Are Health Facilities Providing Quality Care for Newborn and Young Infants in Pakistan?: Findings From a Cross-Sectional Study

Abstract IntroductionPakistan is considered to be the riskiest place for newborns due to its highest neonatal mortality rate. Securing pregnancy and delivery care may not bring a substantial reduction in neonatal mortality, unless coupled with the provision of essential newborn and inpatient care for sick newborns and young infants (NYIs). We undertook this study to assess the availability and quality of newborn care services provided, and the readiness of inpatient care for NYIs in Pakistan.MethodsWe conducted a cross-sectional study across Pakistan from February to June 2019 in 23 public sector health care facilities providing inpatient care for sick NYIs. We interviewed facility managers and health care providers by using structured questionnaires. We observed facility infrastructure and relevant metrics related to the quality of inpatient care such as types of infant care units and essential equipment, staffing cadre and facility management practices, quality assurance activities, essential services for NYI care, discharge planning and support, quality of NYIs care record, and health information system.ResultsOf the 23 facilities assessed, 83% had special care units for the sick NYIs, 70% had newborn intensive care units (NICUs), and 39% had Kangaroo Mother Care Units (KMCs). Almost 100% of the facilities had pediatricians, 13% had neonatologists, and 9% had neonatal surgeons. Around 61% and 13% of the facilities had staff trained in neonatal resuscitation and parental counselling, respectively. About 35% of the facilities monitored nosocomial infection rates, 39% were baby-friendly hospitals, and 26% were accredited. Essential services to diagnose congenital birth defects were offered in only 4% of facilities. Only 39% of facilities had received external supervision for NYI care and 17% reported organizing management team meetings preceding the survey.ConclusionThe study has demonstrated important gaps in the quality of newborn care in inpatient settings in the country. This includes dearth of KMCs, inadequate human resources, untrained staff, insufficient facility management practices, lack of inter-disciplinary meetings, and poor maintenance of records for critical newborn outcome indicators leading to compromised quality of care. To avert neonatal mortality in the country, provincial and district governments have to take action in improving inpatient care.