for access to water for washing (66) amenities scored between 21 and 53 with an average of 39 Access to drinking water (45) and basic infection control practices such as having hand-cleaning items neartoilets (29) were of particular concern

Experience of Care Caregivers reported positive experiences of care by both nurses and doctors (81 and 87) who were considered respectful (74 and 84) sympathetic (84 and 82) listened well (82 and 84) and explained things in a way that could be understood (84) but only 60 considered that communication was adequate which suggests that though the manner of communication was acceptable it was too infrequent

Figure 10 Caregivers perception of respectful care in newborn and young infant units (N = 38)

Staff gentlecomforting Nursing care good Medical care good

Asp

ect

of c

are Baby had pain and staff responsive

Infant experienced pain Touchesholds infant as often as want

Sees infant as often as want Privacy for self has been sufficient

Quiet during night Quiet during day

Clean

0 10 20 30 40 50 60 70 80 90 100 Percentage

As described in Figure 10 most caregivers reported that the medical care (87) and the nursing care (84) were good and though only 29 reported that their infant experienced pain 56 said the staff were responsive to that pain

Observed practices in the units caring for the sickest infants included keeping the unit quiet (81) with lights low (69) to minimize infant stimulation and limiting visitor access to the unit (94) However only 58of caregivers felt the unit was quiet during the day (58) though many found it to be quieter at night (76)

The Tool 2 results described in the Nepal Country Profile section reported that Nepalrsquos nine key guidance documents for implementing newborn health care and promoting beneficial practices did not include the maintenance of a low-stimulation environment (low lightnoise) in NYI units The guidance should be reviewed to better emphasize the importance of maintaining the appropriate environment includingensuring quiet both at night and during the day

Most (76) caregivers felt that privacy was sufficient and that they could see and touch or hold their infant as often as wanted

When results were disaggregated by facility type the provincial hospitals provided the best overall experience of care (76) followed by the national referralother hospitals (71) and finally the district hospitals (62)

Recommendations The priority recommendations discussed at the workshop are included in Table 8

Table 8 Highlights of identified issues and suggested recommendations by assessed theme

Assessed Theme Identified Issue Recommendations for MOHP Action Priority

1 NYI Unit Infrastructure

Lack of functional toilets for parentsvisitors

Basic amenities for parentsvisitors of inpatient NYIs should be prescribed in nationalprovincial guidance and support

Low

Lack of national-level guidance on the organization of KMC services

Develop national KMC guidance on infrastructure and services design High

2 NYI Services

Lack of services magnesium sulfate for neuroprotection assessment of newborn hearing screening for retinopathy of prematurity exchange transfusion for hyperbilirubinemia

Review existing service package and support incorporation according to levels of care determined by national guidelines Add services to national guidelines and policy where not explicitly included

High

Gaps in provision of alternate methods for breast milk feeding

Strengthen alternate methods for breast milk feeding with clear guidance on how to avoid breast milk substitute feeding build staff counseling and clinical skills provide equipment and support to mothers (including privacy during milk expression)

Medium

Sepsis management not standardized in the assessed facilities

Standardize and systematically scale up sepsis management services in all SNCUs and NICUs

High

Limited readiness to manage respiratory distress in NYIs

Expand and improve high-quality services for NYIs in respiratory distress High

Only 47 of facilities can conduct ABO compatibility tests

Expand blood group analysis services to all SNCUs and NICUs Medium

3 Provision of Care Human Resources

Lack of specialized neonatal nursing staff competencies

Determine neonatal nursing competencies required for providers in SNCUs and NICUs with certification

Medium

Develop and roll out capacity-building plan High

Lack of standards for staff rotationnew staff in SNCUs and NICUs

Implement standards for staff rotationnew staff deputation in SNCUs and NICUs Low

SNCUs and NICUs experience staff shortages and staff report stress when working in neonatal units

Develop motivation systems including psychosocial support to encourage staff retention in SNCUs and NICUs

Medium

4 Commodities for Neonatal Services

Provincial shortages of commodities

Strengthen district- and provincial-level forecasting systems to minimize errors and delayed orders

High

Include funds for SNCUs and NICUs as per forecast High

Limited airoxygen blenders CPAP equipment and ventilators

Forecast and procure all newborn resuscitation equipment required for Medium

newborns in respiratory distress and ensure availability as per national guidancestandards

Maintenance guidance is not followed and there are no national- and provincial-level routine checks for functionality of equipment at the facility level

Strengthen routine maintenance practices for all equipment and set aside regular budget line items for routine maintenance and to purchase parts for repair

High

5 Management Services

Weak content of external supervisory visits

Strengthen components of external supervision service dataindicators for QOC on-the-job mentoring skills for communicating with parents discussion on actions required for QOC staff management etc

Medium

Ensure family representation in facility management meetings Medium

6 Monitoring and Evaluation

Weak maintenance of records of daily monitoring of NYI patients

Emphasize importance of daily monitoring records High

Seek digital monitoring solutions Medium

7 QOC

Only 65 of the assessed facilities held routine meetings to review the findings of QOC indicators

Build capacity on use of data and integrate into regular managementmaternal and perinatal death surveillance and responseaudit systems and meetings

High

Only two of the sampled facilities were designated Baby-Friendly

Integrate comprehensive feeding of small and sick newborns and support the wide-scale rollout of WHOrsquos recently updated BFHI guidelines

High

8 Infection Prevention

31 of providers observed touching different infants without cleaning their hands in between

Roll out Clean Clinic initiatives that focus on handwashing and use of sanitizers and support an infection prevention environment

High

9 Discharge Planning

Only 12 of facilities had any linkages with community-based health workers

Develop and implement discharge planning and postdischarge postnatal care guidance across the country

High 3 of parents recorded being counseled on available community-based support or other resources to support household-level care of newborns

10 Parental Support

55 of the 38 interviewed caregivers of inpatient NYIs reported out-of-pocket payments for the cost of care including expenses for food and accommodation

Review present incentive scheme and determine ways to support parents of inpatient NYIs to manage costs of long admissions and opportunity costs

Medium

Poor amenities support for parents

Ensure SNCUs and NICUs have basic amenities for parents of inpatient NYIs Medium

11 Experience of Care

Less attention given to infant pain experience and management privacy for mothers while expressing breast milk and sound levels in the SNCUs and NICUs

Incorporate nurturing care elements into nationally endorsed curricula and mentor staffproviders on the job to demonstrate simple measures for nurturing care

High

Conclusion Nepalrsquos ambitious countrywide implementation of plans that increase access and availability of inpatient newborn care underscore the commitment of the MOHP to pursue continued reductions in newborn and infant mortality rates Progress and investment to date have been laudable and the prioritization of strategies that address newborn health suggest that Nepal is capable of meeting its Sustainable Development Goals by 2030

The recommendations resulting from this situational analysis vary significantly in terms of effort and finances required to implement Some are relatively simple fixes such as additions or amendments to existing policies whereas others such as the nationwide rollout of WHOrsquos BFHI require dedicated funding logistical planning and coordination among stakeholders Nonetheless each recommendation has significant implications for the improved quality of newborn care services and warrants serious consideration BFHI rollout for example has been effectively implemented in comparable contexts and proves highly effective in promoting exclusive breastfeeding and skin-to-skin contact immediately after birth

Staff shortages are a persistent problem within Nepalrsquos broader health system and the lack of specialized staff such as neonatologists is of particular concern Indeed staff shortages are considered to be the primary barrier in the provision of care for NYIs admitted for inpatient services Efforts to incentivize existing staff and offer professional development opportunities may prove effective in motivating and growing the number of providers and inform a strategy to create lasting change

The multicountry brief15 compiled by Every PreemiendashSCALE presents the findings of the same assessment in collaboration with the ministries of health in Ghana Rwanda Tanzania and Uganda The results offer an illuminating context to the Nepal report and similar recommendations may offer opportunities for cross-country learning and future collaboration The involvement of local and global partners is hoped to ensure the translation of the findings into policy and programming at the national level and to inform the effort to define standardize and mainstream inpatient care of small and sick newborns globally building upon the ENC platform

15 Every PreemiendashSCALE USAID Project Concern International Global Alliance to Prevent Prematurity and Stillbirth American College of Nurse-Midwives 2019 Situation Analysis of Inpatient Care of Newborns and Young Infants Highlights of Findings for Ghana Rwanda Tanzania and Uganda Washington DC Every PreemiendashSCALE

evel I (Newborn corner)

SN Ciiteria

Set up Standard stitus

20-30 sq ft working area within labor Yes Senices Standard Stanis

I Care of normal newborn Yes 2 Neonatal resuscitation Yes 3 Thermal protection Yes

4 Infection prevention Yes 5 Breast feeding Yes

Identification management and safe transport of sick

6 neonate Yes 7 GroMh monitoring Yes

8 Identification of common physiological variation Yes Equipmentconsumables Standard Stanis

I Wrapper in delivery package 4

2 Cord damp As per need

3 Digital pan weighing machine I

4 Resuscitation table with warmer 2

5 Wall clock ~th second hands I

6 Room thennometer I

7 Baby stethescope I

8 Bag amp mask Size 0 I

9 Bag amp mask Size I 11

Appendix 1 Nepalrsquos Expected Standards of Care by Service Level (I II and III)

Source Free Newborn Care Services Program Guideline 2018 Child Health Division Department of Health Services Ministry of Health Nepal

10

11

12

13

14

15

16

17

18

19

20

Penguine suction 2

Indentification tag As per need

Sterile gloves As per need

Vitmin KI Injection As per need

Syringe (1ml) As per need

Newborn cloth As per need

KMCwrapper 4m

Room heater I

Newborn emergency kit I

IV Stand 2

Medicine Trolley I

HR Type Lewll

Nursing staffSBA 2-3

Paran1edics 2-3

Medical Officers I (at PHCC)

Newborn service establishment assessment checkist

Level II (Special Newborn Care Unit)

SN Ciiteria

Set up Standard

200 sq with at least 4 beds for newborn

Senices Standard

1 All services at level I + Yes 2 F1uid management Yes

3 Shock managen1ent Yes 4 Hypoglycemia management Yes 5 Hypocalcemia managen1ent Yes

6 Perinatal asphyxia management Yes 7 Neonatal seizure management Yes 8 Hyperbilirubinemia management Yes

Status

~ ~ ~~ Yes

10 Xemtll sep~ ~~ Ys

H ~cEmia ard b~ dismde ~-mm Yes

11 umta- irIldUre Yes

B - sauce yen13

S_1 00 E _Ji1Jnrtsl1 51a~ IV cmailabull14 J6 G il5 reqJired

1 Bei m1h ra_tfud iliEtllm 4

1 ~ ildtf fl 5et 1

4 E2ectrir ixfioo+ ThsJ]oiabh tibe ~S F 1 j Bed --lie Mmi=t llf 4

r5 Lillj~ htBd 0-1 wtm 2 bmr~i mm SJlilll set I

1 loom~~ bull - - i I

s Boomdook I

9 IBgiraJ tbmmcueter 4

10 usl ~-3 1

H Sten_~ ~ieqmred

11 S~Jpmrp 4

u llgJtll WBglllllg 5ale

14 ~

1) ~ tlJlNlilill~Silb1pound) il5~

16 ~tape 4

17 ~emilm ilehsoope 4

l S Xemtll BP ~ middotted) I

19 ~ ~Jmfflffl I

20 G1mm-=m rvlirh mp 1

2 - ~J 1

22 ~--gen---- ~ 4

ll ~~ g middotuoomt~ ibei) I

24 Chgen llmme~ tiei) I - Jlo1Jytfpounde ~~ v_TIp5 ~lEqllired

26 In-adiance meter 1

27 Transport incubator with oxygen 1

28 IV Stand 6

29 Medicine trolley 1

30 CP AP Machine 1

3 1 Infusion Pump 4

HR Type Level II Status

Nursing staffSBA 8

Paramedics 3(OPDemergency)

Medical Officers 2-3

Level III (Neonatal Intensive Care Unit)

SN Criteria

Set up Stanclarcls Status

400sqf area with at least 8 resuscita tion tables with

ratliaul wanwr

Services

1 All s eivice level it level I amp II +

2 Totil pirentemiddotal feecling

3 Intubation and ventilation

4 Advance neonatal monitoring

5 Head cooling for birth asphyxia

6 Surfactant therapy

Diagnosis and management of complicated medical and

7 surgical condition

Equipmentsconsumables Stanclalcl Status

1 Neonatal ventilator support for at least 500 gm baby 4

2 Double surface phototherapy unit with LED 4

vital monitor(neonatal cardio-puhnonary

3 monitor +ECG(per bed) 8

6 Cold light I

7 Bilirubin meter with microcentrifuge I

8 Capilary tube as per need as required

9 CP AP machine 2

10 ABGmachine 1

11 Portable USG with neonatal probe 1

13 Ghestubeneonatal size ~th troacar(disposable)

17 IV Stand 10

18 Medicine Trolley 2

19 Infusion Pump 8

20 Syringe Pump 4

HR Type Lewl m Status

Nursing staffSBA 12

Paran1edics 3(OPDemergency)

Medical Officers 5

Paediatrician 2

Table of Contents
Acknowledgments
Abbreviations
Executive Summary
- Context
- Key Findings and Recommendations
- - Background
  - - Nepal Country Profile
    - Purpose of the Situation Analysis
    - - Methodology
      - Objective
        
        Study Design
        
        Data Analysis
        
        Challenges and Limitations
        
        Results
        
        NYI Units Infrastructure
        
        NYI Services
        
        KMC
        
        Breast Milk Feeding
        
        Severe Bacterial Infection
        
        Respiratory Distress
        
        Seizures
        
        Hyperbilirubinemia
        
        Provision of Care Human Resources
        
        Commodities for Neonatal Services
        
        Drug Procurement
        
        Equipment
        
        Maintenance and Repair
        
        Management Systems
        
        Monitoring and Evaluation
        
        QOC
        
        
        Referrals
        
        Out-Referrals
        
        In-Referrals
        
        Discharge Planning
        
        Parental Support
        
        Experience of Care
        
        Recommendations
        
        Conclusion

Page 2: Situation Analysis of Inpatient Care of Newborns and Young ...

