Global report on preterm birth and stillbirth (4 of 7): delivery of interventions.
BACKGROUND
The efficacious interventions identified in the previous article of this report will fail unless they are delivered at high and equitable coverage. This article discusses critical delivery constraints and strategies.
Achieving universal coverage entails addressing major barriers at many levels. An overarching constraint is the lack of political will, resulting from the dearth of preterm birth and stillbirth data and the lack of visibility. Other barriers exist at the household and community levels, such as insufficient demand for interventions or sociocultural barriers; at the health services level, such as a lack of resources and trained healthcare providers; and at the health sector policy and management level, such as poorly functioning, centralized systems. Additional constraints involve weak governance and accountability, political instability, and challenges in the physical environment.
Scaling up maternal, newborn and child health interventions requires strengthening health systems, but there is also a role for focused, targeted interventions. Choosing a strategy involves identifying appropriate channels for reaching high coverage, which depends on many factors such as access to and attendance at healthcare facilities. Delivery channels vary, and may include facility- and community-based healthcare providers, mass media campaigns, and community-based approaches and marketing strategies. Issues related to scaling up are discussed in the context of four interventions that may be given to mothers at different stages throughout pregnancy or to newborns: (1) detection and treatment of syphilis; (2) emergency Cesarean section; (3) newborn resuscitation; and (4) kangaroo mother care. Systematic reviews of the literature and large-scale implementation studies are analyzed for each intervention.


CONCLUSIONS
Equitable and successful scale-up of preterm birth and stillbirth interventions will require addressing multiple barriers, and utilizing multiple delivery approaches and channels. Another important need is developing strategies to discontinue ineffective or harmful interventions. Preterm birth and stillbirth interventions must also be placed in the broader maternal, newborn and child health context to identify and prioritize those that will help improve several outcomes at the same time. The next article discusses advocacy challenges and opportunities.
Victora
Cesar G
CG
Universidade Federal de Pelotas, Pelotas 96001-970, Brazil. cvictora@gmail.com
Rubens
Craig E
CE
D002585:Cesarean Section; D003362:Cost-Benefit Analysis; D003906:Developing Countries; D004630:Emergencies; D005260:Female; D005313:Fetal Death / Q000517:prevention & control*; D014943:Global Health; D006801:Humans; D007224:Infant Care; D007231:Infant, Newborn; D008427:Maternal Health Services; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000628:therapy; D047928:Premature Birth / Q000517:prevention & control*; D011295:Prenatal Care / Q000191:economics; D012151:Resuscitation; D050497:Stillbirth; D013590:Syphilis, Congenital / Q000517:prevention & control