Health System Preparedness for Newborn Care: A Health Facility Assessment in Rural Uganda

Abstract

Background: Health facilities have a critical role to play in saving the 2.9 million newborns at risk of dying every year worldwide. There is a dearth of data on the capacity of rural facilities in Uganda to care for newborns. This study assessed the capacity of health-facilities to care for newborns in rural Uganda for the main mortality causes: preterm/ low birth-weight, asphyxia and infections. Methods: Between July and August 2013, we conducted a cross-sectional study among 92 healthworkers, in 20 health-facilities: one hospital and 19 primary health care centres .. The indicators included; newborn services, equipment, drugs /supplies, documentation, trained staff and supervision, health-worker knowledge and resuscitation skills for newborns. Analysis was performed using STATA version-10.Availability scores generated using the Service Availability and Readiness Assessment tool, developed by WHO. Results: Fifteen of the 20 health-facilities offered newborn care. Level II facilities had the lowest availability score for resuscitation equipment (31%) compared to the hospital/level IV (71%) and level III (74%) facilities. None of the level II facilities offered kangaroo mother care services, while the availability score for this service was 67% for level III and 100% for the hospital/ level IV. Availability score for newborn sepsis drugs was 8% for level II, 67% and 75% for level III and the hospital/ level IV, respectively. Over two-thirds (33/50, 66%) of the health-workers were knowledgeable in newborn care, but less than a half (17/42, 41%) skilled in newborn resuscitation. Conclusions: Higher level health facilities were more prepared for newborn care than the lower level facilities. The national essential drug-policy should be revised to provide level II facilities with drugs that treat newborn sepsis. Level II Health-facilities that conduct deliveries should be provided with logistics to care for newborns.