The Maternal and Child Survival Program (MCSP) is a global $560 million 5-year cooperative agreement funded by the United States Agency for International Development (USAID) to introduce and support scale-up of high-impact health interventions among USAIDrsquos 25 maternal and child health priority countries as well as other countries MCSP is focused on ensuring that all women newborns and children most in need have equitable access to quality health care services to save lives MCSP supports programming in maternal newborn and child health immunization family planning and reproductive health nutrition health systems strengthening watersanitationhygiene malaria prevention of mother-to-child transmission of HIV and pediatric HIV care and treatment

This study is made possible by the generous support of the American people through USAID under the terms of the Cooperative Agreement AID-OAA-A-14-00028 The contents are the responsibility of MCSP and do not necessarily reflect the views of USAID or the United States Government

Abbreviations v

Context vii

Background 1

Methodology 3

Objective 3

Study Design 3

Data Analysis 4

Results 5

NYI Services 7

QOC 18

Referrals 20

Parental Support22

Recommendations25

Conclusion 27

QOC quality of care

Province 1

Province 2

Province 3

Province 4

Province 5

Province 6

Province 7

TOTAL 33 5 10 5 14 5

TOTAL 38 34

I

Per

cent

age

100 90 80 70 60 50 40 30 20 10 0

bull

NY

I Ser

vice

In

ter

NICU

0 10 20 30 40 50 60 70 80 90 100

Percentage

Treat seizures 14

16 14

Num

ber

of fa

cilit

ies

14

12

10 8

8 6

6 4

4 3 3

2 1

Facilities seeing

Imm

edia

tely

ref

erpa

tien

t w

itho

ut fu

rthe

ras

sess

men

t or

tre

atm

ent

Pro

vide

one

dos

ein

ject

able

ant

ibio

tic

th

en r

efer

Pre

scri

be fu

ll an

tibi

otic

re

gim

en a

nd fo

llow

-up

IV IM

Clin

ical

ass

essm

ent

only

Blo

od c

ultu

re

Lum

bar

punc

ture

and

se

nses

exa

min

atio

n

NICU 3 0 3 2 3 1 2 3 3

SNCU 6 0 6 3 6 3 5 3 2

Total 9 0 9 5 9 4 7 6 5

Facility Type

(observed)

Steth oscop

e

Pulse oximet

er

Respirati on

monitor

Apnea monit

or

X-ray (report

ed)

Sucti on

Neona te

chest tubes

CPAP equipm

ent

Ventilat or

NICU 6 6 6 2 6 6 0 5 5

SNCU 6 5 6 1 7 5 0 4 1

Private 3 3 3 0 3 3 0 2 3

Public 12 11 11 4 13 11 1 7 3

Per

cent

age

44 38 35 32 29

24

Com

pone

nt o

f dis

cuss

Gaps in QOC

0 20 40 60 80 100

Percentage

=

Birthweight 78

Gestational age 75

Temperature 86

Respiratory rate 86

100

Per

cent

age 80

60

40

20

gestational age

-

100

Per

cent

age

90 80 70 60 50 40 30 20 10 0

-

Other

Infant yellow

Seizures

Diarrhea

Vomiting

Difficulty feeding

Decreased movement

Fever

Ris

k si

gn

0 10 20 30 40 50 60 70 80 90 100 Percentage

Tips for staff O

ut-o

f-po

cket

pay

men

0 10 20 30 40 50 60 70 80 90 100

Percentage

Asp

ect

of c

Clean

0 10 20 30 40 50 60 70 80 90 100 Percentage

Low

2 NYI Services

High

Medium

High

Medium

High

Medium

7 QOC

High

10 Parental Support

Medium

High

SN Ciiteria

10

11

12

13

14

15

16

17

18

19

20

Penguine suction 2

KMCwrapper 4m

Room heater I

IV Stand 2

Medicine Trolley I

HR Type Lewll

Paran1edics 2-3

SN Ciiteria

Set up Standard

Senices Standard

Status

~ ~ ~~ Yes

B - sauce yen13

1 ~ ildtf fl 5et 1

s Boomdook I

10 usl ~-3 1

H Sten_~ ~ieqmred

11 S~Jpmrp 4

14 ~

16 ~tape 4

19 ~ ~Jmfflffl I

2 - ~J 1

22 ~--gen---- ~ 4

28 IV Stand 6

30 CP AP Machine 1

3 1 Infusion Pump 4

Nursing staffSBA 8

SN Criteria

ratliaul wanwr

Services

6 Cold light I

9 CP AP machine 2

10 ABGmachine 1

17 IV Stand 10

19 Infusion Pump 8

20 Syringe Pump 4

Nursing staffSBA 12

Medical Officers 5

Paediatrician 2

Table of Contents
Acknowledgments
Abbreviations
Executive Summary
- Context
- - Background
    - - Methodology
      - Objective
        
        Study Design
        
        Data Analysis
        
        
        Results
        
        
        NYI Services
        
        KMC
        
        Breast Milk Feeding
        
        
        
        Seizures
        
        Hyperbilirubinemia
        
        
        
        Drug Procurement
        
        Equipment
        
        
        Management Systems
        
        
        QOC
        
        
        Referrals
        
        Out-Referrals
        
        In-Referrals
        
        Discharge Planning
        
        Parental Support
        
        Experience of Care
        
        Recommendations
        
        Conclusion

Page 3: Situation Analysis of Inpatient Care of Newborns and Young ...

Abbreviations v

Context vii

Background 1

Methodology 3

Objective 3

Study Design 3

Data Analysis 4

Results 5

NYI Services 7

QOC 18

Referrals 20

Parental Support22

Recommendations25

Conclusion 27

QOC quality of care

Province 1

Province 2

Province 3

Province 4

Province 5

Province 6

Province 7

TOTAL 33 5 10 5 14 5

TOTAL 38 34

I

Per

cent

age

100 90 80 70 60 50 40 30 20 10 0

bull

NY

I Ser

vice

In

ter

NICU

0 10 20 30 40 50 60 70 80 90 100

Percentage

Treat seizures 14

16 14

Num

ber

of fa

cilit

ies

14

12

10 8

8 6

6 4

4 3 3

2 1

Facilities seeing

Imm

edia

tely

ref

erpa

tien

t w

itho

ut fu

rthe

ras

sess

men

t or

tre

atm

ent

Pro

vide

one

dos

ein

ject

able

ant

ibio

tic

th

en r

efer

Pre

scri

be fu

ll an

tibi

otic

re

gim

en a

nd fo

llow

-up

IV IM

Clin

ical

ass

essm

ent

only

Blo

od c

ultu

re

Lum

bar

punc

ture

and

se

nses

exa

min

atio

n

NICU 3 0 3 2 3 1 2 3 3

SNCU 6 0 6 3 6 3 5 3 2

Total 9 0 9 5 9 4 7 6 5

Facility Type

(observed)

Steth oscop

e

Pulse oximet

er

Respirati on

monitor

Apnea monit

or

X-ray (report

ed)

Sucti on

Neona te

chest tubes

CPAP equipm

ent

Ventilat or

NICU 6 6 6 2 6 6 0 5 5

SNCU 6 5 6 1 7 5 0 4 1

Private 3 3 3 0 3 3 0 2 3

Public 12 11 11 4 13 11 1 7 3

Per

cent

age

44 38 35 32 29

24

Com

pone

nt o

f dis

cuss

Gaps in QOC

0 20 40 60 80 100

Percentage

=

Birthweight 78

Gestational age 75

Temperature 86

Respiratory rate 86

100

Per

cent

age 80

60

40

20

gestational age

-

100

Per

cent

age

90 80 70 60 50 40 30 20 10 0

-

Other

Infant yellow

Seizures

Diarrhea

Vomiting

Difficulty feeding

Decreased movement

Fever

Ris

k si

gn

0 10 20 30 40 50 60 70 80 90 100 Percentage

Tips for staff O

ut-o

f-po

cket

pay

men

0 10 20 30 40 50 60 70 80 90 100

Percentage

Asp

ect

of c

Clean

0 10 20 30 40 50 60 70 80 90 100 Percentage

Low

2 NYI Services

High

Medium

High

Medium

High

Medium

7 QOC

High

10 Parental Support

Medium

High

SN Ciiteria

10

11

12

13

14

15

16

17

18

19

20

Penguine suction 2

KMCwrapper 4m

Room heater I

IV Stand 2

Medicine Trolley I

HR Type Lewll

Paran1edics 2-3

SN Ciiteria

Set up Standard

Senices Standard

Status

~ ~ ~~ Yes

B - sauce yen13

1 ~ ildtf fl 5et 1

s Boomdook I

10 usl ~-3 1

H Sten_~ ~ieqmred

11 S~Jpmrp 4

14 ~

16 ~tape 4

19 ~ ~Jmfflffl I

2 - ~J 1

22 ~--gen---- ~ 4

28 IV Stand 6

30 CP AP Machine 1

3 1 Infusion Pump 4

Nursing staffSBA 8

SN Criteria

ratliaul wanwr

Services

6 Cold light I

9 CP AP machine 2

10 ABGmachine 1

17 IV Stand 10

19 Infusion Pump 8

20 Syringe Pump 4

Nursing staffSBA 12

Medical Officers 5

Paediatrician 2

Table of Contents
Acknowledgments
Abbreviations
Executive Summary
- Context
- - Background
    - - Methodology
      - Objective
        
        Study Design
        
        Data Analysis
        
        
        Results
        
        
        NYI Services
        
        KMC
        
        Breast Milk Feeding
        
        
        
        Seizures
        
        Hyperbilirubinemia
        
        
        
        Drug Procurement
        
        Equipment
        
        
        Management Systems
        
        
        QOC
        
        
        Referrals
        
        Out-Referrals
        
        In-Referrals
        
        Discharge Planning
        
        Parental Support
        
        Experience of Care
        
        Recommendations
        
        Conclusion

Page 4: Situation Analysis of Inpatient Care of Newborns and Young ...

QOC quality of care

Province 1

Province 2

Province 3

Province 4

Province 5

Province 6

Province 7

TOTAL 33 5 10 5 14 5

TOTAL 38 34

I

Per

cent

age

100 90 80 70 60 50 40 30 20 10 0

bull

NY

I Ser

vice

In

ter

NICU

0 10 20 30 40 50 60 70 80 90 100

Percentage

Treat seizures 14

16 14

Num

ber

of fa

cilit

ies

14

12

10 8

8 6

6 4

4 3 3

2 1

Facilities seeing

Imm

edia

tely

ref

erpa

tien

t w

itho

ut fu

rthe

ras

sess

men

t or

tre

atm

ent

Pro

vide

one

dos

ein

ject

able

ant

ibio

tic

th

en r

efer

Pre

scri

be fu

ll an

tibi

otic

re

gim

en a

nd fo

llow

-up

IV IM

Clin

ical

ass

essm

ent

only

Blo

od c

ultu

re

Lum

bar

punc

ture

and

se

nses

exa

min

atio

n

NICU 3 0 3 2 3 1 2 3 3

SNCU 6 0 6 3 6 3 5 3 2

Total 9 0 9 5 9 4 7 6 5

Facility Type

(observed)

Steth oscop

e

Pulse oximet

er

Respirati on

monitor

Apnea monit

or

X-ray (report

ed)

Sucti on

Neona te

chest tubes

CPAP equipm

ent

Ventilat or

NICU 6 6 6 2 6 6 0 5 5

SNCU 6 5 6 1 7 5 0 4 1

Private 3 3 3 0 3 3 0 2 3

Public 12 11 11 4 13 11 1 7 3

Per

cent

age

44 38 35 32 29

24

Com

pone

nt o

f dis

cuss

Gaps in QOC

0 20 40 60 80 100

Percentage

=

Birthweight 78

Gestational age 75

Temperature 86

Respiratory rate 86

100

Per

cent

age 80

60

40

20

gestational age

-

100

Per

cent

age

90 80 70 60 50 40 30 20 10 0

-

Other

Infant yellow

Seizures

Diarrhea

Vomiting

Difficulty feeding

Decreased movement

Fever

Ris

k si

gn

0 10 20 30 40 50 60 70 80 90 100 Percentage

Tips for staff O

ut-o

f-po

cket

pay

men

0 10 20 30 40 50 60 70 80 90 100

Percentage

Asp

ect

of c

Clean

0 10 20 30 40 50 60 70 80 90 100 Percentage

Low

2 NYI Services

High

Medium

High

Medium

High

Medium

7 QOC

High

10 Parental Support

Medium

High

SN Ciiteria

10

11

12

13

14

15

16

17

18

19

20

Penguine suction 2

KMCwrapper 4m

Room heater I

IV Stand 2

Medicine Trolley I

HR Type Lewll

Paran1edics 2-3

SN Ciiteria

Set up Standard

Senices Standard

Status

~ ~ ~~ Yes

B - sauce yen13

1 ~ ildtf fl 5et 1

s Boomdook I

10 usl ~-3 1

H Sten_~ ~ieqmred

11 S~Jpmrp 4

14 ~

16 ~tape 4

19 ~ ~Jmfflffl I

2 - ~J 1

22 ~--gen---- ~ 4

28 IV Stand 6

30 CP AP Machine 1

3 1 Infusion Pump 4

Nursing staffSBA 8

SN Criteria

ratliaul wanwr

Services

6 Cold light I

9 CP AP machine 2

10 ABGmachine 1

17 IV Stand 10

19 Infusion Pump 8

20 Syringe Pump 4

Nursing staffSBA 12

Medical Officers 5

Paediatrician 2

Table of Contents
Acknowledgments
Abbreviations
Executive Summary
- Context
- - Background
    - - Methodology
      - Objective
        
        Study Design
        
        Data Analysis
        
        
        Results
        
        
        NYI Services
        
        KMC
        
        Breast Milk Feeding
        
        
        
        Seizures
        
        Hyperbilirubinemia
        
        
        
        Drug Procurement
        
        Equipment
        
        
        Management Systems
        
        
        QOC
        
        
        Referrals
        
        Out-Referrals
        
        In-Referrals
        
        Discharge Planning
        
        Parental Support
        
        Experience of Care
        
        Recommendations
        
        Conclusion

Page 5: Situation Analysis of Inpatient Care of Newborns and Young ...

QOC quality of care

Province 1

Province 2

Province 3

Province 4

Province 5

Province 6

Province 7

TOTAL 33 5 10 5 14 5

TOTAL 38 34

I

Per

cent

age

100 90 80 70 60 50 40 30 20 10 0

bull

NY

I Ser

vice

In

ter

NICU

0 10 20 30 40 50 60 70 80 90 100

Percentage

Treat seizures 14

16 14

Num

ber

of fa

cilit

ies

14

12

10 8

8 6

6 4

4 3 3

2 1

Facilities seeing

Imm

edia

tely

ref

erpa

tien

t w

itho

ut fu

rthe

ras

sess

men

t or

tre

atm

ent

Pro

vide

one

dos

ein

ject

able

ant

ibio

tic

th

en r

efer

Pre

scri

be fu

ll an

tibi

otic

re

gim

en a

nd fo

llow

-up

IV IM

Clin

ical

ass

essm

ent

only

Blo

od c

ultu

re

Lum

bar

punc

ture

and

se

nses

exa

min

atio

n

NICU 3 0 3 2 3 1 2 3 3

SNCU 6 0 6 3 6 3 5 3 2

Total 9 0 9 5 9 4 7 6 5

Facility Type

(observed)

Steth oscop

e

Pulse oximet

er

Respirati on

monitor

Apnea monit

or

X-ray (report

ed)

Sucti on

Neona te

chest tubes

CPAP equipm

ent

Ventilat or

NICU 6 6 6 2 6 6 0 5 5

SNCU 6 5 6 1 7 5 0 4 1

Private 3 3 3 0 3 3 0 2 3

Public 12 11 11 4 13 11 1 7 3

Per

cent

age

44 38 35 32 29

24

Com

pone

nt o

f dis

cuss

Gaps in QOC

0 20 40 60 80 100

Percentage

=

Birthweight 78

Gestational age 75

Temperature 86

Respiratory rate 86

100

Per

cent

age 80

60

40

20

gestational age

-

100

Per

cent

age

90 80 70 60 50 40 30 20 10 0

-

Other

Infant yellow

Seizures

Diarrhea

Vomiting

Difficulty feeding

Decreased movement

Fever

Ris

k si

gn

0 10 20 30 40 50 60 70 80 90 100 Percentage

Tips for staff O

ut-o

f-po

cket

pay

men

0 10 20 30 40 50 60 70 80 90 100

Percentage

Asp

ect

of c

Clean

0 10 20 30 40 50 60 70 80 90 100 Percentage

Low

2 NYI Services

High

Medium

High

Medium

High

Medium

7 QOC

High

10 Parental Support

Medium

High

SN Ciiteria

10

11

12

13

14

15

16

17

18

19

20

Penguine suction 2

KMCwrapper 4m

Room heater I

IV Stand 2

Medicine Trolley I

HR Type Lewll

Paran1edics 2-3

SN Ciiteria

Set up Standard

Senices Standard

Status

~ ~ ~~ Yes

B - sauce yen13

1 ~ ildtf fl 5et 1

s Boomdook I

10 usl ~-3 1

H Sten_~ ~ieqmred

11 S~Jpmrp 4

14 ~

16 ~tape 4

19 ~ ~Jmfflffl I

2 - ~J 1

22 ~--gen---- ~ 4

28 IV Stand 6

30 CP AP Machine 1

3 1 Infusion Pump 4

Nursing staffSBA 8

SN Criteria

ratliaul wanwr

Services

6 Cold light I

9 CP AP machine 2

10 ABGmachine 1

17 IV Stand 10

19 Infusion Pump 8

20 Syringe Pump 4

Nursing staffSBA 12

Medical Officers 5

Paediatrician 2

Table of Contents
Acknowledgments
Abbreviations
Executive Summary
- Context
- - Background
    - - Methodology
      - Objective
        
        Study Design
        
        Data Analysis
        
        
        Results
        
        
        NYI Services
        
        KMC
        
        Breast Milk Feeding
        
        
        
        Seizures
        
        Hyperbilirubinemia
        
        
        
        Drug Procurement
        
        Equipment
        
        
        Management Systems
        
        
        QOC
        
        
        Referrals
        
        Out-Referrals
        
        In-Referrals
        
        Discharge Planning
        
        Parental Support
        
        Experience of Care
        
        Recommendations
        
        Conclusion

Page 6: Situation Analysis of Inpatient Care of Newborns and Young ...

