Every Newborn Bottleneck Analysis Tool

This tool from the global initiative Every Newborn aims to support countries to analyse health system bottlenecks and challenges preventing the scale up of high-impact, cost-effective interventions for newborns and to identify solutions. It is part of the Every Newborn Toolkit associated with the Every Newborn Action Plan.

This tool is divided into 2 main sections, each of which includes a chapter on "[p]otential and successful strategies and solutions...under each health system building block":

Section I: Identification of Bottlenecks Applicable to All Newborn Interventions

"Section I includes questions related to newborn health programmes in general and is organized into 7 sub-sections according to the health system building blocks as follows:

1. Leadership and governance
2. Health finance
3. Health workforce
4. Health service delivery
5. Essential medical products and technologies
6. Health information systems
7. Community ownership and partnership

At the end of each health system building block, summarize the key bottlenecks and provide an assessment of whether the health system area is:

• Good (not a bottleneck to scale up)
• Needs some improvements (minor bottleneck to scale up)
• Needs major improvements (significant bottleneck to scale up)
• Inadequate (very major bottleneck to scale up)"

SECTION II: Identification of Bottlenecks Applicable to Each Critical Newborn Intervention

"Section II is sub-divided into 9 sections representing critical newborn interventions listed below. Bottlenecks specific to each essential intervention are also assessed according to the 7 health system building blocks.

1. Management of pre-term birth -  focus on antenatal corticosteroids
2. Skilled care at birth - focus on the use of the partograph
3. Basic Emergency Obstetric Care - focus on assisted vaginal delivery
4. Comprehensive Emergency Obstetric Care - focus on caesarean section
5. Basic Newborn Care -  focus on cleanliness/cord care, warmth, and feeding
6. Neonatal resuscitation
7. Kangaroo mother care -  focus on skin to skin, breastfeeding and feeding support for premature and small babies
8. Treatment of severe infections - focus on using injectable antibiotics
9. Inpatient supportive care -  focus on IV fluids/feeding support and safe oxygen for sick and small newborns

At the end of each health system building block, summarize the key bottlenecks and provide an assessment of whether the health system area is:

• Good (not a bottleneck to scale up)
• Needs some improvements (minor bottleneck to scale up)
• Needs major improvements (significant bottleneck to scale up)
• Inadequate (very major bottleneck to scale up)"

The process of drafting the Every Newborn action plan has been undertaken by a group of partners, coordinated by the United Nations Children's Fund (UNICEF) and the World Health Organization and including: The Partnership for Maternal, Newborn & Child Health, the London School of Hygiene and Tropical Medicine, the Bill and Melinda Gates Foundation, Save the Children/Saving Newborn Lives, the Global Alliance to Prevent Prematurity and Stillbirths, Aga Khan University and Centre for Global Child Health, the United Nations Population Fund (UNFPA), and the Children’s Investment Fund Foundation. In addition, this process is supported by a  group of constituents including governments, health professional associations, academic institutions, multi-lateral and bilateral agencies, foundations, the private sector, and civil society, including women’s and parents’ groups.