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In 2014 Ethiopia introduced the Community-Based Newborn Care programme to improve newborn survival. The programme included an innovative component allowing community health workers to provide antibiotics for young infants. This study looks at the available capacities and possible challenges from district health managers' perspectives.

The Community-Based Newborn Care programme (CBNC) was introduced at district level in Ethiopia in 2014 in response to the country’s high neonatal mortality rates. The programme aimed to improve antenatal, intrapartum and newborn care. Given that infections were among the main causes of neonatal mortality, the unique feature of this initiative was shifting the task of managing sick young infants (0–59 days old) with any danger sign of possible serious bacterial infection from clinicians at health centres and hospitals to community health care workers. This treatment protocol was based on global evidence that trained and supported community health care workers can identify and treat newborns with possible serious bacterial infections.

This study then used WHO health system building blocks to assess the challenges of introducing the management of possible serious bacterial infection through the CBNC programme into the district health system.

The study is part of the CBNC programme evaluation. Two rounds of qualitative data were collected, in 2014 and 2015, the latter is the source of data for the current study. Data were collected through semi-structured in-depth interviews.


Study participants reported that community health workers were successfully trained to provide injectable antibiotics. However, the Community-Based Newborn Care programme was scaled up without allowing the health system to adapt to programme needs. There were inadequate processes and standards to ensure consistent availability of (1) trained staff for technical supervision, (2) antibiotics and (3) monitoring data specific to the programme. Furthermore, Non-Governmental Organizations played a central implementing role, which had implications for the long-term district level ownership and thus for the sustainability of the programme.

The study authors conclude that the health system challenges identified indicate the importance of having pre-defined and tested standards in place for supervision, health worker training, the routine health information system and for the drug supply chain. Findings also showed how working with NGO partners can achieve rapid change but has implications for the long-term ownership of the programme. Collaborations between government and NGOs partners need to, early in the implementation period, identify and fill gaps in the district health system that ensure the longevity of the service once the NGO support is withdrawn. The findings from this study have relevance for low-and-middle income countries that are planning to integrate new health services into the district health system.



Profile picture of Dr Della Berhanu
Dr Della Berhanu

Assistant Professor

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Professor Joanna Schellenberg

IDEAS Co-Principal Investigator and Professor

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Dr Bilal Avan

Associate Professor