Table 1 Barriers and facilitators of community-based management of PSBI when a referral is not possible during the COVID-19 pandemic

Characteristics of the intervention

(-) Complexity of the intervention

(-) Perceived scalability, feasibility for scale

Outer setting

(-) Mother’s fear of COVID-19 infection at health facilities

✓ 58.9% of mothers in Lume and 25.2% of mothers in Dembecha reported fear of COVID-19 infection for themselves or their fetus during ANC, delivery, or seeking care for a sick child

(-) COVID-19 response measures (restricted mass gatherings, limited mobility, and restricted public transportation)

( ±) Geographic distance to higher-level facilities

(-) Phase-out of partner support

( +) NGO-delivered support

(-) Community perceptions about newborn illnesses and sociocultural beliefs

(-) Low functionality of WDAs

✓ Lume: 65.5%; and Dembecha: 64.5% WDAs were active

(-) Low community demand

✓ Lume: 4.7% prevalence of sepsis; 11% prevalence of neonatal sepsis

✓ 69.9% and 52.4% of mothers in Lume and Dembecha, respectively, received antibiotics for neonatal sepsis

(-) State of Emergency and business shutdown in Amhara region (and shift of attention and resources)

Inner setting

(-) Supply and logistics management system

✓ 68.6% and 51.6% of HPs stocked out for gentamicin 20 mg/ml in Lume and Dembecha, respectively

(-) Strength of HEP

Individuals involved in the implementation

(-) Competence and confidence of HEWs

✓ 40.5% and 33.3% of HEWs knew all signs of PSBI in Lume and Dembecha, respectively

✓ There were 16 untrained HEWs on iCCM in Dembecha

(-) Motivation of HEWs

(-) Attendance/engagement of HEWs and PHCUs on PSBI treatment work

(-) Competing priorities

(-) Fear of COVID-19

(-) HEWs workload and engagement in non-health activities

Process of implementation

(-) Integration of management of the PSBI program

( +) Coordination, ownership, and stakeholder engagement