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Table 2 Findings from the in-depth interviews of the key stakeholders

From: Quality of inpatient care of small and sick newborns in Pakistan: perceptions of key stakeholders

Theme I: Barriers contributing to the poor quality of inpatient care for small and sick newborns across Pakistan
S.# Categories Codes
1. Lack of essential neonatal care standards ▪ Protocol should be available
▪ Unavailability of newborn care guidelines
▪ Develop proper guidelines
▪ One child per bed
▪ System of protocols
▪ Criteria
2. Inadequate infrastructure and equipment for the care of small and sick newborns ▪ No electricity
▪ Unavailability of NICUs
▪ Unavailability of labor rooms
▪ Unavailability of space
▪ Absence of baby cots
▪ Operation theater is non-functional
▪ Ultrasound facility
▪ Early discharge of preterm
▪ No ambulatory bags
▪ No Incubators
3. Issues with neonatal health care workforce
3.1. Deficiency of specialized workforce for neonatal case management ▪ Shortage of manpower
▪ Inadequate staff
▪ Single neonatologist
▪ Cannot find paediatricians
▪ Neonatologist not available
▪ One nurse in evening and night shift
▪ Staff shortage
▪ Golden minutes wasted
▪ Child specialist on call
3.2 Inadequate thermal care management for newborns ▪ Child still cold
▪ Hypothermia
▪ Newborn dying
▪ Baby handed over to TBAs
▪ Lack of thermal care
▪ TBAs do not keep the baby warm
4. Inadequate referral system ▪ No proper referral or support
▪ Must send him (patient) forward
▪ Unavailability of transportation
▪ No follow up after referral
▪ Delay at DHQ level
▪ Effective communication in emergency situations
5. Absence of a multidisciplinary approach in neonatal case management ▪ Neonatologist do not reach on time
▪ Communication gap
▪ Lack of coordination
▪ Need for teamwork
6. Need to institute strong monitoring system to prevent neonatal deaths and stillbirths ▪ Review of reports
▪ 10 deaths in one month
▪ Verbal autopsies
▪ Cause of stillbirths and neonatal deaths
▪ Audits and follow ups
▪ Training needs
▪ No audits
Theme II: Enablers contributing to improved inpatient care for small sick newborns
1. Improved federal and provincial oversight for reproductive, maternal, and newborn (RMNCH) care ▪ Technical group
▪ Actively working
▪ WHO and UNICEF
▪ INGOs
▪ Promoting RMNCH care
▪ Evidenced based interventions
▪ Umbilical cord care
  1. This table presents the themes, categories, and codes arriving from the in-depth interviews of the key stakeholders to assess their perspectives of the quality of in-patient care for small and sick newborns across public sector health care facilities in Pakistan