1. Andrew Baleyku Imperial Royale Hotel, Kampala 26 June 2013 Session 2: Introduction to the bottleneck analysis tool

2. Outline Purpose of Every Newborn Bottleneck Analysis Tool Overview of Every Newborn BNA Tool – Section I overview – Section II overview – Section III overview Group work Uganda is the first country testing the tool -today’s output will inform the process for other country teams Please document feedback

3. Purpose of Every Newborn BNA Tool Analyse the health systems bottlenecks and challenges preventing the scale up of high-impact, cost-effective interventions/packages for newborns Identify potential solutions including innovative strategies to overcome the barriers, bottlenecks and challenges identified Contribute to multicountry analysis to identify common barriers of progress and associated solutions – 20 analysis countries, including Uganda

4. The Every Newborn BNA Tool A standardized questionnaire is used to facilitate data collection, compilation, analysis and comparison of data across countries. The questionnaire is divided into 3 sections: – Section I: newborn health programmes – Section II: critical newborn interventions – Section III: strategies and solutions

5. Section I – Newborn health programmes Seeks to identify bottlenecks applicable to all newborn interventions Organized into health system building blocks as follows: 1.Leadership and governance (enabling environment) 2.Health financing (enabling environment) 3.Health work force (supply) 4.Essential medical products and technologies (supply) 5.Health services (supply, quality) 6.Health information systems (quality) 7.Community ownership and partnership (demand)

6. Section II – critical newborn interventions Seeks to identify bottlenecks applicable to each critical newborn interventions 9 sub-sections representing interventions identified as: – Essential to provide basic care for all newborns and mothers – Prevent and treat the 3 main causes of newborn mortality Considered as “tracer interventions” and most likely appropriate to be used as “proxy” to get an understanding of common challenges related to key newborn interventions delivered through a similar platform Focusing on interventions around the 24 hours of birth; labour, child birth and immediate postnatal care

7. Section II – critical newborn interventions 1.Management of preterm birth 2.Skilled care at birth 3.Basic Emergency Obstetric Care 4.Comprehensive Emergency Obstetric Care 5.Basic Newborn Care 6.Neonatal resuscitation 7.Kangaroo mother care 8.Treatment of severe infections 9.Inpatient supportive care for sick and small newborns

8. Section III – strategies and solutions Seeks to identify strategies and solutions to address identified bottlenecks Each group will prioritize the identified intervention bottlenecks for each health system building block and identify potential solutions to overcome the bottlenecks identified. Solutions should be feasible (with clear milestones), cost-effective, equity-focused, and sustainable.

9. Group Work Break into groups with a mix of experts/stakeholders in each group Exercise 1 – Complete 3 cards stating what you feel is the critical bottleneck preventing delivery at sustained high effective coverage – Discuss cards as a group Select 5 highest priority bottlenecks with suggested actions Exercise 2 – Go through the questions in the tool (section 2) and answer them collectively with a brief discussion of each – Add additional priority bottlenecks to those identified in exercise 1 Report back to plenary: priority bottlenecks and actions

10. Proposed groups GroupTopicIntervention Group 1Preterm/low birth weightInterventions 1,7 Group 2Normal deliveryInterventions 2,6 Group 3Managing complications of childbirth and post- partum/postnatal period Interventions 3,4 Group 4Normal postnatal careIntervention 5 Group 5Prevention and treatment of infection Intervention 8 Group 6Cross-cutting and systems- related issues Section 1