Quantifying health facility service readiness for small and sick newborn care: comparing standards-based and WHO level-2 + scoring for 64 hospitals implementing with NEST360 in Kenya, Malawi, Nigeria, and Tanzania
Rebecca E. Penzias, Christine Bohne, Edith Gicheha, Elizabeth Molyneux, David Gathara, Samuel Ngwala, Evelyn Zimba, Ekran Rashid, Opeyemi Odedere, Olabisi Dosunmu, Robert Tillya, Josephine Shabani, James Cross, Christian B. Ochieng, Harriet Webster, Msandeni Chiume, Queen Dube, John Wainaina, Irabi Kassim, Grace Irimu, Steve Adudans, Femi James, Olukemi Oluwatoyin Tongo, Chinyere Ezeaka, Nahya Salim, Honorati Masanja, Maria Odén, Rebecca Richards‐Kortum, Tedbabe Hailegabriel, Gagan Gupta, Simon Cousens, Joy E Lawn, Eric O. Ohuma, with the Health Facility Assessment Data Collection Learning Collaborative Group, Christina Mchoma, Joseph Bilitinyu, Pius Chalamanda, Mirriam Dzinkambani, Ruth Mhango, Fanny Stevens, Joseph Mulungu, Blessings Makhumula, Loveness Banda, Charles Banda, Brian Chumbi, Chifundo Banda, Evelyn Chimombo, Nicodemus Nyasulu, Innocent Ndau, Pilirani Kumwembe, Edna Kerubo, Nyphry Ambuso, Kevin Koech, Noel Waithaka, Calet Wakhungu, Steven Otieno, Felix Bahati, Josphine Ayaga, Jedida Obure, Nellius Nderitu, Violet Mtambo, George Mkude, Mustapha Miraji, Caroline Shayo, Camilius Nambombi, Christopher Cyrilo, Temilade Aderounmu, Akingbehin Wakeel Wale, Odeleye Victoria Yemisi, Akinola Amudalat Dupe, Samuel Awolowo, Ojelabi Oluwaseun A., John Ajiwohwodoma Ovuoraye, Balogun Adeleke Mujaid, Adedoyin Fetuga, Juilana Okanlawon, Flora Awosika, Awotayo Olasupo Michael, Omotayo Adegboyega Abiodun
Abstract
BACKGROUND: Service readiness tools are important for assessing hospital capacity to provide quality small and sick newborn care (SSNC). Lack of summary scoring approaches for SSNC service readiness means we are unable to track national targets such as the Every Newborn Action Plan targets. METHODS: A health facility assessment (HFA) tool was co-designed by Newborn Essential Solutions and Technologies (NEST360) and UNICEF with four African governments. Data were collected in 68 NEST360-implementing neonatal units in Kenya, Malawi, Nigeria, and Tanzania (September 2019-March 2021). Two summary scoring approaches were developed: a) standards-based, including items for SSNC service readiness by health system building block (HSBB), and scored on availability and functionality, and b) level-2 + , scoring items on readiness to provide WHO level-2 + clinical interventions. For each scoring approach, scores were aggregated and summarised as a percentage and equally weighted to obtain an overall score by hospital, HSBB, and clinical intervention. RESULTS: Of 1508 HFA items, 1043 (69%) were included in standards-based and 309 (20%) in level-2 + scoring. Sixty-eight neonatal units across four countries had median standards-based scores of 51% [IQR 48-57%] at baseline, with variation by country: 62% [IQR 59-66%] in Kenya, 49% [IQR 46-51%] in Malawi, 50% [IQR 42-58%] in Nigeria, and 55% [IQR 53-62%] in Tanzania. The lowest scoring was family-centred care [27%, IQR 18-40%] with governance highest scoring [76%, IQR 71-82%]. For level-2 + scores, the overall median score was 41% [IQR 35-51%] with variation by country: 50% [IQR 44-53%] in Kenya, 41% [IQR 35-50%] in Malawi, 33% [IQR 27-37%] in Nigeria, and 41% [IQR 32-52%] in Tanzania. Readiness to provide antibiotics by culture report was the highest-scoring intervention [58%, IQR 50-75%] and neonatal encephalopathy management was the lowest-scoring [21%, IQR 8-42%]. In both methods, overall scores were low (< 50%) for 27 neonatal units in standards-based scoring and 48 neonatal units in level-2 + scoring. No neonatal unit achieved high scores of > 75%. DISCUSSION: Two scoring approaches reveal gaps in SSNC readiness with no neonatal units achieving high scores (> 75%). Government-led quality improvement teams can use these summary scores to identify areas for health systems change. Future analyses could determine which items are most directly linked with quality SSNC and newborn outcomes.