Province 1

Province 2

Province 3

Province 4

Province 5

Province 6

Province 7

TOTAL 33 5 10 5 14 5

TOTAL 38 34

I

Per

cent

age

100 90 80 70 60 50 40 30 20 10 0

bull

NY

I Ser

vice

In

ter

NICU

0 10 20 30 40 50 60 70 80 90 100

Percentage

Treat seizures 14

16 14

Num

ber

of fa

cilit

ies

14

12

10 8

8 6

6 4

4 3 3

2 1

Facilities seeing

Imm

edia

tely

ref

erpa

tien

t w

itho

ut fu

rthe

ras

sess

men

t or

tre

atm

ent

Pro

vide

one

dos

ein

ject

able

ant

ibio

tic

th

en r

efer

Pre

scri

be fu

ll an

tibi

otic

re

gim

en a

nd fo

llow

-up

IV IM

Clin

ical

ass

essm

ent

only

Blo

od c

ultu

re

Lum

bar

punc

ture

and

se

nses

exa

min

atio

n

NICU 3 0 3 2 3 1 2 3 3

SNCU 6 0 6 3 6 3 5 3 2

Total 9 0 9 5 9 4 7 6 5

Facility Type

(observed)

Steth oscop

e

Pulse oximet

er

Respirati on

monitor

Apnea monit

or

X-ray (report

ed)

Sucti on

Neona te

chest tubes

CPAP equipm

ent

Ventilat or

NICU 6 6 6 2 6 6 0 5 5

SNCU 6 5 6 1 7 5 0 4 1

Private 3 3 3 0 3 3 0 2 3

Public 12 11 11 4 13 11 1 7 3

Per

cent

age

44 38 35 32 29

24

Com

pone

nt o

f dis

cuss

Gaps in QOC

0 20 40 60 80 100

Percentage

=

Birthweight 78

Gestational age 75

Temperature 86

Respiratory rate 86

100

Per

cent

age 80

60

40

20

gestational age

-

100

Per

cent

age

90 80 70 60 50 40 30 20 10 0

-

Other

Infant yellow

Seizures

Diarrhea

Vomiting

Difficulty feeding

Decreased movement

Fever

Ris

k si

gn

0 10 20 30 40 50 60 70 80 90 100 Percentage

Tips for staff O

ut-o

f-po

cket

pay

men

0 10 20 30 40 50 60 70 80 90 100

Percentage

Asp

ect

of c

Clean

0 10 20 30 40 50 60 70 80 90 100 Percentage

Low

2 NYI Services

High

Medium

High

Medium

High

Medium

7 QOC

High

10 Parental Support

Medium

High

SN Ciiteria

10

11

12

13

14

15

16

17

18

19

20

Penguine suction 2

KMCwrapper 4m

Room heater I

IV Stand 2

Medicine Trolley I

HR Type Lewll

Paran1edics 2-3

SN Ciiteria

Set up Standard

Senices Standard

Status

~ ~ ~~ Yes

B - sauce yen13

1 ~ ildtf fl 5et 1

s Boomdook I

10 usl ~-3 1

H Sten_~ ~ieqmred

11 S~Jpmrp 4

14 ~

16 ~tape 4

19 ~ ~Jmfflffl I

2 - ~J 1

22 ~--gen---- ~ 4

28 IV Stand 6

30 CP AP Machine 1

3 1 Infusion Pump 4

Nursing staffSBA 8

SN Criteria

ratliaul wanwr

Services

6 Cold light I

9 CP AP machine 2

10 ABGmachine 1

17 IV Stand 10

19 Infusion Pump 8

20 Syringe Pump 4

Nursing staffSBA 12

Medical Officers 5

Paediatrician 2

Table of Contents
Acknowledgments
Abbreviations
Executive Summary
- Context
- - Background
    - - Methodology
      - Objective
        
        Study Design
        
        Data Analysis
        
        
        Results
        
        
        NYI Services
        
        KMC
        
        Breast Milk Feeding
        
        
        
        Seizures
        
        Hyperbilirubinemia
        
        
        
        Drug Procurement
        
        Equipment
        
        
        Management Systems
        
        
        QOC
        
        
        Referrals
        
        Out-Referrals
        
        In-Referrals
        
        Discharge Planning
        
        Parental Support
        
        Experience of Care
        
        Recommendations
        
        Conclusion

Page 7: Situation Analysis of Inpatient Care of Newborns and Young ...

Province 1

Province 2

Province 3

Province 4

Province 5

Province 6

Province 7

TOTAL 33 5 10 5 14 5

TOTAL 38 34

I

Per

cent

age

100 90 80 70 60 50 40 30 20 10 0

bull

NY

I Ser

vice

In

ter

NICU

0 10 20 30 40 50 60 70 80 90 100

Percentage

Treat seizures 14

16 14

Num

ber

of fa

cilit

ies

14

12

10 8

8 6

6 4

4 3 3

2 1

Facilities seeing

Imm

edia

tely

ref

erpa

tien

t w

itho

ut fu

rthe

ras

sess

men

t or

tre

atm

ent

Pro

vide

one

dos

ein

ject

able

ant

ibio

tic

th

en r

efer

Pre

scri

be fu

ll an

tibi

otic

re

gim

en a

nd fo

llow

-up

IV IM

Clin

ical

ass

essm

ent

only

Blo

od c

ultu

re

Lum

bar

punc

ture

and

se

nses

exa

min

atio

n

NICU 3 0 3 2 3 1 2 3 3

SNCU 6 0 6 3 6 3 5 3 2

Total 9 0 9 5 9 4 7 6 5

Facility Type

(observed)

Steth oscop

e

Pulse oximet

er

Respirati on

monitor

Apnea monit

or

X-ray (report

ed)

Sucti on

Neona te

chest tubes

CPAP equipm

ent

Ventilat or

NICU 6 6 6 2 6 6 0 5 5

SNCU 6 5 6 1 7 5 0 4 1

Private 3 3 3 0 3 3 0 2 3

Public 12 11 11 4 13 11 1 7 3

Per

cent

age

44 38 35 32 29

24

Com

pone

nt o

f dis

cuss

Gaps in QOC

0 20 40 60 80 100

Percentage

=

Birthweight 78

Gestational age 75

Temperature 86

Respiratory rate 86

100

Per

cent

age 80

60

40

20

gestational age

-

100

Per

cent

age

90 80 70 60 50 40 30 20 10 0

-

Other

Infant yellow

Seizures

Diarrhea

Vomiting

Difficulty feeding

Decreased movement

Fever

Ris

k si

gn

0 10 20 30 40 50 60 70 80 90 100 Percentage

Tips for staff O

ut-o

f-po

cket

pay

men

0 10 20 30 40 50 60 70 80 90 100

Percentage

Asp

ect

of c

Clean

0 10 20 30 40 50 60 70 80 90 100 Percentage

Low

2 NYI Services

High

Medium

High

Medium

High

Medium

7 QOC

High

10 Parental Support

Medium

High

SN Ciiteria

10

11

12

13

14

15

16

17

18

19

20

Penguine suction 2

KMCwrapper 4m

Room heater I

IV Stand 2

Medicine Trolley I

HR Type Lewll

Paran1edics 2-3

SN Ciiteria

Set up Standard

Senices Standard

Status

~ ~ ~~ Yes

B - sauce yen13

1 ~ ildtf fl 5et 1

s Boomdook I

10 usl ~-3 1

H Sten_~ ~ieqmred

11 S~Jpmrp 4

14 ~

16 ~tape 4

19 ~ ~Jmfflffl I

2 - ~J 1

22 ~--gen---- ~ 4

28 IV Stand 6

30 CP AP Machine 1

3 1 Infusion Pump 4

Nursing staffSBA 8

SN Criteria

ratliaul wanwr

Services

6 Cold light I

9 CP AP machine 2

10 ABGmachine 1

17 IV Stand 10

19 Infusion Pump 8

20 Syringe Pump 4

Nursing staffSBA 12

Medical Officers 5

Paediatrician 2

Table of Contents
Acknowledgments
Abbreviations
Executive Summary
- Context
- - Background
    - - Methodology
      - Objective
        
        Study Design
        
        Data Analysis
        
        
        Results
        
        
        NYI Services
        
        KMC
        
        Breast Milk Feeding
        
        
        
        Seizures
        
        Hyperbilirubinemia
        
        
        
        Drug Procurement
        
        Equipment
        
        
        Management Systems
        
        
        QOC
        
        
        Referrals
        
        Out-Referrals
        
        In-Referrals
        
        Discharge Planning
        
        Parental Support
        
        Experience of Care
        
        Recommendations
        
        Conclusion

Page 8: Situation Analysis of Inpatient Care of Newborns and Young ...

Province 1

Province 2

Province 3

Province 4

Province 5

Province 6

Province 7

TOTAL 33 5 10 5 14 5

TOTAL 38 34

I

Per

cent

age

100 90 80 70 60 50 40 30 20 10 0

bull

NY

I Ser

vice

In

ter

NICU

0 10 20 30 40 50 60 70 80 90 100

Percentage

Treat seizures 14

16 14

Num

ber

of fa

cilit

ies

14

12

10 8

8 6

6 4

4 3 3

2 1

Facilities seeing

Imm

edia

tely

ref

erpa

tien

t w

itho

ut fu

rthe

ras

sess

men

t or

tre

atm

ent

Pro

vide

one

dos

ein

ject

able

ant

ibio

tic

th

en r

efer

Pre

scri

be fu

ll an

tibi

otic

re

gim

en a

nd fo

llow

-up

IV IM

Clin

ical

ass

essm

ent

only

Blo

od c

ultu

re

Lum

bar

punc

ture

and

se

nses

exa

min

atio

n

NICU 3 0 3 2 3 1 2 3 3

SNCU 6 0 6 3 6 3 5 3 2

Total 9 0 9 5 9 4 7 6 5

Facility Type

(observed)

Steth oscop

e

Pulse oximet

er

Respirati on

monitor

Apnea monit

or

X-ray (report

ed)

Sucti on

Neona te

chest tubes

CPAP equipm

ent

Ventilat or

NICU 6 6 6 2 6 6 0 5 5

SNCU 6 5 6 1 7 5 0 4 1

Private 3 3 3 0 3 3 0 2 3

Public 12 11 11 4 13 11 1 7 3

Per

cent

age

44 38 35 32 29

24

Com

pone

nt o

f dis

cuss

Gaps in QOC

0 20 40 60 80 100

Percentage

=

Birthweight 78

Gestational age 75

Temperature 86

Respiratory rate 86

100

Per

cent

age 80

60

40

20

gestational age

-

100

Per

cent

age

90 80 70 60 50 40 30 20 10 0

-

Other

Infant yellow

Seizures

Diarrhea

Vomiting

Difficulty feeding

Decreased movement

Fever

Ris

k si

gn

0 10 20 30 40 50 60 70 80 90 100 Percentage

Tips for staff O

ut-o

f-po

cket

pay

men

0 10 20 30 40 50 60 70 80 90 100

Percentage

Asp

ect

of c

Clean

0 10 20 30 40 50 60 70 80 90 100 Percentage

Low

2 NYI Services

High

Medium

High

Medium

High

Medium

7 QOC

High

10 Parental Support

Medium

High

SN Ciiteria

10

11

12

13

14

15

16

17

18

19

20

Penguine suction 2

KMCwrapper 4m

Room heater I

IV Stand 2

Medicine Trolley I

HR Type Lewll

Paran1edics 2-3

SN Ciiteria

Set up Standard

Senices Standard

Status

~ ~ ~~ Yes

B - sauce yen13

1 ~ ildtf fl 5et 1

s Boomdook I

10 usl ~-3 1

H Sten_~ ~ieqmred

11 S~Jpmrp 4

14 ~

16 ~tape 4

19 ~ ~Jmfflffl I

2 - ~J 1

22 ~--gen---- ~ 4

28 IV Stand 6

30 CP AP Machine 1

3 1 Infusion Pump 4

Nursing staffSBA 8

SN Criteria

ratliaul wanwr

Services

6 Cold light I

9 CP AP machine 2

10 ABGmachine 1

17 IV Stand 10

19 Infusion Pump 8

20 Syringe Pump 4

Nursing staffSBA 12

Medical Officers 5

Paediatrician 2

Table of Contents
Acknowledgments
Abbreviations
Executive Summary
- Context
- - Background
    - - Methodology
      - Objective
        
        Study Design
        
        Data Analysis
        
        
        Results
        
        
        NYI Services
        
        KMC
        
        Breast Milk Feeding
        
        
        
        Seizures
        
        Hyperbilirubinemia
        
        
        
        Drug Procurement
        
        Equipment
        
        
        Management Systems
        
        
        QOC
        
        
        Referrals
        
        Out-Referrals
        
        In-Referrals
        
        Discharge Planning
        
        Parental Support
        
        Experience of Care
        
        Recommendations
        
        Conclusion

Page 9: Situation Analysis of Inpatient Care of Newborns and Young ...

