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 | â–ª Protocol should be available â–ª Unavailability of newborn care guidelines â–ª Develop proper guidelines â–ª One child per bed â–ª System of protocols â–ª Criteria |
2. | Inadequate infrastructure and equipment for the care of small and sick newborns | â–ª No electricity â–ª Unavailability of NICUs â–ª Unavailability of labor rooms â–ª Unavailability of space â–ª Absence of baby cots â–ª Operation theater is non-functional â–ª Ultrasound facility â–ª Early discharge of preterm â–ª No ambulatory bags â–ª No Incubators |
3. | Issues with neonatal health care workforce | |
3.1. | Deficiency of specialized workforce for neonatal case management | â–ª Shortage of manpower â–ª Inadequate staff â–ª Single neonatologist â–ª Cannot find paediatricians â–ª Neonatologist not available â–ª One nurse in evening and night shift â–ª Staff shortage â–ª Golden minutes wasted â–ª Child specialist on call |
3.2 | Inadequate thermal care management for newborns | â–ª Child still cold â–ª Hypothermia â–ª Newborn dying â–ª Baby handed over to TBAs â–ª Lack of thermal care â–ª TBAs do not keep the baby warm |
4. | Inadequate referral system | â–ª No proper referral or support â–ª Must send him (patient) forward â–ª Unavailability of transportation â–ª No follow up after referral â–ª Delay at DHQ level â–ª Effective communication in emergency situations |
5. | Absence of a multidisciplinary approach in neonatal case management | â–ª Neonatologist do not reach on time â–ª Communication gap â–ª Lack of coordination â–ª Need for teamwork |
6. | Need to institute strong monitoring system to prevent neonatal deaths and stillbirths | â–ª Review of reports â–ª 10 deaths in one month â–ª Verbal autopsies â–ª Cause of stillbirths and neonatal deaths â–ª Audits and follow ups â–ª Training needs â–ª 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 | â–ª Technical group â–ª Actively working â–ª WHO and UNICEF â–ª INGOs â–ª Promoting RMNCH care â–ª Evidenced based interventions â–ª Umbilical cord care |