073 A qualitative study of healthcare workers perceived barriers and facilitators to neonatal care in a central hospital in malawi. (December 2018)

• Record Type: Journal Article
• Authors: Crehan, C; Huq, T; Kesler, E; Dube, Q; Lakhanpaul, M; Heys, M
• Is Part Of: Archives of disease in childhood. Volume 103:Supplement 2(2018)
• Page Start: A30
• Page End: A30
• Publication Date: 2018-12
• Subjects: Infants -- Diseases -- Periodicals; Newborn infants -- Diseases -- Periodicals; Fetus -- Diseases -- Periodicals; 618.920105
• DOI: 10.1136/goshabs.73
• Languages: English
• ISSNs: 1359-2998

Abstract

Abstract : Background: Every year, 2.7 million neonatal deaths occur worldwide. The Millennium development goals have seen significant gains made in under five mortality, but neonatal mortality remains persistently high, particularly in low resource countries such as Malawi. Frameworks and standards for quality improvement in newborn care have been drawn up by the World Health Organisation (WHO) to be delivered by health care workers (HCW). However, very little is known about HCWs perceptions of the barriers and facilitators to the delivery of quality newborn care, in settings such as Malawi. Method: Focus group discussions were conducted with 13 newborn health workers from a central health facility by a Chichewa/English speaking facilitator. Thematic analysis was carried out. Findings: HCWs identified their perceived barriers to the delivery of quality newborn care to include; lack of resources and knowledge, issues with staffing (including low numbers of HCWs, frequent staff rotation and lack of ability to specialise), poor staff attitude and integration of the health care system (figure 1). Their identified facilitators to quality of newborn care included the provision of greater resources and staffing, the organisation of work load, improvement in staff attitude, strengthening of the health care system; and improved training, environment, data systems and communication. Interpretation: Our findings add to the relative paucity of qualitative data from frontline newborn HCWs, which may be vital in understanding quality improvement in low-resource neonatal units. Most themes, although inductive, can be mapped to the WHO quality of care framework. Our data emphasise the complexities of human resource retention and motivation, issues around incentivising training, and the value of mortality audits and data systems. Suggested next steps for quality improvement include developing death audit into perinatal mortality meetings and empowering HCWs to take responsibility for data collection through user friendly health information systems.