Province 1

Province 2

Province 3

Province 4

Province 5

Province 6

Province 7

TOTAL 33 5 10 5 14 5

TOTAL 38 34

I

Per

cent

age

100 90 80 70 60 50 40 30 20 10 0

bull

NY

I Ser

vice

In

ter

NICU

0 10 20 30 40 50 60 70 80 90 100

Percentage

Treat seizures 14

16 14

Num

ber

of fa

cilit

ies

14

12

10 8

8 6

6 4

4 3 3

2 1

Facilities seeing

Imm

edia

tely

ref

erpa

tien

t w

itho

ut fu

rthe

ras

sess

men

t or

tre

atm

ent

Pro

vide

one

dos

ein

ject

able

ant

ibio

tic

th

en r

efer

Pre

scri

be fu

ll an

tibi

otic

re

gim

en a

nd fo

llow

-up

IV IM

Clin

ical

ass

essm

ent

only

Blo

od c

ultu

re

Lum

bar

punc

ture

and

se

nses

exa

min

atio

n

NICU 3 0 3 2 3 1 2 3 3

SNCU 6 0 6 3 6 3 5 3 2

Total 9 0 9 5 9 4 7 6 5

Facility Type

(observed)

Steth oscop

e

Pulse oximet

er

Respirati on

monitor

Apnea monit

or

X-ray (report

ed)

Sucti on

Neona te

chest tubes

CPAP equipm

ent

Ventilat or

NICU 6 6 6 2 6 6 0 5 5

SNCU 6 5 6 1 7 5 0 4 1

Private 3 3 3 0 3 3 0 2 3

Public 12 11 11 4 13 11 1 7 3

Per

cent

age

44 38 35 32 29

24

Com

pone

nt o

f dis

cuss

Gaps in QOC

0 20 40 60 80 100

Percentage

=

Birthweight 78

Gestational age 75

Temperature 86

Respiratory rate 86

100

Per

cent

age 80

60

40

20

gestational age

-

100

Per

cent

age

90 80 70 60 50 40 30 20 10 0

-

Other

Infant yellow

Seizures

Diarrhea

Vomiting

Difficulty feeding

Decreased movement

Fever

Ris

k si

gn

0 10 20 30 40 50 60 70 80 90 100 Percentage

Tips for staff O

ut-o

f-po

cket

pay

men

0 10 20 30 40 50 60 70 80 90 100

Percentage

Asp

ect

of c

Clean

0 10 20 30 40 50 60 70 80 90 100 Percentage

Low

2 NYI Services

High

Medium

High

Medium

High

Medium

7 QOC

High

10 Parental Support

Medium

High

SN Ciiteria

10

11

12

13

14

15

16

17

18

19

20

Penguine suction 2

KMCwrapper 4m

Room heater I

IV Stand 2

Medicine Trolley I

HR Type Lewll

Paran1edics 2-3

SN Ciiteria

Set up Standard

Senices Standard

Status

~ ~ ~~ Yes

B - sauce yen13

1 ~ ildtf fl 5et 1

s Boomdook I

10 usl ~-3 1

H Sten_~ ~ieqmred

11 S~Jpmrp 4

14 ~

16 ~tape 4

19 ~ ~Jmfflffl I

2 - ~J 1

22 ~--gen---- ~ 4

28 IV Stand 6

30 CP AP Machine 1

3 1 Infusion Pump 4

Nursing staffSBA 8

SN Criteria

ratliaul wanwr

Services

6 Cold light I

9 CP AP machine 2

10 ABGmachine 1

17 IV Stand 10

19 Infusion Pump 8

20 Syringe Pump 4

Nursing staffSBA 12

Medical Officers 5

Paediatrician 2

Table of Contents
Acknowledgments
Abbreviations
Executive Summary
- Context
- - Background
    - - Methodology
      - Objective
        
        Study Design
        
        Data Analysis
        
        
        Results
        
        
        NYI Services
        
        KMC
        
        Breast Milk Feeding
        
        
        
        Seizures
        
        Hyperbilirubinemia
        
        
        
        Drug Procurement
        
        Equipment
        
        
        Management Systems
        
        
        QOC
        
        
        Referrals
        
        Out-Referrals
        
        In-Referrals
        
        Discharge Planning
        
        Parental Support
        
        Experience of Care
        
        Recommendations
        
        Conclusion

Page 10: Situation Analysis of Inpatient Care of Newborns and Young ...

Province 1

Province 2

Province 3

Province 4

Province 5

Province 6

Province 7

TOTAL 33 5 10 5 14 5

TOTAL 38 34

I

Per

cent

age

100 90 80 70 60 50 40 30 20 10 0

bull

NY

I Ser

vice

In

ter

NICU

0 10 20 30 40 50 60 70 80 90 100

Percentage

Treat seizures 14

16 14

Num

ber

of fa

cilit

ies

14

12

10 8

8 6

6 4

4 3 3

2 1

Facilities seeing

Imm

edia

tely

ref

erpa

tien

t w

itho

ut fu

rthe

ras

sess

men

t or

tre

atm

ent

Pro

vide

one

dos

ein

ject

able

ant

ibio

tic

th

en r

efer

Pre

scri

be fu

ll an

tibi

otic

re

gim

en a

nd fo

llow

-up

IV IM

Clin

ical

ass

essm

ent

only

Blo

od c

ultu

re

Lum

bar

punc

ture

and

se

nses

exa

min

atio

n

NICU 3 0 3 2 3 1 2 3 3

SNCU 6 0 6 3 6 3 5 3 2

Total 9 0 9 5 9 4 7 6 5

Facility Type

(observed)

Steth oscop

e

Pulse oximet

er

Respirati on

monitor

Apnea monit

or

X-ray (report

ed)

Sucti on

Neona te

chest tubes

CPAP equipm

ent

Ventilat or

NICU 6 6 6 2 6 6 0 5 5

SNCU 6 5 6 1 7 5 0 4 1

Private 3 3 3 0 3 3 0 2 3

Public 12 11 11 4 13 11 1 7 3

Per

cent

age

44 38 35 32 29

24

Com

pone

nt o

f dis

cuss

Gaps in QOC

0 20 40 60 80 100

Percentage

=

Birthweight 78

Gestational age 75

Temperature 86

Respiratory rate 86

100

Per

cent

age 80

60

40

20

gestational age

-

100

Per

cent

age

90 80 70 60 50 40 30 20 10 0

-

Other

Infant yellow

Seizures

Diarrhea

Vomiting

Difficulty feeding

Decreased movement

Fever

Ris

k si

gn

0 10 20 30 40 50 60 70 80 90 100 Percentage

Tips for staff O

ut-o

f-po

cket

pay

men

0 10 20 30 40 50 60 70 80 90 100

Percentage

Asp

ect

of c

Clean

0 10 20 30 40 50 60 70 80 90 100 Percentage

Low

2 NYI Services

High

Medium

High

Medium

High

Medium

7 QOC

High

10 Parental Support

Medium

High

SN Ciiteria

10

11

12

13

14

15

16

17

18

19

20

Penguine suction 2

KMCwrapper 4m

Room heater I

IV Stand 2

Medicine Trolley I

HR Type Lewll

Paran1edics 2-3

SN Ciiteria

Set up Standard

Senices Standard

Status

~ ~ ~~ Yes

B - sauce yen13

1 ~ ildtf fl 5et 1

s Boomdook I

10 usl ~-3 1

H Sten_~ ~ieqmred

11 S~Jpmrp 4

14 ~

16 ~tape 4

19 ~ ~Jmfflffl I

2 - ~J 1

22 ~--gen---- ~ 4

28 IV Stand 6

30 CP AP Machine 1

3 1 Infusion Pump 4

Nursing staffSBA 8

SN Criteria

ratliaul wanwr

Services

6 Cold light I

9 CP AP machine 2

10 ABGmachine 1

17 IV Stand 10

19 Infusion Pump 8

20 Syringe Pump 4

Nursing staffSBA 12

Medical Officers 5

Paediatrician 2

Table of Contents
Acknowledgments
Abbreviations
Executive Summary
- Context
- - Background
    - - Methodology
      - Objective
        
        Study Design
        
        Data Analysis
        
        
        Results
        
        
        NYI Services
        
        KMC
        
        Breast Milk Feeding
        
        
        
        Seizures
        
        Hyperbilirubinemia
        
        
        
        Drug Procurement
        
        Equipment
        
        
        Management Systems
        
        
        QOC
        
        
        Referrals
        
        Out-Referrals
        
        In-Referrals
        
        Discharge Planning
        
        Parental Support
        
        Experience of Care
        
        Recommendations
        
        Conclusion

Page 11: Situation Analysis of Inpatient Care of Newborns and Young ...

Province 1

Province 2

Province 3

Province 4

Province 5

Province 6

Province 7

TOTAL 33 5 10 5 14 5

TOTAL 38 34

I

Per

cent

age

100 90 80 70 60 50 40 30 20 10 0

bull

NY

I Ser

vice

In

ter

NICU

0 10 20 30 40 50 60 70 80 90 100

Percentage

Treat seizures 14

16 14

Num

ber

of fa

cilit

ies

14

12

10 8

8 6

6 4

4 3 3

2 1

Facilities seeing

Imm

edia

tely

ref

erpa

tien

t w

itho

ut fu

rthe

ras

sess

men

t or

tre

atm

ent

Pro

vide

one

dos

ein

ject

able

ant

ibio

tic

th

en r

efer

Pre

scri

be fu

ll an

tibi

otic

re

gim

en a

nd fo

llow

-up

IV IM

Clin

ical

ass

essm

ent

only

Blo

od c

ultu

re

Lum

bar

punc

ture

and

se

nses

exa

min

atio

n

NICU 3 0 3 2 3 1 2 3 3

SNCU 6 0 6 3 6 3 5 3 2

Total 9 0 9 5 9 4 7 6 5

Facility Type

(observed)

Steth oscop

e

Pulse oximet

er

Respirati on

monitor

Apnea monit

or

X-ray (report

ed)

Sucti on

Neona te

chest tubes

CPAP equipm

ent

Ventilat or

NICU 6 6 6 2 6 6 0 5 5

SNCU 6 5 6 1 7 5 0 4 1

Private 3 3 3 0 3 3 0 2 3

Public 12 11 11 4 13 11 1 7 3

Per

cent

age

44 38 35 32 29

24

Com

pone

nt o

f dis

cuss

Gaps in QOC

0 20 40 60 80 100

Percentage

=

Birthweight 78

Gestational age 75

Temperature 86

Respiratory rate 86

100

Per

cent

age 80

60

40

20

gestational age

-

100

Per

cent

age

90 80 70 60 50 40 30 20 10 0

-

Other

Infant yellow

Seizures

Diarrhea

Vomiting

Difficulty feeding

Decreased movement

Fever

Ris

k si

gn

0 10 20 30 40 50 60 70 80 90 100 Percentage

Tips for staff O

ut-o

f-po

cket

pay

men

0 10 20 30 40 50 60 70 80 90 100

Percentage

Asp

ect

of c

Clean

0 10 20 30 40 50 60 70 80 90 100 Percentage

Low

2 NYI Services

High

Medium

High

Medium

High

Medium

7 QOC

High

10 Parental Support

Medium

High

SN Ciiteria

10

11

12

13

14

15

16

17

18

19

20

Penguine suction 2

KMCwrapper 4m

Room heater I

IV Stand 2

Medicine Trolley I

HR Type Lewll

Paran1edics 2-3

SN Ciiteria

Set up Standard

Senices Standard

Status

~ ~ ~~ Yes

B - sauce yen13

1 ~ ildtf fl 5et 1

s Boomdook I

10 usl ~-3 1

H Sten_~ ~ieqmred

11 S~Jpmrp 4

14 ~

16 ~tape 4

19 ~ ~Jmfflffl I

2 - ~J 1

22 ~--gen---- ~ 4

28 IV Stand 6

30 CP AP Machine 1

3 1 Infusion Pump 4

Nursing staffSBA 8

SN Criteria

ratliaul wanwr

Services

6 Cold light I

9 CP AP machine 2

10 ABGmachine 1

17 IV Stand 10

19 Infusion Pump 8

20 Syringe Pump 4

Nursing staffSBA 12

Medical Officers 5

Paediatrician 2

Table of Contents
Acknowledgments
Abbreviations
Executive Summary
- Context
- - Background
    - - Methodology
      - Objective
        
        Study Design
        
        Data Analysis
        
        
        Results
        
        
        NYI Services
        
        KMC
        
        Breast Milk Feeding
        
        
        
        Seizures
        
        Hyperbilirubinemia
        
        
        
        Drug Procurement
        
        Equipment
        
        
        Management Systems
        
        
        QOC
        
        
        Referrals
        
        Out-Referrals
        
        In-Referrals
        
        Discharge Planning
        
        Parental Support
        
        Experience of Care
        
        Recommendations
        
        Conclusion

Page 12: Situation Analysis of Inpatient Care of Newborns and Young ...

Province 1

Province 2

Province 3

Province 4

Province 5

Province 6

Province 7

TOTAL 33 5 10 5 14 5

TOTAL 38 34

I

Per

cent

age

100 90 80 70 60 50 40 30 20 10 0

bull

NY

I Ser

vice

In

ter

NICU

0 10 20 30 40 50 60 70 80 90 100

Percentage

Treat seizures 14

16 14

Num

ber

of fa

cilit

ies

14

12

10 8

8 6

6 4

4 3 3

2 1

Facilities seeing

Imm

edia

tely

ref

erpa

tien

t w

itho

ut fu

rthe

ras

sess

men

t or

tre

atm

ent

Pro

vide

one

dos

ein

ject

able

ant

ibio

tic

th

en r

efer

Pre

scri

be fu

ll an

tibi

otic

re

gim

en a

nd fo

llow

-up

IV IM

Clin

ical

ass

essm

ent

only

Blo

od c

ultu

re

Lum

bar

punc

ture

and

se

nses

exa

min

atio

n

NICU 3 0 3 2 3 1 2 3 3

SNCU 6 0 6 3 6 3 5 3 2

Total 9 0 9 5 9 4 7 6 5

Facility Type

(observed)

Steth oscop

e

Pulse oximet

er

Respirati on

monitor

Apnea monit

or

X-ray (report

ed)

Sucti on

Neona te

chest tubes

CPAP equipm

ent

Ventilat or

NICU 6 6 6 2 6 6 0 5 5

SNCU 6 5 6 1 7 5 0 4 1

Private 3 3 3 0 3 3 0 2 3

Public 12 11 11 4 13 11 1 7 3

Per

cent

age

44 38 35 32 29

24

Com

pone

nt o

f dis

cuss

Gaps in QOC

0 20 40 60 80 100

Percentage

=

Birthweight 78

Gestational age 75

Temperature 86

Respiratory rate 86

100

Per

cent

age 80

60

40

20

gestational age

-

100

Per

cent

age

90 80 70 60 50 40 30 20 10 0

-

Other

Infant yellow

Seizures

Diarrhea

Vomiting

Difficulty feeding

Decreased movement

Fever

Ris

k si

gn

0 10 20 30 40 50 60 70 80 90 100 Percentage

Tips for staff O

ut-o

f-po

cket

pay

men

0 10 20 30 40 50 60 70 80 90 100

Percentage

Asp

ect

of c

Clean

0 10 20 30 40 50 60 70 80 90 100 Percentage

Low

2 NYI Services

High

Medium

High

Medium

High

Medium

7 QOC

High

10 Parental Support

Medium

High

SN Ciiteria

10

11

12

13

14

15

16

17

18

19

20

Penguine suction 2

KMCwrapper 4m

Room heater I

IV Stand 2

Medicine Trolley I

HR Type Lewll

Paran1edics 2-3

SN Ciiteria

Set up Standard

Senices Standard

Status

~ ~ ~~ Yes

B - sauce yen13

1 ~ ildtf fl 5et 1

s Boomdook I

10 usl ~-3 1

H Sten_~ ~ieqmred

11 S~Jpmrp 4

14 ~

16 ~tape 4

19 ~ ~Jmfflffl I

2 - ~J 1

22 ~--gen---- ~ 4

28 IV Stand 6

30 CP AP Machine 1

3 1 Infusion Pump 4

Nursing staffSBA 8

SN Criteria

ratliaul wanwr

Services

6 Cold light I

9 CP AP machine 2

10 ABGmachine 1

17 IV Stand 10

19 Infusion Pump 8

20 Syringe Pump 4

Nursing staffSBA 12

Medical Officers 5

Paediatrician 2

Table of Contents
Acknowledgments
Abbreviations
Executive Summary
- Context
- - Background
    - - Methodology
      - Objective
        
        Study Design
        
        Data Analysis
        
        
        Results
        
        
        NYI Services
        
        KMC
        
        Breast Milk Feeding
        
        
        
        Seizures
        
        Hyperbilirubinemia
        
        
        
        Drug Procurement
        
        Equipment
        
        
        Management Systems
        
        
        QOC
        
        
        Referrals
        
        Out-Referrals
        
        In-Referrals
        
        Discharge Planning
        
        Parental Support
        
        Experience of Care
        
        Recommendations
        
        Conclusion

Page 13: Situation Analysis of Inpatient Care of Newborns and Young ...

