title: Bottleneck analysis approach to accelerate newborn care services in two regions in Ghana: implications for national newborn care.
abstract: OBJECTIVE
  The aim of this work is to describe application of a data-driven approach (bottleneck analysis [BNA] approach process) to accelerate newborn care services in two regions and what effect it had on national-level newborn care interventions in Ghana.
  
  
  METHODS
  A mixed-method approach was used for the study. The BNA tool generated quantitative data and group discussions provided phenomenological explanations to identified service gaps.
  
  
  METHODS
  Regional newborn care health service assessments were conducted in November 2013 through desk reviews, field and health facility visits and coaching/mentorship. The BNA tool (an excel-based tool) directly utilized service coverage data and programme monitoring and review reports in Ghana. Outputs were generated based on service coverage indicators: supply side/health system factors (commodities, human resource and access), demand side (service utilization) and quality/effective coverage. National targets were used as benchmarks to assess gaps in coverage indicators.
  
  
  RESULTS
  Key health system bottlenecks included absence/stock-out of essential newborn care commodities/resuscitation kits and absence of updated policies at services delivery points. In both regions, less than 55% of health facilities had at least 80% of midwives trained to provide essential obstetric and newborn care, management of preterm babies, resuscitation and inpatient paediatric care. In addition, less than 35% of pregnant women were assisted by a skilled birth attendant (midwife) and monitored with a partograph in the two regions. Demand-side bottlenecks included cultural preference for home deliveries, limited knowledge on importance of postnatal care and poor community involvement.The BNA approach in the two regions resulted in the development of national and other regional operational plans and monitoring and evaluation framework for newborn care services in Ghana over the period 2012-2016, and a relative improvement in neonatal mortality at the regional and national level.
  
  
  CONCLUSIONS
  The BNA tool and approach provided data-driven planning for newborn care service delivery in a low-income setting. It identified gaps in service coverage based on empirical data at lower levels of the health system and garnered strategies in addressing bottlenecks to newborn care services at the national level.
authors.affiliation: Department of Community Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana. Electronic address: aeyawson@yahoo.com.
authors.forename: A E
authors.initials: AE
authors.lastname: Yawson
authors.affiliation: Regional Health Directorate, Ghana Health Service, Upper East Region, Ghana. Electronic address: kawoonor@gmail.com.
authors.forename: J K
authors.initials: JK
authors.lastname: Awoonor-Williams
authors.affiliation: Family Health Division, Ghana Health Service, Accra, Ghana. Electronic address: i_sagoemoses@yahoo.com.
authors.forename: I
authors.initials: I
authors.lastname: Sagoe-Moses
authors.affiliation: Family Health Division, Ghana Health Service, Accra, Ghana. Electronic address: patrick.kumaaboagye@ghsmail.org.
authors.forename: P K
authors.initials: PK
authors.lastname: Aboagye
authors.affiliation: Department of Anaesthesia, Korle-Bu Teaching Hospital, Accra, Ghana. Electronic address: anitaromeo1977@yahoo.com.
authors.forename: A O
authors.initials: AO
authors.lastname: Yawson
authors.affiliation: New Juabeng Municipal Health Directorate, Ghana Health Service, Koforidua, Ghana. Electronic address: lksenaya@yahoo.com.
authors.forename: L K
authors.initials: LK
authors.lastname: Senaya
authors.affiliation: National Expanded Programme on Immunisation, Public Health Directorate, Ghana Health Service, Ghana. Electronic address: gybonsu@yahoo.com.
authors.forename: G
authors.initials: G
authors.lastname: Bonsu
authors.affiliation: Greater Accra Health Directorate, Ghana Health Service, Accra, Ghana. Electronic address: john.eleeza@gmail.com.
authors.forename: J B
authors.initials: JB
authors.lastname: Eleeza
authors.affiliation: Office of the Director, Policy, Planning, Monitoring and Evaluation Division, Ghana Health Service, Accra, Ghana. Electronic address: erasmus.agongo@ghsmail.org.
authors.forename: E E A
authors.initials: EE
authors.lastname: Agongo
authors.affiliation: United Nations Children Fund (UNICEF) Country Office, Accra, Ghana. Electronic address: hbanskota@unicef.org.
authors.forename: H K
authors.initials: HK
authors.lastname: Banskota
mesh_terms: D005260:Female; D005869:Ghana; D006285:Health Planning / Q000458:organization & administration*; D006302:Health Services Research / Q000379:methods*; D006801:Humans; D007224:Infant Care / Q000458:organization & administration*; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000706:statistics & numerical data; D011204:Poverty Areas; D011247:Pregnancy
keywords: Data-driven health planning; Ghana; Health services; Newborn care