Table 2 Summary of key values and strategies within the six main documents
Key values (approach, underpinning principles) | Strategies (strategic interventions) |
|---|---|
National Neonatal Health Strategy 2004 | |
• Access to care and survival as the greatest right of every vulnerable newborn • Mothers and babies’ health in a continuum from pre-pregnancy to postnatal • A linkage of care across home, community and health institution • Gender equality in newborn care | • Focusing on proven interventions addressing causes of maternal and neonatal complications • Promoting institutional births and preventing newborn deaths during the process of childbirth or shortly after birth • Institutionalising provision of newborn care from Nepal’s healthcare system: (i) home/community; (ii) primary healthcare; (iii) district hospital; (iv) above the district hospital at zonal, regional and central hospital level • Setting forth five key interventions: (i) registration of all births and deaths; (ii) targeted behaviour change of women, their husbands and mothers-in-law; (iii) strengthening health service delivery—focus on SBAs, focus on postnatal care of mother and baby; (iv) service management--mainly about ensuring supplies and logistics; (v) and research focussing on quality of care, and verbal autopsy |
National Policy on Skilled Birth Attendant, 2006 | |
• Women-friendly services that are culturally sensitive and affordable to all families, especially those in poor and underserved areas | • Pregnancy and birthing care by an Skilled Birth Attendant [An accredited health professional such as a midwife, doctor or nurse] • Focus on (i) production of SBAs by in-service training and incorporating SBA skills in pre-service curricula of ANM, SN and Doctor training; and (ii) deployment of SBAs to health institutions • Availability of 24 h a day, 7 days a week emergency obstetric care in a close partnership with health workers other than SBAs • Encouraged NGOs and communities to establish community based birthing units • SBA to be supported by: strong referral back-up by a district health team, including supportive supervision; effective partnerships with other health workers, volunteers and TBAs, safety and security |
National Safe Motherhood and Newborn Health Long Term Plan (2006–2017) | |
• Equity and women centred care • Equity in access and utilisation of health services for newborn babies including safe motherhood services among the needy • Access embracing financial, institutional and infra-structural factors including, but not limited to, funding, transportation and education; and positive and welcoming service provider attitudes, trust, honesty, responsiveness, accountability • Multi-sectoral approach as underlying value to address Safe Motherhood and Maternal and Newborn Health (SMNH) issues; the role of other sectors is particularly important in enhancing access and promoting equity • Women understood not simply as individuals, but as members of families and communities functioning within complex relationships and social expectations | • Eight strategic outputs to ensure progress in the health of mother and babies: (i) Equity and access: empowerment of individuals, groups and networks with the maternal and newborn care related Behaviour Change Communication (BCC) messages and promotion of birth preparedness and non-discriminatory interpersonal communication between providers and clients; (ii) Delivery of quality maternal and newborn care: 24-h availability of skilled staff with essential drugs and equipment, good community and inter-facility linkages and feedback systems; (iii) Public-private partnership; (iv) Decentralisation: planning and supervising capacity of District Health Office; (v) SBA training; (vi) Information management: collection and use of data according to ethnicity, caste and wealth; and supplement quantitative with qualitative information from; (vii) Physical asset management and procurement; and (viii) Finance such as safety nets for poor and socially excluded |
Mother’s Protection Program, Implementation Guideline, 2013 | |
• Ensure the right to health as a fundamental constitutional right of every citizen in accordance with the provision of Nepal’s interim constitution 2006 • Financial incentives to improve health outcomes, providing incentives to encourage women to come to institution to have their babies as well as pregnancy check-ups | • The intention of the policy is clear on promoting institutional birth by allocating incentives to women to come to institutions for pregnancy check-ups and birthing; to service providers to motivate them to provide birthing care at institutions; and to health institutions to encourage them to strengthen birthing and emergency obstetric care • Expands the concept of birthing units by setting specific criteria such as separate birthing room, living apartment for SBA, equipment, 24-h presence of a SBA including a support staff, good referral network, friendly behaviour to woman and her visitors, and the respect of a woman’s privacy • Obstetric reporting to the district and central department of neonatal deaths, stillbirths and babies resuscitated for asphyxia management by each health institution. • Birth or the death registration of a baby, providers receive incentive of home births only if births or deaths are registered by parents |
Maternal and Perinatal Death Surveillance and Response (MPDSR), Guideline 2014 | |
• Value of a life of every mother and every baby; every death can provide information that can result in actions to prevent future maternal and perinatal deaths • Self-reliant and sustainable approach to the improvement of healthcare for women and their babies | • Linking the information system with quality improvement process at a health institution level; real-time monitoring of deaths and assessment of interventions employed. Two main focuses are on: (i) Notification of every death, and (ii) review for further actions to prevent future deaths |
Community Based Integrated Management of Neonatal and Childhood Illness (Program Management Module, 2015) | |
• Reaching care to disadvantaged and marginalised groups • Provision of quality care through a single integrated package of interventions for newborn and under-five children • Community based care | • Takes into it the lessons from CBNCP, and merges the package with IMCI--thus making a single package for managing newborn and all under-5 years old children’s health problems • Despite the community based in its title, still focuses mainly on promotion of institutional births and strengthening of quality of care from health institutions to prevent neonatal deaths • Focus on strengthening the capacity of institutions to manage and treat newborn babies’ complications such as infection, asphyxia and low birth weight • Added a component which describes treatment of baby’s cord infections by using an antiseptic ointment, chlorhexidine • Does not consider management of asphyxia as local health volunteers’ job, which however was considered in previous version—the Community Based Newborn Care • Envisioned developing one to two birthing centres per district to ensure quality referral care for newborns with complications |