Province 1

Province 2

Province 3

Province 4

Province 5

Province 6

Province 7

TOTAL 33 5 10 5 14 5

TOTAL 38 34

I

Per

cent

age

100 90 80 70 60 50 40 30 20 10 0

bull

NY

I Ser

vice

In

ter

NICU

0 10 20 30 40 50 60 70 80 90 100

Percentage

Treat seizures 14

16 14

Num

ber

of fa

cilit

ies

14

12

10 8

8 6

6 4

4 3 3

2 1

Facilities seeing

Imm

edia

tely

ref

erpa

tien

t w

itho

ut fu

rthe

ras

sess

men

t or

tre

atm

ent

Pro

vide

one

dos

ein

ject

able

ant

ibio

tic

th

en r

efer

Pre

scri

be fu

ll an

tibi

otic

re

gim

en a

nd fo

llow

-up

IV IM

Clin

ical

ass

essm

ent

only

Blo

od c

ultu

re

Lum

bar

punc

ture

and

se

nses

exa

min

atio

n

NICU 3 0 3 2 3 1 2 3 3

SNCU 6 0 6 3 6 3 5 3 2

Total 9 0 9 5 9 4 7 6 5

Facility Type

(observed)

Steth oscop

e

Pulse oximet

er

Respirati on

monitor

Apnea monit

or

X-ray (report

ed)

Sucti on

Neona te

chest tubes

CPAP equipm

ent

Ventilat or

NICU 6 6 6 2 6 6 0 5 5

SNCU 6 5 6 1 7 5 0 4 1

Private 3 3 3 0 3 3 0 2 3

Public 12 11 11 4 13 11 1 7 3

Per

cent

age

44 38 35 32 29

24

Com

pone

nt o

f dis

cuss

Gaps in QOC

0 20 40 60 80 100

Percentage

=

Birthweight 78

Gestational age 75

Temperature 86

Respiratory rate 86

100

Per

cent

age 80

60

40

20

gestational age

-

100

Per

cent

age

90 80 70 60 50 40 30 20 10 0

-

Other

Infant yellow

Seizures

Diarrhea

Vomiting

Difficulty feeding

Decreased movement

Fever

Ris

k si

gn

0 10 20 30 40 50 60 70 80 90 100 Percentage

Tips for staff O

ut-o

f-po

cket

pay

men

0 10 20 30 40 50 60 70 80 90 100

Percentage

Asp

ect

of c

Clean

0 10 20 30 40 50 60 70 80 90 100 Percentage

Low

2 NYI Services

High

Medium

High

Medium

High

Medium

7 QOC

High

10 Parental Support

Medium

High

SN Ciiteria

10

11

12

13

14

15

16

17

18

19

20

Penguine suction 2

KMCwrapper 4m

Room heater I

IV Stand 2

Medicine Trolley I

HR Type Lewll

Paran1edics 2-3

SN Ciiteria

Set up Standard

Senices Standard

Status

~ ~ ~~ Yes

B - sauce yen13

1 ~ ildtf fl 5et 1

s Boomdook I

10 usl ~-3 1

H Sten_~ ~ieqmred

11 S~Jpmrp 4

14 ~

16 ~tape 4

19 ~ ~Jmfflffl I

2 - ~J 1

22 ~--gen---- ~ 4

28 IV Stand 6

30 CP AP Machine 1

3 1 Infusion Pump 4

Nursing staffSBA 8

SN Criteria

ratliaul wanwr

Services

6 Cold light I

9 CP AP machine 2

10 ABGmachine 1

17 IV Stand 10

19 Infusion Pump 8

20 Syringe Pump 4

Nursing staffSBA 12

Medical Officers 5

Paediatrician 2

Table of Contents
Acknowledgments
Abbreviations
Executive Summary
- Context
- - Background
    - - Methodology
      - Objective
        
        Study Design
        
        Data Analysis
        
        
        Results
        
        
        NYI Services
        
        KMC
        
        Breast Milk Feeding
        
        
        
        Seizures
        
        Hyperbilirubinemia
        
        
        
        Drug Procurement
        
        Equipment
        
        
        Management Systems
        
        
        QOC
        
        
        Referrals
        
        Out-Referrals
        
        In-Referrals
        
        Discharge Planning
        
        Parental Support
        
        Experience of Care
        
        Recommendations
        
        Conclusion

Page 14: Situation Analysis of Inpatient Care of Newborns and Young ...

I

Per

cent

age

100 90 80 70 60 50 40 30 20 10 0

bull

NY

I Ser

vice

In

ter

NICU

0 10 20 30 40 50 60 70 80 90 100

Percentage

Treat seizures 14

16 14

Num

ber

of fa

cilit

ies

14

12

10 8

8 6

6 4

4 3 3

2 1

Facilities seeing

Imm

edia

tely

ref

erpa

tien

t w

itho

ut fu

rthe

ras

sess

men

t or

tre

atm

ent

Pro

vide

one

dos

ein

ject

able

ant

ibio

tic

th

en r

efer

Pre

scri

be fu

ll an

tibi

otic

re

gim

en a

nd fo

llow

-up

IV IM

Clin

ical

ass

essm

ent

only

Blo

od c

ultu

re

Lum

bar

punc

ture

and

se

nses

exa

min

atio

n

NICU 3 0 3 2 3 1 2 3 3

SNCU 6 0 6 3 6 3 5 3 2

Total 9 0 9 5 9 4 7 6 5

Facility Type

(observed)

Steth oscop

e

Pulse oximet

er

Respirati on

monitor

Apnea monit

or

X-ray (report

ed)

Sucti on

Neona te

chest tubes

CPAP equipm

ent

Ventilat or

NICU 6 6 6 2 6 6 0 5 5

SNCU 6 5 6 1 7 5 0 4 1

Private 3 3 3 0 3 3 0 2 3

Public 12 11 11 4 13 11 1 7 3

Per

cent

age

44 38 35 32 29

24

Com

pone

nt o

f dis

cuss

Gaps in QOC

0 20 40 60 80 100

Percentage

=

Birthweight 78

Gestational age 75

Temperature 86

Respiratory rate 86

100

Per

cent

age 80

60

40

20

gestational age

-

100

Per

cent

age

90 80 70 60 50 40 30 20 10 0

-

Other

Infant yellow

Seizures

Diarrhea

Vomiting

Difficulty feeding

Decreased movement

Fever

Ris

k si

gn

0 10 20 30 40 50 60 70 80 90 100 Percentage

Tips for staff O

ut-o

f-po

cket

pay

men

0 10 20 30 40 50 60 70 80 90 100

Percentage

Asp

ect

of c

Clean

0 10 20 30 40 50 60 70 80 90 100 Percentage

Low

2 NYI Services

High

Medium

High

Medium

High

Medium

7 QOC

High

10 Parental Support

Medium

High

SN Ciiteria

10

11

12

13

14

15

16

17

18

19

20

Penguine suction 2

KMCwrapper 4m

Room heater I

IV Stand 2

Medicine Trolley I

HR Type Lewll

Paran1edics 2-3

SN Ciiteria

Set up Standard

Senices Standard

Status

~ ~ ~~ Yes

B - sauce yen13

1 ~ ildtf fl 5et 1

s Boomdook I

10 usl ~-3 1

H Sten_~ ~ieqmred

11 S~Jpmrp 4

14 ~

16 ~tape 4

19 ~ ~Jmfflffl I

2 - ~J 1

22 ~--gen---- ~ 4

28 IV Stand 6

30 CP AP Machine 1

3 1 Infusion Pump 4

Nursing staffSBA 8

SN Criteria

ratliaul wanwr

Services

6 Cold light I

9 CP AP machine 2

10 ABGmachine 1

17 IV Stand 10

19 Infusion Pump 8

20 Syringe Pump 4

Nursing staffSBA 12

Medical Officers 5

Paediatrician 2

Table of Contents
Acknowledgments
Abbreviations
Executive Summary
- Context
- - Background
    - - Methodology
      - Objective
        
        Study Design
        
        Data Analysis
        
        
        Results
        
        
        NYI Services
        
        KMC
        
        Breast Milk Feeding
        
        
        
        Seizures
        
        Hyperbilirubinemia
        
        
        
        Drug Procurement
        
        Equipment
        
        
        Management Systems
        
        
        QOC
        
        
        Referrals
        
        Out-Referrals
        
        In-Referrals
        
        Discharge Planning
        
        Parental Support
        
        Experience of Care
        
        Recommendations
        
        Conclusion

Page 15: Situation Analysis of Inpatient Care of Newborns and Young ...

I

Per

cent

age

100 90 80 70 60 50 40 30 20 10 0

bull

NY

I Ser

vice

In

ter

NICU

0 10 20 30 40 50 60 70 80 90 100

Percentage

Treat seizures 14

16 14

Num

ber

of fa

cilit

ies

14

12

10 8

8 6

6 4

4 3 3

2 1

Facilities seeing

Imm

edia

tely

ref

erpa

tien

t w

itho

ut fu

rthe

ras

sess

men

t or

tre

atm

ent

Pro

vide

one

dos

ein

ject

able

ant

ibio

tic

th

en r

efer

Pre

scri

be fu

ll an

tibi

otic

re

gim

en a

nd fo

llow

-up

IV IM

Clin

ical

ass

essm

ent

only

Blo

od c

ultu

re

Lum

bar

punc

ture

and

se

nses

exa

min

atio

n

NICU 3 0 3 2 3 1 2 3 3

SNCU 6 0 6 3 6 3 5 3 2

Total 9 0 9 5 9 4 7 6 5

Facility Type

(observed)

Steth oscop

e

Pulse oximet

er

Respirati on

monitor

Apnea monit

or

X-ray (report

ed)

Sucti on

Neona te

chest tubes

CPAP equipm

ent

Ventilat or

NICU 6 6 6 2 6 6 0 5 5

SNCU 6 5 6 1 7 5 0 4 1

Private 3 3 3 0 3 3 0 2 3

Public 12 11 11 4 13 11 1 7 3

Per

cent

age

44 38 35 32 29

24

Com

pone

nt o

f dis

cuss

Gaps in QOC

0 20 40 60 80 100

Percentage

=

Birthweight 78

Gestational age 75

Temperature 86

Respiratory rate 86

100

Per

cent

age 80

60

40

20

gestational age

-

100

Per

cent

age

90 80 70 60 50 40 30 20 10 0

-

Other

Infant yellow

Seizures

Diarrhea

Vomiting

Difficulty feeding

Decreased movement

Fever

Ris

k si

gn

0 10 20 30 40 50 60 70 80 90 100 Percentage

Tips for staff O

ut-o

f-po

cket

pay

men

0 10 20 30 40 50 60 70 80 90 100

Percentage

Asp

ect

of c

Clean

0 10 20 30 40 50 60 70 80 90 100 Percentage

Low

2 NYI Services

High

Medium

High

Medium

High

Medium

7 QOC

High

10 Parental Support

Medium

High

SN Ciiteria

10

11

12

13

14

15

16

17

18

19

20

Penguine suction 2

KMCwrapper 4m

Room heater I

IV Stand 2

Medicine Trolley I

HR Type Lewll

Paran1edics 2-3

SN Ciiteria

Set up Standard

Senices Standard

Status

~ ~ ~~ Yes

B - sauce yen13

1 ~ ildtf fl 5et 1

s Boomdook I

10 usl ~-3 1

H Sten_~ ~ieqmred

11 S~Jpmrp 4

14 ~

16 ~tape 4

19 ~ ~Jmfflffl I

2 - ~J 1

22 ~--gen---- ~ 4

28 IV Stand 6

30 CP AP Machine 1

3 1 Infusion Pump 4

Nursing staffSBA 8

SN Criteria

ratliaul wanwr

Services

6 Cold light I

9 CP AP machine 2

10 ABGmachine 1

17 IV Stand 10

19 Infusion Pump 8

20 Syringe Pump 4

Nursing staffSBA 12

Medical Officers 5

Paediatrician 2

Table of Contents
Acknowledgments
Abbreviations
Executive Summary
- Context
- - Background
    - - Methodology
      - Objective
        
        Study Design
        
        Data Analysis
        
        
        Results
        
        
        NYI Services
        
        KMC
        
        Breast Milk Feeding
        
        
        
        Seizures
        
        Hyperbilirubinemia
        
        
        
        Drug Procurement
        
        Equipment
        
        
        Management Systems
        
        
        QOC
        
        
        Referrals
        
        Out-Referrals
        
        In-Referrals
        
        Discharge Planning
        
        Parental Support
        
        Experience of Care
        
        Recommendations
        
        Conclusion

Page 16: Situation Analysis of Inpatient Care of Newborns and Young ...

bull

NY

I Ser

vice

In

ter

NICU

0 10 20 30 40 50 60 70 80 90 100

Percentage

Treat seizures 14

16 14

Num

ber

of fa

cilit

ies

14

12

10 8

8 6

6 4

4 3 3

2 1

Facilities seeing

Imm

edia

tely

ref

erpa

tien

t w

itho

ut fu

rthe

ras

sess

men

t or

tre

atm

ent

Pro

vide

one

dos

ein

ject

able

ant

ibio

tic

th

en r

efer

Pre

scri

be fu

ll an

tibi

otic

re

gim

en a

nd fo

llow

-up

IV IM

Clin

ical

ass

essm

ent

only

Blo

od c

ultu

re

Lum

bar

punc

ture

and

se

nses

exa

min

atio

n

NICU 3 0 3 2 3 1 2 3 3

SNCU 6 0 6 3 6 3 5 3 2

Total 9 0 9 5 9 4 7 6 5

Facility Type

(observed)

Steth oscop

e

Pulse oximet

er

Respirati on

monitor

Apnea monit

or

X-ray (report

ed)

Sucti on

Neona te

chest tubes

CPAP equipm

ent

Ventilat or

NICU 6 6 6 2 6 6 0 5 5

SNCU 6 5 6 1 7 5 0 4 1

Private 3 3 3 0 3 3 0 2 3

Public 12 11 11 4 13 11 1 7 3

Per

cent

age

44 38 35 32 29

24

Com

pone

nt o

f dis

cuss

Gaps in QOC

0 20 40 60 80 100

Percentage

=

Birthweight 78

Gestational age 75

Temperature 86

Respiratory rate 86

100

Per

cent

age 80

60

40

20

gestational age

-

100

Per

cent

age

90 80 70 60 50 40 30 20 10 0

-

Other

Infant yellow

Seizures

Diarrhea

Vomiting

Difficulty feeding

Decreased movement

Fever

Ris

k si

gn

0 10 20 30 40 50 60 70 80 90 100 Percentage

Tips for staff O

ut-o

f-po

cket

pay

men

0 10 20 30 40 50 60 70 80 90 100

Percentage

Asp

ect

of c

Clean

0 10 20 30 40 50 60 70 80 90 100 Percentage

Low

2 NYI Services

High

Medium

High

Medium

High

Medium

7 QOC

High

10 Parental Support

Medium

High

SN Ciiteria

10

11

12

13

14

15

16

17

18

19

20

Penguine suction 2

KMCwrapper 4m

Room heater I

IV Stand 2

Medicine Trolley I

HR Type Lewll

Paran1edics 2-3

SN Ciiteria

Set up Standard

Senices Standard

Status

~ ~ ~~ Yes

B - sauce yen13

1 ~ ildtf fl 5et 1

s Boomdook I

10 usl ~-3 1

H Sten_~ ~ieqmred

11 S~Jpmrp 4

14 ~

16 ~tape 4

19 ~ ~Jmfflffl I

2 - ~J 1

22 ~--gen---- ~ 4

28 IV Stand 6

30 CP AP Machine 1

3 1 Infusion Pump 4

Nursing staffSBA 8

SN Criteria

ratliaul wanwr

Services

6 Cold light I

9 CP AP machine 2

10 ABGmachine 1

17 IV Stand 10

19 Infusion Pump 8

20 Syringe Pump 4

Nursing staffSBA 12

Medical Officers 5

Paediatrician 2

Table of Contents
Acknowledgments
Abbreviations
Executive Summary
- Context
- - Background
    - - Methodology
      - Objective
        
        Study Design
        
        Data Analysis
        
        
        Results
        
        
        NYI Services
        
        KMC
        
        Breast Milk Feeding
        
        
        
        Seizures
        
        Hyperbilirubinemia
        
        
        
        Drug Procurement
        
        Equipment
        
        
        Management Systems
        
        
        QOC
        
        
        Referrals
        
        Out-Referrals
        
        In-Referrals
        
        Discharge Planning
        
        Parental Support
        
        Experience of Care
        
        Recommendations
        
        Conclusion

Page 17: Situation Analysis of Inpatient Care of Newborns and Young ...

