TABLE 1.

Strategies to Establish Small and Sick Newborn Care, by Health System Building Block and Country

Health System Building Block	Ethiopia	India	Malawi	Rwanda
Leadership and governance	Improve ownership, leadership, and accountability through Ministry of Health-led partnerships and coordination platforms for newborn and child survival.¹⁶^,¹⁷	Coordinate systematic implementation of small and sick newborn activities led by national (financial and technical guidance), state, and district health departments (planning and implementation) using national FBNC guidelines and training modules.⁸¹	Oversight of small and sick newborn care led by newborn focal point at the Ministry of Health.⁴^,¹³⁴	Government of Rwanda provides strong leadership and accountability.
Human resources	Accelerate health workforce development through in-service training, mentorship, and continuing professional development of mid-level health workforce.	Develop health workforce with the necessary skills to provide the appropriate level of care through specialized training courses for FBNC.⁷⁷	Build capacity among available personnel to create a pool of specialized health workers to deliver inpatient care and are retained within the setting by embedding neonatal care in preservice training and specialized courses decisions to scale up care to prevent neonatal mortality.¹⁴⁰	Build capacity of specialized workforce to deliver small and sick newborn care through a learning collaborative model where doctors, nurses, community health workers, and political leaders share data and take appropriate decisions to scale up care to prevent neonatal mortality.¹⁶⁵^,¹⁸⁰^,¹⁸¹
Information systems	Include neonatal care indicators in the HMIS to ensure data use for informed decision-making.	Monitor measurable indicators to inform health policy and programs on newborn health.	Capture all neonatal-related indicators within the health management information system.	Integrate data collection, monitoring, and use at all levels of care and building capacity of those using data to make life-changing decisions for improving the quality of small and sick newborn care services.
Infrastructure	Standardize and build appropriate infrastructure for NICU and newborn care at hospitals and health centers, respectively.	Establish nationwide network of NBCCs at every point of childbirth, NBSUs at first referral units, and SNCUs at district hospitals.⁷¹^,⁸⁴	Advocate that all hospitals to be built and those being renovated should have a purpose-built neonatal unit included in it.	Adapt existing infrastructure for small and sick newborn care according to available budgets.
Health system financing	Subsidize the cost of care in public health facilities and implement community-based health insurance schemes.²¹⁶	Support states with financial resources in 60:40 (national/state) sharing ratio using annual program implementation plans to develop budgets for FBNC.	Ensure that funding for small and sick newborn care is allocated at the district and facility levels.	Fully fund small and sick newborn care services through universal health coverage.
Medical supplies and devices	Ensure availability of essential medical supplies and devices for NICU through an Integrated Pharmaceutical Logistic System.	Encourage collaboration of neonatologists, engineers, and entrepreneurs to produce and supply high-quality neonatal equipment of several high-volume categories at affordable cost.²¹⁷^–²²¹	Maintain adequate inventory of equipment and supplies for management of small and sick newborns in the central medical stores.¹²¹^,¹²⁸	Provide centralized guidance around the small and sick newborn package of care and related supply/equipment needs.
Service delivery	Apply the life course continuum of care to gradually expand access to small and sick newborn care at facilities and referrals from the community through the community-based newborn care approach.	Provide no-cost, quality newborn care services at public health facilities along with introductions of various other schemes (like JSY, JSSK, PMSMA, SUMAN initiative) to reduce out-of-pocket expenditures and wage loss for parents.⁶⁷^,¹⁰⁸	Introduce services for small and sick newborn care at district hospitals in a stepwise manner—focusing first on KMC, then CPAP, and finally integrated care.¹²¹^,¹²⁷^,¹³¹^,¹³⁶^,¹⁴⁵^,¹⁵⁷	Test a model of neonatal care in limited sites and then scaling successful results at national level.¹⁶⁴^,¹⁸²^,¹⁸³
Family-centered care	Communicate and counsel both mother and husband for informed decision.	Introduce a national policy to integrate family-centered care in all SNCUs.¹⁰⁴^,¹⁰⁵	Care for the mother-baby dyad as a unit.¹⁵⁵^,¹⁶¹^,¹⁶²	Create an enabling environment for family members to become involved in provision of newborn care.

Abbreviations: CPAP, continuous positive airway pressure; FBNC, facility-based newborn care; HMIS, health management information system; JSSK, Janani Shishu Suraksha Karyakaram; JSY, Janani Suraksha Yojana; KMC, kangaroo mother care; NBCC, newborn care corner; NBSU, newborn stabilization unit; NICU, neonatal intensive care unit; PMSMA, Pradhan Mantri Surakshit Matritva Abhiyan; SNCU, special newborn care unit; SUMAN, Surakshit Matritva Aashwasan.