title: Scaling up quality care for mothers and newborns around the time of birth: an overview of methods and analyses of intervention-specific bottlenecks and solutions.
abstract: BACKGROUND
  The Every Newborn Action Plan (ENAP) and Ending Preventable Maternal Mortality targets cannot be achieved without high quality, equitable coverage of interventions at and around the time of birth. This paper provides an overview of the methodology and findings of a nine paper series of in-depth analyses which focus on the specific challenges to scaling up high-impact interventions and improving quality of care for mothers and newborns around the time of birth, including babies born small and sick.
  
  
  METHODS
  The bottleneck analysis tool was applied in 12 countries in Africa and Asia as part of the ENAP process. Country workshops engaged technical experts to complete a tool designed to synthesise "bottlenecks" hindering the scale up of maternal-newborn intervention packages across seven health system building blocks. We used quantitative and qualitative methods and literature review to analyse the data and present priority actions relevant to different health system building blocks for skilled birth attendance, emergency obstetric care, antenatal corticosteroids (ACS), basic newborn care, kangaroo mother care (KMC), treatment of neonatal infections and inpatient care of small and sick newborns.
  
  
  RESULTS
  The 12 countries included in our analysis account for the majority of global maternal (48%) and newborn (58%) deaths and stillbirths (57%). Our findings confirm previously published results that the interventions with the most perceived bottlenecks are facility-based where rapid emergency care is needed, notably inpatient care of small and sick newborns, ACS, treatment of neonatal infections and KMC. Health systems building blocks with the highest rated bottlenecks varied for different interventions. Attention needs to be paid to the context specific bottlenecks for each intervention to scale up quality care. Crosscutting findings on health information gaps inform two final papers on a roadmap for improvement of coverage data for newborns and indicate the need for leadership for effective audit systems.
  
  
  CONCLUSIONS
  Achieving the Sustainable Development Goal targets for ending preventable mortality and provision of universal health coverage will require large-scale approaches to improving quality of care. These analyses inform the development of systematic, targeted approaches to strengthening of health systems, with a focus on overcoming specific bottlenecks for the highest impact interventions.
authors.forename: Kim E
authors.initials: KE
authors.lastname: Dickson
authors.forename: Mary V
authors.initials: MV
authors.lastname: Kinney
authors.forename: Sarah G
authors.initials: SG
authors.lastname: Moxon
authors.forename: Joanne
authors.initials: J
authors.lastname: Ashton
authors.forename: Nabila
authors.initials: N
authors.lastname: Zaka
authors.forename: Aline
authors.initials: A
authors.lastname: Simen-Kapeu
authors.forename: Gaurav
authors.initials: G
authors.lastname: Sharma
authors.forename: Kate J
authors.initials: KJ
authors.lastname: Kerber
authors.forename: Bernadette
authors.initials: B
authors.lastname: Daelmans
authors.forename: A
authors.initials: A
authors.lastname: Gülmezoglu
authors.forename: Matthews
authors.initials: M
authors.lastname: Mathai
authors.forename: Christabel
authors.initials: C
authors.lastname: Nyange
authors.forename: Martina
authors.initials: M
authors.lastname: Baye
authors.forename: Joy E
authors.initials: JE
authors.lastname: Lawn
mesh_terms: D000305:Adrenal Cortex Hormones / Q000600:supply & distribution / Q000627:therapeutic use; D000349:Africa; D001208:Asia; D003256:Community Participation; D003695:Delivery of Health Care / Q000458:organization & administration*; D036861:Delivery, Obstetric; D004630:Emergencies; D004864:Equipment and Supplies / Q000600:supply & distribution; D005260:Female; D063005:Health Information Systems; D006280:Health Workforce; D061889:Healthcare Financing; D006801:Humans; D007224:Infant Care / Q000295:instrumentation / Q000458:organization & administration / Q000592:standards*; D007231:Infant, Newborn; D007239:Infections / Q000188:drug therapy; D060127:Kangaroo-Mother Care Method; D007857:Leadership; D008427:Maternal Health Services / Q000458:organization & administration / Q000592:standards*; D011247:Pregnancy; D016730:Program Development; D058996:Quality Improvement / Q000458:organization & administration*
chemical_list: D000305:Adrenal Cortex Hormones