bull

NY

I Ser

vice

In

ter

NICU

0 10 20 30 40 50 60 70 80 90 100

Percentage

Treat seizures 14

16 14

Num

ber

of fa

cilit

ies

14

12

10 8

8 6

6 4

4 3 3

2 1

Facilities seeing

Imm

edia

tely

ref

erpa

tien

t w

itho

ut fu

rthe

ras

sess

men

t or

tre

atm

ent

Pro

vide

one

dos

ein

ject

able

ant

ibio

tic

th

en r

efer

Pre

scri

be fu

ll an

tibi

otic

re

gim

en a

nd fo

llow

-up

IV IM

Clin

ical

ass

essm

ent

only

Blo

od c

ultu

re

Lum

bar

punc

ture

and

se

nses

exa

min

atio

n

NICU 3 0 3 2 3 1 2 3 3

SNCU 6 0 6 3 6 3 5 3 2

Total 9 0 9 5 9 4 7 6 5

Facility Type

(observed)

Steth oscop

e

Pulse oximet

er

Respirati on

monitor

Apnea monit

or

X-ray (report

ed)

Sucti on

Neona te

chest tubes

CPAP equipm

ent

Ventilat or

NICU 6 6 6 2 6 6 0 5 5

SNCU 6 5 6 1 7 5 0 4 1

Private 3 3 3 0 3 3 0 2 3

Public 12 11 11 4 13 11 1 7 3

Per

cent

age

44 38 35 32 29

24

Com

pone

nt o

f dis

cuss

Gaps in QOC

0 20 40 60 80 100

Percentage

=

Birthweight 78

Gestational age 75

Temperature 86

Respiratory rate 86

100

Per

cent

age 80

60

40

20

gestational age

-

100

Per

cent

age

90 80 70 60 50 40 30 20 10 0

-

Other

Infant yellow

Seizures

Diarrhea

Vomiting

Difficulty feeding

Decreased movement

Fever

Ris

k si

gn

0 10 20 30 40 50 60 70 80 90 100 Percentage

Tips for staff O

ut-o

f-po

cket

pay

men

0 10 20 30 40 50 60 70 80 90 100

Percentage

Asp

ect

of c

Clean

0 10 20 30 40 50 60 70 80 90 100 Percentage

Low

2 NYI Services

High

Medium

High

Medium

High

Medium

7 QOC

High

10 Parental Support

Medium

High

SN Ciiteria

10

11

12

13

14

15

16

17

18

19

20

Penguine suction 2

KMCwrapper 4m

Room heater I

IV Stand 2

Medicine Trolley I

HR Type Lewll

Paran1edics 2-3

SN Ciiteria

Set up Standard

Senices Standard

Status

~ ~ ~~ Yes

B - sauce yen13

1 ~ ildtf fl 5et 1

s Boomdook I

10 usl ~-3 1

H Sten_~ ~ieqmred

11 S~Jpmrp 4

14 ~

16 ~tape 4

19 ~ ~Jmfflffl I

2 - ~J 1

22 ~--gen---- ~ 4

28 IV Stand 6

30 CP AP Machine 1

3 1 Infusion Pump 4

Nursing staffSBA 8

SN Criteria

ratliaul wanwr

Services

6 Cold light I

9 CP AP machine 2

10 ABGmachine 1

17 IV Stand 10

19 Infusion Pump 8

20 Syringe Pump 4

Nursing staffSBA 12

Medical Officers 5

Paediatrician 2

Table of Contents
Acknowledgments
Abbreviations
Executive Summary
- Context
- - Background
    - - Methodology
      - Objective
        
        Study Design
        
        Data Analysis
        
        
        Results
        
        
        NYI Services
        
        KMC
        
        Breast Milk Feeding
        
        
        
        Seizures
        
        Hyperbilirubinemia
        
        
        
        Drug Procurement
        
        Equipment
        
        
        Management Systems
        
        
        QOC
        
        
        Referrals
        
        Out-Referrals
        
        In-Referrals
        
        Discharge Planning
        
        Parental Support
        
        Experience of Care
        
        Recommendations
        
        Conclusion

Page 18: Situation Analysis of Inpatient Care of Newborns and Young ...

Treat seizures 14

16 14

Num

ber

of fa

cilit

ies

14

12

10 8

8 6

6 4

4 3 3

2 1

Facilities seeing

Imm

edia

tely

ref

erpa

tien

t w

itho

ut fu

rthe

ras

sess

men

t or

tre

atm

ent

Pro

vide

one

dos

ein

ject

able

ant

ibio

tic

th

en r

efer

Pre

scri

be fu

ll an

tibi

otic

re

gim

en a

nd fo

llow

-up

IV IM

Clin

ical

ass

essm

ent

only

Blo

od c

ultu

re

Lum

bar

punc

ture

and

se

nses

exa

min

atio

n

NICU 3 0 3 2 3 1 2 3 3

SNCU 6 0 6 3 6 3 5 3 2

Total 9 0 9 5 9 4 7 6 5

Facility Type

(observed)

Steth oscop

e

Pulse oximet

er

Respirati on

monitor

Apnea monit

or

X-ray (report

ed)

Sucti on

Neona te

chest tubes

CPAP equipm

ent

Ventilat or

NICU 6 6 6 2 6 6 0 5 5

SNCU 6 5 6 1 7 5 0 4 1

Private 3 3 3 0 3 3 0 2 3

Public 12 11 11 4 13 11 1 7 3

Per

cent

age

44 38 35 32 29

24

Com

pone

nt o

f dis

cuss

Gaps in QOC

0 20 40 60 80 100

Percentage

=

Birthweight 78

Gestational age 75

Temperature 86

Respiratory rate 86

100

Per

cent

age 80

60

40

20

gestational age

-

100

Per

cent

age

90 80 70 60 50 40 30 20 10 0

-

Other

Infant yellow

Seizures

Diarrhea

Vomiting

Difficulty feeding

Decreased movement

Fever

Ris

k si

gn

0 10 20 30 40 50 60 70 80 90 100 Percentage

Tips for staff O

ut-o

f-po

cket

pay

men

0 10 20 30 40 50 60 70 80 90 100

Percentage

Asp

ect

of c

Clean

0 10 20 30 40 50 60 70 80 90 100 Percentage

Low

2 NYI Services

High

Medium

High

Medium

High

Medium

7 QOC

High

10 Parental Support

Medium

High

SN Ciiteria

10

11

12

13

14

15

16

17

18

19

20

Penguine suction 2

KMCwrapper 4m

Room heater I

IV Stand 2

Medicine Trolley I

HR Type Lewll

Paran1edics 2-3

SN Ciiteria

Set up Standard

Senices Standard

Status

~ ~ ~~ Yes

B - sauce yen13

1 ~ ildtf fl 5et 1

s Boomdook I

10 usl ~-3 1

H Sten_~ ~ieqmred

11 S~Jpmrp 4

14 ~

16 ~tape 4

19 ~ ~Jmfflffl I

2 - ~J 1

22 ~--gen---- ~ 4

28 IV Stand 6

30 CP AP Machine 1

3 1 Infusion Pump 4

Nursing staffSBA 8

SN Criteria

ratliaul wanwr

Services

6 Cold light I

9 CP AP machine 2

10 ABGmachine 1

17 IV Stand 10

19 Infusion Pump 8

20 Syringe Pump 4

Nursing staffSBA 12

Medical Officers 5

Paediatrician 2

Table of Contents
Acknowledgments
Abbreviations
Executive Summary
- Context
- - Background
    - - Methodology
      - Objective
        
        Study Design
        
        Data Analysis
        
        
        Results
        
        
        NYI Services
        
        KMC
        
        Breast Milk Feeding
        
        
        
        Seizures
        
        Hyperbilirubinemia
        
        
        
        Drug Procurement
        
        Equipment
        
        
        Management Systems
        
        
        QOC
        
        
        Referrals
        
        Out-Referrals
        
        In-Referrals
        
        Discharge Planning
        
        Parental Support
        
        Experience of Care
        
        Recommendations
        
        Conclusion

Page 19: Situation Analysis of Inpatient Care of Newborns and Young ...

16 14

Num

ber

of fa

cilit

ies

14

12

10 8

8 6

6 4

4 3 3

2 1

Facilities seeing

Imm

edia

tely

ref

erpa

tien

t w

itho

ut fu

rthe

ras

sess

men

t or

tre

atm

ent

Pro

vide

one

dos

ein

ject

able

ant

ibio

tic

th

en r

efer

Pre

scri

be fu

ll an

tibi

otic

re

gim

en a

nd fo

llow

-up

IV IM

Clin

ical

ass

essm

ent

only

Blo

od c

ultu

re

Lum

bar

punc

ture

and

se

nses

exa

min

atio

n

NICU 3 0 3 2 3 1 2 3 3

SNCU 6 0 6 3 6 3 5 3 2

Total 9 0 9 5 9 4 7 6 5

Facility Type

(observed)

Steth oscop

e

Pulse oximet

er

Respirati on

monitor

Apnea monit

or

X-ray (report

ed)

Sucti on

Neona te

chest tubes

CPAP equipm

ent

Ventilat or

NICU 6 6 6 2 6 6 0 5 5

SNCU 6 5 6 1 7 5 0 4 1

Private 3 3 3 0 3 3 0 2 3

Public 12 11 11 4 13 11 1 7 3

Per

cent

age

44 38 35 32 29

24

Com

pone

nt o

f dis

cuss

Gaps in QOC

0 20 40 60 80 100

Percentage

=

Birthweight 78

Gestational age 75

Temperature 86

Respiratory rate 86

100

Per

cent

age 80

60

40

20

gestational age

-

100

Per

cent

age

90 80 70 60 50 40 30 20 10 0

-

Other

Infant yellow

Seizures

Diarrhea

Vomiting

Difficulty feeding

Decreased movement

Fever

Ris

k si

gn

0 10 20 30 40 50 60 70 80 90 100 Percentage

Tips for staff O

ut-o

f-po

cket

pay

men

0 10 20 30 40 50 60 70 80 90 100

Percentage

Asp

ect

of c

Clean

0 10 20 30 40 50 60 70 80 90 100 Percentage

Low

2 NYI Services

High

Medium

High

Medium

High

Medium

7 QOC

High

10 Parental Support

Medium

High

SN Ciiteria

10

11

12

13

14

15

16

17

18

19

20

Penguine suction 2

KMCwrapper 4m

Room heater I

IV Stand 2

Medicine Trolley I

HR Type Lewll

Paran1edics 2-3

SN Ciiteria

Set up Standard

Senices Standard

Status

~ ~ ~~ Yes

B - sauce yen13

1 ~ ildtf fl 5et 1

s Boomdook I

10 usl ~-3 1

H Sten_~ ~ieqmred

11 S~Jpmrp 4

14 ~

16 ~tape 4

19 ~ ~Jmfflffl I

2 - ~J 1

22 ~--gen---- ~ 4

28 IV Stand 6

30 CP AP Machine 1

3 1 Infusion Pump 4

Nursing staffSBA 8

SN Criteria

ratliaul wanwr

Services

6 Cold light I

9 CP AP machine 2

10 ABGmachine 1

17 IV Stand 10

19 Infusion Pump 8

20 Syringe Pump 4

Nursing staffSBA 12

Medical Officers 5

Paediatrician 2

Table of Contents
Acknowledgments
Abbreviations
Executive Summary
- Context
- - Background
    - - Methodology
      - Objective
        
        Study Design
        
        Data Analysis
        
        
        Results
        
        
        NYI Services
        
        KMC
        
        Breast Milk Feeding
        
        
        
        Seizures
        
        Hyperbilirubinemia
        
        
        
        Drug Procurement
        
        Equipment
        
        
        Management Systems
        
        
        QOC
        
        
        Referrals
        
        Out-Referrals
        
        In-Referrals
        
        Discharge Planning
        
        Parental Support
        
        Experience of Care
        
        Recommendations
        
        Conclusion

Page 20: Situation Analysis of Inpatient Care of Newborns and Young ...

Facilities seeing

Imm

edia

tely

ref

erpa

tien

t w

itho

ut fu

rthe

ras

sess

men

t or

tre

atm

ent

Pro

vide

one

dos

ein

ject

able

ant

ibio

tic

th

en r

efer

Pre

scri

be fu

ll an

tibi

otic

re

gim

en a

nd fo

llow

-up

IV IM

Clin

ical

ass

essm

ent

only

Blo

od c

ultu

re

Lum

bar

punc

ture

and

se

nses

exa

min

atio

n

NICU 3 0 3 2 3 1 2 3 3

SNCU 6 0 6 3 6 3 5 3 2

Total 9 0 9 5 9 4 7 6 5

Facility Type

(observed)

Steth oscop

e

Pulse oximet

er

Respirati on

monitor

Apnea monit

or

X-ray (report

ed)

Sucti on

Neona te

chest tubes

CPAP equipm

ent

Ventilat or

NICU 6 6 6 2 6 6 0 5 5

SNCU 6 5 6 1 7 5 0 4 1

Private 3 3 3 0 3 3 0 2 3

Public 12 11 11 4 13 11 1 7 3

Per

cent

age

44 38 35 32 29

24

Com

pone

nt o

f dis

cuss

Gaps in QOC

0 20 40 60 80 100

Percentage

=

Birthweight 78

Gestational age 75

Temperature 86

Respiratory rate 86

100

Per

cent

age 80

60

40

20

gestational age

-

100

Per

cent

age

90 80 70 60 50 40 30 20 10 0

-

Other

Infant yellow

Seizures

Diarrhea

Vomiting

Difficulty feeding

Decreased movement

Fever

Ris

k si

gn

0 10 20 30 40 50 60 70 80 90 100 Percentage

Tips for staff O

ut-o

f-po

cket

pay

men

0 10 20 30 40 50 60 70 80 90 100

Percentage

Asp

ect

of c

Clean

0 10 20 30 40 50 60 70 80 90 100 Percentage

Low

2 NYI Services

High

Medium

High

Medium

High

Medium

7 QOC

High

10 Parental Support

Medium

High

SN Ciiteria

10

11

12

13

14

15

16

17

18

19

20

Penguine suction 2

KMCwrapper 4m

Room heater I

IV Stand 2

Medicine Trolley I

HR Type Lewll

Paran1edics 2-3

SN Ciiteria

Set up Standard

Senices Standard

Status

~ ~ ~~ Yes

B - sauce yen13

1 ~ ildtf fl 5et 1

s Boomdook I

10 usl ~-3 1

H Sten_~ ~ieqmred

11 S~Jpmrp 4

14 ~

16 ~tape 4

19 ~ ~Jmfflffl I

2 - ~J 1

22 ~--gen---- ~ 4

28 IV Stand 6

30 CP AP Machine 1

3 1 Infusion Pump 4

Nursing staffSBA 8

SN Criteria

ratliaul wanwr

Services

6 Cold light I

9 CP AP machine 2

10 ABGmachine 1

17 IV Stand 10

19 Infusion Pump 8

20 Syringe Pump 4

Nursing staffSBA 12

Medical Officers 5

Paediatrician 2

Table of Contents
Acknowledgments
Abbreviations
Executive Summary
- Context
- - Background
    - - Methodology
      - Objective
        
        Study Design
        
        Data Analysis
        
        
        Results
        
        
        NYI Services
        
        KMC
        
        Breast Milk Feeding
        
        
        
        Seizures
        
        Hyperbilirubinemia
        
        
        
        Drug Procurement
        
        Equipment
        
        
        Management Systems
        
        
        QOC
        
        
        Referrals
        
        Out-Referrals
        
        In-Referrals
        
        Discharge Planning
        
        Parental Support
        
        Experience of Care
        
        Recommendations
        
        Conclusion

Page 21: Situation Analysis of Inpatient Care of Newborns and Young ...

