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Table 2 Summary of key values and strategies within the six main documents

From: A critical account of the policy context shaping perinatal survival in Nepal: policy tension of socio-cultural versus a medical approach

Key values (approach, underpinning principles) Strategies (strategic interventions)
National Neonatal Health Strategy 2004
Access to care and survival as the greatest right of every vulnerable newborn
• Mothers and babies’ health in a continuum from pre-pregnancy to postnatal
• A linkage of care across home, community and health institution
Gender equality in newborn care
• Focusing on proven interventions addressing causes of maternal and neonatal complications
• Promoting institutional births and preventing newborn deaths during the process of childbirth or shortly after birth
• Institutionalising provision of newborn care from Nepal’s healthcare system: (i) home/community; (ii) primary healthcare; (iii) district hospital; (iv) above the district hospital at zonal, regional and central hospital level
• Setting forth five key interventions: (i) registration of all births and deaths; (ii) targeted behaviour change of women, their husbands and mothers-in-law; (iii) strengthening health service delivery—focus on SBAs, focus on postnatal care of mother and baby; (iv) service management--mainly about ensuring supplies and logistics; (v) and research focussing on quality of care, and verbal autopsy
National Policy on Skilled Birth Attendant, 2006
Women-friendly services that are culturally sensitive and affordable to all families, especially those in poor and underserved areas • Pregnancy and birthing care by an Skilled Birth Attendant [An accredited health professional such as a midwife, doctor or nurse]
• Focus on (i) production of SBAs by in-service training and incorporating SBA skills in pre-service curricula of ANM, SN and Doctor training; and (ii) deployment of SBAs to health institutions
• Availability of 24 h a day, 7 days a week emergency obstetric care in a close partnership with health workers other than SBAs
• Encouraged NGOs and communities to establish community based birthing units
• SBA to be supported by: strong referral back-up by a district health team, including supportive supervision; effective partnerships with other health workers, volunteers and TBAs, safety and security
National Safe Motherhood and Newborn Health Long Term Plan (2006–2017)
Equity and women centred care
Equity in access and utilisation of health services for newborn babies including safe motherhood services among the needy
• Access embracing financial, institutional and infra-structural factors including, but not limited to, funding, transportation and education; and positive and welcoming service provider attitudes, trust, honesty, responsiveness, accountability
Multi-sectoral approach as underlying value to address Safe Motherhood and Maternal and Newborn Health (SMNH) issues; the role of other sectors is particularly important in enhancing access and promoting equity
Women understood not simply as individuals, but as members of families and communities functioning within complex relationships and social expectations
• Eight strategic outputs to ensure progress in the health of mother and babies:
(i) Equity and access: empowerment of individuals, groups and networks with the maternal and newborn care related Behaviour Change Communication (BCC) messages and promotion of birth preparedness and non-discriminatory interpersonal communication between providers and clients;
(ii) Delivery of quality maternal and newborn care: 24-h availability of skilled staff with essential drugs and equipment, good community and inter-facility linkages and feedback systems;
(iii) Public-private partnership;
(iv) Decentralisation: planning and supervising capacity of District Health Office;
(v) SBA training;
(vi) Information management: collection and use of data according to ethnicity, caste and wealth; and supplement quantitative with qualitative information from;
(vii) Physical asset management and procurement; and
(viii) Finance such as safety nets for poor and socially excluded
Mother’s Protection Program, Implementation Guideline, 2013
• Ensure the right to health as a fundamental constitutional right of every citizen in accordance with the provision of Nepal’s interim constitution 2006
Financial incentives to improve health outcomes, providing incentives to encourage women to come to institution to have their babies as well as pregnancy check-ups
• The intention of the policy is clear on promoting institutional birth by allocating incentives to women to come to institutions for pregnancy check-ups and birthing; to service providers to motivate them to provide birthing care at institutions; and to health institutions to encourage them to strengthen birthing and emergency obstetric care
• Expands the concept of birthing units by setting specific criteria such as separate birthing room, living apartment for SBA, equipment, 24-h presence of a SBA including a support staff, good referral network, friendly behaviour to woman and her visitors, and the respect of a woman’s privacy
• Obstetric reporting to the district and central department of neonatal deaths, stillbirths and babies resuscitated for asphyxia management by each health institution.
• Birth or the death registration of a baby, providers receive incentive of home births only if births or deaths are registered by parents
Maternal and Perinatal Death Surveillance and Response (MPDSR), Guideline 2014
• Value of a life of every mother and every baby; every death can provide information that can result in actions to prevent future maternal and perinatal deaths
• Self-reliant and sustainable approach to the improvement of healthcare for women and their babies
• Linking the information system with quality improvement process at a health institution level; real-time monitoring of deaths and assessment of interventions employed. Two main focuses are on: (i) Notification of every death, and (ii) review for further actions to prevent future deaths
Community Based Integrated Management of Neonatal and Childhood Illness (Program Management Module, 2015)
• Reaching care to disadvantaged and marginalised groups
• Provision of quality care through a single integrated package of interventions for newborn and under-five children
• Community based care
• Takes into it the lessons from CBNCP, and merges the package with IMCI--thus making a single package for managing newborn and all under-5 years old children’s health problems
• Despite the community based in its title, still focuses mainly on promotion of institutional births and strengthening of quality of care from health institutions to prevent neonatal deaths
• Focus on strengthening the capacity of institutions to manage and treat newborn babies’ complications such as infection, asphyxia and low birth weight
• Added a component which describes treatment of baby’s cord infections by using an antiseptic ointment, chlorhexidine
• Does not consider management of asphyxia as local health volunteers’ job, which however was considered in previous version—the Community Based Newborn Care
• Envisioned developing one to two birthing centres per district to ensure quality referral care for newborns with complications