Newborn care in Indonesia, Lao People’s Democratic Republic and the Philippines: a comprehensive needs assessment
1 International Centre for Reproductive Health (ICRH), Ghent University, De Pintelaan 185 UZP114, 9000 Ghent, Belgium
2 HERA, Right to Health & Development, Laarstraat 43, 2840 Reet, Belgium
3 Jl. Meditran X Blok.M30/7 Pondok Ranji, Ciputat Timur, Tangerang Selatan, Banten 15412, Indonesia
4 Unit 11-O Torre Venezia Suites, 170 Timog Avenue cor Scout Santiago Street, Quezon City 1103, Philippines
5 Ban Nongthathai, Chanhthabuly District, Vientiane, Laos
6 Department of Reproductive Health and Research, World Health Organisation, Avenue Appia 20, 1211 Geneva, Switzerland
7 UNICEF East Asia Pacific Regional Office, 19 Phra Atit Road, Chanasongkram, Phra Nakorn, Bangkok 10200, Thailand
BMC Pediatrics 2014, 14:46 doi:10.1186/1471-2431-14-46Published: 15 February 2014
Between 1990 and 2011, global neonatal mortality decline was slower than that of under-five mortality. As a result, the proportion of under-five deaths due to neonatal mortality increased. This increase is primarily a consequence of decreasing post-neonatal and child under-five mortality as a result of the typical focus of child survival programmes of the past two decades on diseases affecting children over four weeks of age. Newborns are lagging behind in improved child health outcomes. The aim of this study was to conduct a comprehensive, equity-focussed newborn care assessment and to explore options to improve newborn survival in Indonesia, Lao People’s Democratic Republic (PDR) and the Philippines.
We assessed newborn health policies, services and care in the three countries through document review, interviews and health facility visits. Findings were triangulated to describe newborns’ health status, the health policy and the health system context for newborn care and the equity situation regarding newborn survival.
Main findings: (1) In the three countries, decline of neonatal mortality is lagging behind compared to that of under-five mortality. (2) Comprehensive newborn policies in line with international standards exist, although implementation remains poor. An important factor hampering implementation is decentralisation of the health sector, which created confusion regarding roles and responsibilities. Management capacity and skills at decentralised level were often found to be limited. (3) Quality of newborn care provided at primary healthcare and referral level is generally substandard. Limited knowledge and skills among providers of newborn care are contributing to poor quality of care. (4) Socio-economic and geographic inequities in newborn care are considerable.
Similar important challenges for newborn care have been identified in Indonesia, Lao PDR and the Philippines. There is an urgent need to address weak leadership and governance regarding newborn care, quality of newborn care provided and inequities in newborn care. Child survival programmes focussed on children over four weeks of age have shown to have positive outcomes. Similar efforts as those used in these programmes should be considered in newborn care.