Facility Type

(observed)

Steth oscop

e

Pulse oximet

er

Respirati on

monitor

Apnea monit

or

X-ray (report

ed)

Sucti on

Neona te

chest tubes

CPAP equipm

ent

Ventilat or

NICU 6 6 6 2 6 6 0 5 5

SNCU 6 5 6 1 7 5 0 4 1

Private 3 3 3 0 3 3 0 2 3

Public 12 11 11 4 13 11 1 7 3

Per

cent

age

44 38 35 32 29

24

Com

pone

nt o

f dis

cuss

Gaps in QOC

0 20 40 60 80 100

Percentage

=

Birthweight 78

Gestational age 75

Temperature 86

Respiratory rate 86

100

Per

cent

age 80

60

40

20

gestational age

-

100

Per

cent

age

90 80 70 60 50 40 30 20 10 0

-

Other

Infant yellow

Seizures

Diarrhea

Vomiting

Difficulty feeding

Decreased movement

Fever

Ris

k si

gn

0 10 20 30 40 50 60 70 80 90 100 Percentage

Tips for staff O

ut-o

f-po

cket

pay

men

0 10 20 30 40 50 60 70 80 90 100

Percentage

Asp

ect

of c

Clean

0 10 20 30 40 50 60 70 80 90 100 Percentage

Low

2 NYI Services

High

Medium

High

Medium

High

Medium

7 QOC

High

10 Parental Support

Medium

High

SN Ciiteria

10

11

12

13

14

15

16

17

18

19

20

Penguine suction 2

KMCwrapper 4m

Room heater I

IV Stand 2

Medicine Trolley I

HR Type Lewll

Paran1edics 2-3

SN Ciiteria

Set up Standard

Senices Standard

Status

~ ~ ~~ Yes

B - sauce yen13

1 ~ ildtf fl 5et 1

s Boomdook I

10 usl ~-3 1

H Sten_~ ~ieqmred

11 S~Jpmrp 4

14 ~

16 ~tape 4

19 ~ ~Jmfflffl I

2 - ~J 1

22 ~--gen---- ~ 4

28 IV Stand 6

30 CP AP Machine 1

3 1 Infusion Pump 4

Nursing staffSBA 8

SN Criteria

ratliaul wanwr

Services

6 Cold light I

9 CP AP machine 2

10 ABGmachine 1

17 IV Stand 10

19 Infusion Pump 8

20 Syringe Pump 4

Nursing staffSBA 12

Medical Officers 5

Paediatrician 2

Table of Contents
Acknowledgments
Abbreviations
Executive Summary
- Context
- - Background
    - - Methodology
      - Objective
        
        Study Design
        
        Data Analysis
        
        
        Results
        
        
        NYI Services
        
        KMC
        
        Breast Milk Feeding
        
        
        
        Seizures
        
        Hyperbilirubinemia
        
        
        
        Drug Procurement
        
        Equipment
        
        
        Management Systems
        
        
        QOC
        
        
        Referrals
        
        Out-Referrals
        
        In-Referrals
        
        Discharge Planning
        
        Parental Support
        
        Experience of Care
        
        Recommendations
        
        Conclusion

Page 22: Situation Analysis of Inpatient Care of Newborns and Young ...

Per

cent

age

44 38 35 32 29

24

Com

pone

nt o

f dis

cuss

Gaps in QOC

0 20 40 60 80 100

Percentage

=

Birthweight 78

Gestational age 75

Temperature 86

Respiratory rate 86

100

Per

cent

age 80

60

40

20

gestational age

-

100

Per

cent

age

90 80 70 60 50 40 30 20 10 0

-

Other

Infant yellow

Seizures

Diarrhea

Vomiting

Difficulty feeding

Decreased movement

Fever

Ris

k si

gn

0 10 20 30 40 50 60 70 80 90 100 Percentage

Tips for staff O

ut-o

f-po

cket

pay

men

0 10 20 30 40 50 60 70 80 90 100

Percentage

Asp

ect

of c

Clean

0 10 20 30 40 50 60 70 80 90 100 Percentage

Low

2 NYI Services

High

Medium

High

Medium

High

Medium

7 QOC

High

10 Parental Support

Medium

High

SN Ciiteria

10

11

12

13

14

15

16

17

18

19

20

Penguine suction 2

KMCwrapper 4m

Room heater I

IV Stand 2

Medicine Trolley I

HR Type Lewll

Paran1edics 2-3

SN Ciiteria

Set up Standard

Senices Standard

Status

~ ~ ~~ Yes

B - sauce yen13

1 ~ ildtf fl 5et 1

s Boomdook I

10 usl ~-3 1

H Sten_~ ~ieqmred

11 S~Jpmrp 4

14 ~

16 ~tape 4

19 ~ ~Jmfflffl I

2 - ~J 1

22 ~--gen---- ~ 4

28 IV Stand 6

30 CP AP Machine 1

3 1 Infusion Pump 4

Nursing staffSBA 8

SN Criteria

ratliaul wanwr

Services

6 Cold light I

9 CP AP machine 2

10 ABGmachine 1

17 IV Stand 10

19 Infusion Pump 8

20 Syringe Pump 4

Nursing staffSBA 12

Medical Officers 5

Paediatrician 2

Table of Contents
Acknowledgments
Abbreviations
Executive Summary
- Context
- - Background
    - - Methodology
      - Objective
        
        Study Design
        
        Data Analysis
        
        
        Results
        
        
        NYI Services
        
        KMC
        
        Breast Milk Feeding
        
        
        
        Seizures
        
        Hyperbilirubinemia
        
        
        
        Drug Procurement
        
        Equipment
        
        
        Management Systems
        
        
        QOC
        
        
        Referrals
        
        Out-Referrals
        
        In-Referrals
        
        Discharge Planning
        
        Parental Support
        
        Experience of Care
        
        Recommendations
        
        Conclusion

Page 23: Situation Analysis of Inpatient Care of Newborns and Young ...

Per

cent

age

44 38 35 32 29

24

Com

pone

nt o

f dis

cuss

Gaps in QOC

0 20 40 60 80 100

Percentage

=

Birthweight 78

Gestational age 75

Temperature 86

Respiratory rate 86

100

Per

cent

age 80

60

40

20

gestational age

-

100

Per

cent

age

90 80 70 60 50 40 30 20 10 0

-

Other

Infant yellow

Seizures

Diarrhea

Vomiting

Difficulty feeding

Decreased movement

Fever

Ris

k si

gn

0 10 20 30 40 50 60 70 80 90 100 Percentage

Tips for staff O

ut-o

f-po

cket

pay

men

0 10 20 30 40 50 60 70 80 90 100

Percentage

Asp

ect

of c

Clean

0 10 20 30 40 50 60 70 80 90 100 Percentage

Low

2 NYI Services

High

Medium

High

Medium

High

Medium

7 QOC

High

10 Parental Support

Medium

High

SN Ciiteria

10

11

12

13

14

15

16

17

18

19

20

Penguine suction 2

KMCwrapper 4m

Room heater I

IV Stand 2

Medicine Trolley I

HR Type Lewll

Paran1edics 2-3

SN Ciiteria

Set up Standard

Senices Standard

Status

~ ~ ~~ Yes

B - sauce yen13

1 ~ ildtf fl 5et 1

s Boomdook I

10 usl ~-3 1

H Sten_~ ~ieqmred

11 S~Jpmrp 4

14 ~

16 ~tape 4

19 ~ ~Jmfflffl I

2 - ~J 1

22 ~--gen---- ~ 4

28 IV Stand 6

30 CP AP Machine 1

3 1 Infusion Pump 4

Nursing staffSBA 8

SN Criteria

ratliaul wanwr

Services

6 Cold light I

9 CP AP machine 2

10 ABGmachine 1

17 IV Stand 10

19 Infusion Pump 8

20 Syringe Pump 4

Nursing staffSBA 12

Medical Officers 5

Paediatrician 2

Table of Contents
Acknowledgments
Abbreviations
Executive Summary
- Context
- - Background
    - - Methodology
      - Objective
        
        Study Design
        
        Data Analysis
        
        
        Results
        
        
        NYI Services
        
        KMC
        
        Breast Milk Feeding
        
        
        
        Seizures
        
        Hyperbilirubinemia
        
        
        
        Drug Procurement
        
        Equipment
        
        
        Management Systems
        
        
        QOC
        
        
        Referrals
        
        Out-Referrals
        
        In-Referrals
        
        Discharge Planning
        
        Parental Support
        
        Experience of Care
        
        Recommendations
        
        Conclusion

Page 24: Situation Analysis of Inpatient Care of Newborns and Young ...

Com

pone

nt o

f dis

cuss

Gaps in QOC

0 20 40 60 80 100

Percentage

=

Birthweight 78

Gestational age 75

Temperature 86

Respiratory rate 86

100

Per

cent

age 80

60

40

20

gestational age

-

100

Per

cent

age

90 80 70 60 50 40 30 20 10 0

-

Other

Infant yellow

Seizures

Diarrhea

Vomiting

Difficulty feeding

Decreased movement

Fever

Ris

k si

gn

0 10 20 30 40 50 60 70 80 90 100 Percentage

Tips for staff O

ut-o

f-po

cket

pay

men

0 10 20 30 40 50 60 70 80 90 100

Percentage

Asp

ect

of c

Clean

0 10 20 30 40 50 60 70 80 90 100 Percentage

Low

2 NYI Services

High

Medium

High

Medium

High

Medium

7 QOC

High

10 Parental Support

Medium

High

SN Ciiteria

10

11

12

13

14

15

16

17

18

19

20

Penguine suction 2

KMCwrapper 4m

Room heater I

IV Stand 2

Medicine Trolley I

HR Type Lewll

Paran1edics 2-3

SN Ciiteria

Set up Standard

Senices Standard

Status

~ ~ ~~ Yes

B - sauce yen13

1 ~ ildtf fl 5et 1

s Boomdook I

10 usl ~-3 1

H Sten_~ ~ieqmred

11 S~Jpmrp 4

14 ~

16 ~tape 4

19 ~ ~Jmfflffl I

2 - ~J 1

22 ~--gen---- ~ 4

28 IV Stand 6

30 CP AP Machine 1

3 1 Infusion Pump 4

Nursing staffSBA 8

SN Criteria

ratliaul wanwr

Services

6 Cold light I

9 CP AP machine 2

10 ABGmachine 1

17 IV Stand 10

19 Infusion Pump 8

20 Syringe Pump 4

Nursing staffSBA 12

Medical Officers 5

Paediatrician 2

Table of Contents
Acknowledgments
Abbreviations
Executive Summary
- Context
- - Background
    - - Methodology
      - Objective
        
        Study Design
        
        Data Analysis
        
        
        Results
        
        
        NYI Services
        
        KMC
        
        Breast Milk Feeding
        
        
        
        Seizures
        
        Hyperbilirubinemia
        
        
        
        Drug Procurement
        
        Equipment
        
        
        Management Systems
        
        
        QOC
        
        
        Referrals
        
        Out-Referrals
        
        In-Referrals
        
        Discharge Planning
        
        Parental Support
        
        Experience of Care
        
        Recommendations
        
        Conclusion

Page 25: Situation Analysis of Inpatient Care of Newborns and Young ...

Com

pone

nt o

f dis

cuss

Gaps in QOC

0 20 40 60 80 100

Percentage

=

Birthweight 78

Gestational age 75

Temperature 86

Respiratory rate 86

100

Per

cent

age 80

60

40

20

gestational age

-

100

Per

cent

age

90 80 70 60 50 40 30 20 10 0

-

Other

Infant yellow

Seizures

Diarrhea

Vomiting

Difficulty feeding

Decreased movement

Fever

Ris

k si

gn

0 10 20 30 40 50 60 70 80 90 100 Percentage

Tips for staff O

ut-o

f-po

cket

pay

men

0 10 20 30 40 50 60 70 80 90 100

Percentage

Asp

ect

of c

Clean

0 10 20 30 40 50 60 70 80 90 100 Percentage

Low

2 NYI Services

High

Medium

High

Medium

High

Medium

7 QOC

High

10 Parental Support

Medium

High

SN Ciiteria

10

11

12

13

14

15

16

17

18

19

20

Penguine suction 2

KMCwrapper 4m

Room heater I

IV Stand 2

Medicine Trolley I

HR Type Lewll

Paran1edics 2-3

SN Ciiteria

Set up Standard

Senices Standard

Status

~ ~ ~~ Yes

B - sauce yen13

1 ~ ildtf fl 5et 1

s Boomdook I

10 usl ~-3 1

H Sten_~ ~ieqmred

11 S~Jpmrp 4

14 ~

16 ~tape 4

19 ~ ~Jmfflffl I

2 - ~J 1

22 ~--gen---- ~ 4

28 IV Stand 6

30 CP AP Machine 1

3 1 Infusion Pump 4

Nursing staffSBA 8

SN Criteria

ratliaul wanwr

Services

6 Cold light I

9 CP AP machine 2

10 ABGmachine 1

17 IV Stand 10

19 Infusion Pump 8

20 Syringe Pump 4

Nursing staffSBA 12

Medical Officers 5

Paediatrician 2

Table of Contents
Acknowledgments
Abbreviations
Executive Summary
- Context
- - Background
    - - Methodology
      - Objective
        
        Study Design
        
        Data Analysis
        
        
        Results
        
        
        NYI Services
        
        KMC
        
        Breast Milk Feeding
        
        
        
        Seizures
        
        Hyperbilirubinemia
        
        
        
        Drug Procurement
        
        Equipment
        
        
        Management Systems
        
        
        QOC
        
        
        Referrals
        
        Out-Referrals
        
        In-Referrals
        
        Discharge Planning
        
        Parental Support
        
        Experience of Care
        
        Recommendations
        
        Conclusion

Page 26: Situation Analysis of Inpatient Care of Newborns and Young ...

=

Birthweight 78

Gestational age 75

Temperature 86

Respiratory rate 86

100

Per

cent

age 80

60

40

20

gestational age

-

100

Per

cent

age

90 80 70 60 50 40 30 20 10 0

-

Other

Infant yellow

Seizures

Diarrhea

Vomiting

Difficulty feeding

Decreased movement

Fever

Ris

k si

gn

0 10 20 30 40 50 60 70 80 90 100 Percentage

Tips for staff O

ut-o

f-po

cket

pay

men

0 10 20 30 40 50 60 70 80 90 100

Percentage

Asp

ect

of c

Clean

0 10 20 30 40 50 60 70 80 90 100 Percentage

Low

2 NYI Services

High

Medium

High

Medium

High

Medium

7 QOC

High

10 Parental Support

Medium

High

SN Ciiteria

10

11

12

13

14

15

16

17

18

19

20

Penguine suction 2

KMCwrapper 4m

Room heater I

IV Stand 2

Medicine Trolley I

HR Type Lewll

Paran1edics 2-3

SN Ciiteria

Set up Standard

Senices Standard

Status

~ ~ ~~ Yes

B - sauce yen13

1 ~ ildtf fl 5et 1

s Boomdook I

10 usl ~-3 1

H Sten_~ ~ieqmred

11 S~Jpmrp 4

14 ~

16 ~tape 4

19 ~ ~Jmfflffl I

2 - ~J 1

22 ~--gen---- ~ 4

28 IV Stand 6

30 CP AP Machine 1

3 1 Infusion Pump 4

Nursing staffSBA 8

SN Criteria

ratliaul wanwr

Services

6 Cold light I

9 CP AP machine 2

10 ABGmachine 1

17 IV Stand 10

19 Infusion Pump 8

20 Syringe Pump 4

Nursing staffSBA 12

Medical Officers 5

Paediatrician 2

Table of Contents
Acknowledgments
Abbreviations
Executive Summary
- Context
- - Background
    - - Methodology
      - Objective
        
        Study Design
        
        Data Analysis
        
        
        Results
        
        
        NYI Services
        
        KMC
        
        Breast Milk Feeding
        
        
        
        Seizures
        
        Hyperbilirubinemia
        
        
        
        Drug Procurement
        
        Equipment
        
        
        Management Systems
        
        
        QOC
        
        
        Referrals
        
        Out-Referrals
        
        In-Referrals
        
        Discharge Planning
        
        Parental Support
        
        Experience of Care
        
        Recommendations
        
        Conclusion

Page 27: Situation Analysis of Inpatient Care of Newborns and Young ...

100

Per

cent

age 80

60

40

20

gestational age

-

100

Per

cent

age

90 80 70 60 50 40 30 20 10 0

-

Other

Infant yellow

Seizures

Diarrhea

Vomiting

Difficulty feeding

Decreased movement

Fever

Ris

k si

gn

0 10 20 30 40 50 60 70 80 90 100 Percentage

Tips for staff O

ut-o

f-po

cket

pay

men

0 10 20 30 40 50 60 70 80 90 100

Percentage

Asp

ect

of c

Clean

0 10 20 30 40 50 60 70 80 90 100 Percentage

Low

2 NYI Services

High

Medium

High

Medium

High

Medium

7 QOC

High

10 Parental Support

Medium

High

SN Ciiteria

10

11

12

13

14

15

16

17

18

19

20

Penguine suction 2

KMCwrapper 4m

Room heater I

IV Stand 2

Medicine Trolley I

HR Type Lewll

Paran1edics 2-3

SN Ciiteria

Set up Standard

Senices Standard

Status

~ ~ ~~ Yes

B - sauce yen13

1 ~ ildtf fl 5et 1

s Boomdook I

10 usl ~-3 1

H Sten_~ ~ieqmred

11 S~Jpmrp 4

14 ~

16 ~tape 4

19 ~ ~Jmfflffl I

2 - ~J 1

22 ~--gen---- ~ 4

28 IV Stand 6

30 CP AP Machine 1

3 1 Infusion Pump 4

Nursing staffSBA 8

SN Criteria

ratliaul wanwr

Services

6 Cold light I

9 CP AP machine 2

10 ABGmachine 1

17 IV Stand 10

19 Infusion Pump 8

20 Syringe Pump 4

Nursing staffSBA 12

Medical Officers 5

Paediatrician 2

Table of Contents
Acknowledgments
Abbreviations
Executive Summary
- Context
- - Background
    - - Methodology
      - Objective
        
        Study Design
        
        Data Analysis
        
        
        Results
        
        
        NYI Services
        
        KMC
        
        Breast Milk Feeding
        
        
        
        Seizures
        
        Hyperbilirubinemia
        
        
        
        Drug Procurement
        
        Equipment
        
        
        Management Systems
        
        
        QOC
        
        
        Referrals
        
        Out-Referrals
        
        In-Referrals
        
        Discharge Planning
        
        Parental Support
        
        Experience of Care
        
        Recommendations
        
        Conclusion

Page 28: Situation Analysis of Inpatient Care of Newborns and Young ...

-

100

Per

cent

age

90 80 70 60 50 40 30 20 10 0

-

Other

Infant yellow

Seizures

Diarrhea

Vomiting

Difficulty feeding

Decreased movement

Fever

Ris

k si

gn

0 10 20 30 40 50 60 70 80 90 100 Percentage

Tips for staff O

ut-o

f-po

cket

pay

men

0 10 20 30 40 50 60 70 80 90 100

Percentage

Asp

ect

of c

Clean

0 10 20 30 40 50 60 70 80 90 100 Percentage

Low

2 NYI Services

High

Medium

High

Medium

High

Medium

7 QOC

High

10 Parental Support

Medium

High

SN Ciiteria

10

11

12

13

14

15

16

17

18

19

20

Penguine suction 2

KMCwrapper 4m

Room heater I

IV Stand 2

Medicine Trolley I

HR Type Lewll

Paran1edics 2-3

SN Ciiteria

Set up Standard

Senices Standard

Status

~ ~ ~~ Yes

B - sauce yen13

1 ~ ildtf fl 5et 1

s Boomdook I

10 usl ~-3 1

H Sten_~ ~ieqmred

11 S~Jpmrp 4

14 ~

16 ~tape 4

19 ~ ~Jmfflffl I

2 - ~J 1

22 ~--gen---- ~ 4

28 IV Stand 6

30 CP AP Machine 1

3 1 Infusion Pump 4

Nursing staffSBA 8

SN Criteria

ratliaul wanwr

Services

6 Cold light I

9 CP AP machine 2

10 ABGmachine 1

17 IV Stand 10

19 Infusion Pump 8

20 Syringe Pump 4

Nursing staffSBA 12

Medical Officers 5

Paediatrician 2

Table of Contents
Acknowledgments
Abbreviations
Executive Summary
- Context
- - Background
    - - Methodology
      - Objective
        
        Study Design
        
        Data Analysis
        
        
        Results
        
        
        NYI Services
        
        KMC
        
        Breast Milk Feeding
        
        
        
        Seizures
        
        Hyperbilirubinemia
        
        
        
        Drug Procurement
        
        Equipment
        
        
        Management Systems
        
        
        QOC
        
        
        Referrals
        
        Out-Referrals
        
        In-Referrals
        
        Discharge Planning
        
        Parental Support
        
        Experience of Care
        
        Recommendations
        
        Conclusion

Page 29: Situation Analysis of Inpatient Care of Newborns and Young ...

-

Other

Infant yellow

Seizures

Diarrhea

Vomiting

Difficulty feeding

Decreased movement

Fever

Ris

k si

gn

0 10 20 30 40 50 60 70 80 90 100 Percentage

Tips for staff O

ut-o

f-po

cket

pay

men

0 10 20 30 40 50 60 70 80 90 100

Percentage

Asp

ect

of c

Clean

0 10 20 30 40 50 60 70 80 90 100 Percentage

Low

2 NYI Services

High

Medium

High

Medium

High

Medium

7 QOC

High

10 Parental Support

Medium

High

SN Ciiteria

10

11

12

13

14

15

16

17

18

19

20

Penguine suction 2

KMCwrapper 4m

Room heater I

IV Stand 2

Medicine Trolley I

HR Type Lewll

Paran1edics 2-3

SN Ciiteria

Set up Standard

Senices Standard

Status

~ ~ ~~ Yes

B - sauce yen13

1 ~ ildtf fl 5et 1

s Boomdook I

10 usl ~-3 1

H Sten_~ ~ieqmred

11 S~Jpmrp 4

14 ~

16 ~tape 4

19 ~ ~Jmfflffl I

2 - ~J 1

22 ~--gen---- ~ 4

28 IV Stand 6

30 CP AP Machine 1

3 1 Infusion Pump 4

Nursing staffSBA 8

SN Criteria

ratliaul wanwr

Services

6 Cold light I

9 CP AP machine 2

10 ABGmachine 1

17 IV Stand 10

19 Infusion Pump 8

20 Syringe Pump 4

Nursing staffSBA 12

Medical Officers 5

Paediatrician 2

Table of Contents
Acknowledgments
Abbreviations
Executive Summary
- Context
- - Background
    - - Methodology
      - Objective
        
        Study Design
        
        Data Analysis
        
        
        Results
        
        
        NYI Services
        
        KMC
        
        Breast Milk Feeding
        
        
        
        Seizures
        
        Hyperbilirubinemia
        
        
        
        Drug Procurement
        
        Equipment
        
        
        Management Systems
        
        
        QOC
        
        
        Referrals
        
        Out-Referrals
        
        In-Referrals
        
        Discharge Planning
        
        Parental Support
        
        Experience of Care
        
        Recommendations
        
        Conclusion

Page 30: Situation Analysis of Inpatient Care of Newborns and Young ...

-

Other

Infant yellow

Seizures

Diarrhea

Vomiting

Difficulty feeding

Decreased movement

Fever

Ris

k si

gn

0 10 20 30 40 50 60 70 80 90 100 Percentage

Tips for staff O

ut-o

f-po

cket

pay

men

0 10 20 30 40 50 60 70 80 90 100

Percentage

Asp

ect

of c

Clean

0 10 20 30 40 50 60 70 80 90 100 Percentage

Low

2 NYI Services

High

Medium

High

Medium

High

Medium

7 QOC

High

10 Parental Support

Medium

High

SN Ciiteria

10

11

12

13

14

15

16

17

18

19

20

Penguine suction 2

KMCwrapper 4m

Room heater I

IV Stand 2

Medicine Trolley I

HR Type Lewll

Paran1edics 2-3

SN Ciiteria

Set up Standard

Senices Standard

Status

~ ~ ~~ Yes

B - sauce yen13

1 ~ ildtf fl 5et 1

s Boomdook I

10 usl ~-3 1

H Sten_~ ~ieqmred

11 S~Jpmrp 4

14 ~

16 ~tape 4

19 ~ ~Jmfflffl I

2 - ~J 1

22 ~--gen---- ~ 4

28 IV Stand 6

30 CP AP Machine 1

3 1 Infusion Pump 4

Nursing staffSBA 8

SN Criteria

ratliaul wanwr

Services

6 Cold light I

9 CP AP machine 2

10 ABGmachine 1

17 IV Stand 10

19 Infusion Pump 8

20 Syringe Pump 4

Nursing staffSBA 12

Medical Officers 5

Paediatrician 2

Table of Contents
Acknowledgments
Abbreviations
Executive Summary
- Context
- - Background
    - - Methodology
      - Objective
        
        Study Design
        
        Data Analysis
        
        
        Results
        
        
        NYI Services
        
        KMC
        
        Breast Milk Feeding
        
        
        
        Seizures
        
        Hyperbilirubinemia
        
        
        
        Drug Procurement
        
        Equipment
        
        
        Management Systems
        
        
        QOC
        
        
        Referrals
        
        Out-Referrals
        
        In-Referrals
        
        Discharge Planning
        
        Parental Support
        
        Experience of Care
        
        Recommendations
        
        Conclusion

Page 31: Situation Analysis of Inpatient Care of Newborns and Young ...

Tips for staff O

ut-o

f-po

cket

pay

men

0 10 20 30 40 50 60 70 80 90 100

Percentage

Asp

ect

of c

Clean

0 10 20 30 40 50 60 70 80 90 100 Percentage

Low

2 NYI Services

High

Medium

High

Medium

High

Medium

7 QOC

High

10 Parental Support

Medium

High

SN Ciiteria

10

11

12

13

14

15

16

17

18

19

20

Penguine suction 2

KMCwrapper 4m

Room heater I

IV Stand 2

Medicine Trolley I

HR Type Lewll

Paran1edics 2-3

SN Ciiteria

Set up Standard

Senices Standard

Status

~ ~ ~~ Yes

B - sauce yen13

1 ~ ildtf fl 5et 1

s Boomdook I

10 usl ~-3 1

H Sten_~ ~ieqmred

11 S~Jpmrp 4

14 ~

16 ~tape 4

19 ~ ~Jmfflffl I

2 - ~J 1

22 ~--gen---- ~ 4

28 IV Stand 6

30 CP AP Machine 1

3 1 Infusion Pump 4

Nursing staffSBA 8

SN Criteria

ratliaul wanwr

Services

6 Cold light I

9 CP AP machine 2

10 ABGmachine 1

17 IV Stand 10

19 Infusion Pump 8

20 Syringe Pump 4

Nursing staffSBA 12

Medical Officers 5

Paediatrician 2

Table of Contents
Acknowledgments
Abbreviations
Executive Summary
- Context
- - Background
    - - Methodology
      - Objective
        
        Study Design
        
        Data Analysis
        
        
        Results
        
        
        NYI Services
        
        KMC
        
        Breast Milk Feeding
        
        
        
        Seizures
        
        Hyperbilirubinemia
        
        
        
        Drug Procurement
        
        Equipment
        
        
        Management Systems
        
        
        QOC
        
        
        Referrals
        
        Out-Referrals
        
        In-Referrals
        
        Discharge Planning
        
        Parental Support
        
        Experience of Care
        
        Recommendations
        
        Conclusion

Page 32: Situation Analysis of Inpatient Care of Newborns and Young ...

Low

2 NYI Services

High

Medium

High

Medium

High

Medium

7 QOC

High

10 Parental Support

Medium

High

SN Ciiteria

10

11

12

13

14

15

16

17

18

19

20

Penguine suction 2

KMCwrapper 4m

Room heater I

IV Stand 2

Medicine Trolley I

HR Type Lewll

Paran1edics 2-3

SN Ciiteria

Set up Standard

Senices Standard

Status

~ ~ ~~ Yes

B - sauce yen13

1 ~ ildtf fl 5et 1

s Boomdook I

10 usl ~-3 1

H Sten_~ ~ieqmred

11 S~Jpmrp 4

14 ~

16 ~tape 4

19 ~ ~Jmfflffl I

2 - ~J 1

22 ~--gen---- ~ 4

28 IV Stand 6

30 CP AP Machine 1

3 1 Infusion Pump 4

Nursing staffSBA 8

SN Criteria

ratliaul wanwr

Services

6 Cold light I

9 CP AP machine 2

10 ABGmachine 1

17 IV Stand 10

19 Infusion Pump 8

20 Syringe Pump 4

Nursing staffSBA 12

Medical Officers 5

Paediatrician 2

Table of Contents
Acknowledgments
Abbreviations
Executive Summary
- Context
- - Background
    - - Methodology
      - Objective
        
        Study Design
        
        Data Analysis
        
        
        Results
        
        
        NYI Services
        
        KMC
        
        Breast Milk Feeding
        
        
        
        Seizures
        
        Hyperbilirubinemia
        
        
        
        Drug Procurement
        
        Equipment
        
        
        Management Systems
        
        
        QOC
        
        
        Referrals
        
        Out-Referrals
        
        In-Referrals
        
        Discharge Planning
        
        Parental Support
        
        Experience of Care
        
        Recommendations
        
        Conclusion

Page 33: Situation Analysis of Inpatient Care of Newborns and Young ...

Low

2 NYI Services

High

Medium

High

Medium

High

Medium

7 QOC

High

10 Parental Support

Medium

High

SN Ciiteria

10

11

12

13

14

15

16

17

18

19

20

Penguine suction 2

KMCwrapper 4m

Room heater I

IV Stand 2

Medicine Trolley I

HR Type Lewll

Paran1edics 2-3

SN Ciiteria

Set up Standard

Senices Standard

Status

~ ~ ~~ Yes

B - sauce yen13

1 ~ ildtf fl 5et 1

s Boomdook I

10 usl ~-3 1

H Sten_~ ~ieqmred

11 S~Jpmrp 4

14 ~

16 ~tape 4

19 ~ ~Jmfflffl I

2 - ~J 1

22 ~--gen---- ~ 4

28 IV Stand 6

30 CP AP Machine 1

3 1 Infusion Pump 4

Nursing staffSBA 8

SN Criteria

ratliaul wanwr

Services

6 Cold light I

9 CP AP machine 2

10 ABGmachine 1

17 IV Stand 10

19 Infusion Pump 8

20 Syringe Pump 4

Nursing staffSBA 12

Medical Officers 5

Paediatrician 2

Table of Contents
Acknowledgments
Abbreviations
Executive Summary
- Context
- - Background
    - - Methodology
      - Objective
        
        Study Design
        
        Data Analysis
        
        
        Results
        
        
        NYI Services
        
        KMC
        
        Breast Milk Feeding
        
        
        
        Seizures
        
        Hyperbilirubinemia
        
        
        
        Drug Procurement
        
        Equipment
        
        
        Management Systems
        
        
        QOC
        
        
        Referrals
        
        Out-Referrals
        
        In-Referrals
        
        Discharge Planning
        
        Parental Support
        
        Experience of Care
        
        Recommendations
        
        Conclusion

Date post:	15-Apr-2022
Category:	Documents
Upload:	others
View:	2 times
Download:	0 times

Situation Analysis of Inpatient Care of Newborns and Young ...

Documents