Progress towards Every Newborn Action Plan (ENAP) implementation in Iran: obstacles and bottlenecks

Area of Science:

• Neonatal Health
• Health Systems Strengthening
• Public Health Policy

Background:

• Neonatal mortality constitutes over 47% of global under-five deaths, with two-thirds preventable through timely care.
• The Every Newborn Action Plan (ENAP) provides a framework for equitable, high-quality maternal and newborn care.
• Bottleneck analysis is crucial for identifying and overcoming barriers to scaling up essential newborn services.

Purpose of the Study:

• To identify obstacles hindering the scale-up of newborn care in Iran using the ENAP bottleneck analysis tool.
• To assess challenges across seven health system building blocks impacting neonatal services.

Main Methods:

• Qualitative data collection through interviews with experts, key informants, and stakeholders in neonatal care.
• Analysis of performance reports from 16 medical universities regarding neonatal care services.
• Application of the Every Newborn Bottleneck Analysis Tool across seven health system building blocks.

Main Results:

• Significant challenges identified in scaling up newborn care in Iran.
• Key obstacles include the absence of a unified governing body for newborn care.
• Insufficient financial resources, a shortage of skilled health professionals, and inadequate patient transfer systems were major findings.

Conclusions:

• Recommendations include establishing a national coordinating entity for newborn care.
• Specific budget allocation for neonatal services is essential.
• Improving the distribution and transfer of neonatal intensive care unit (NICU) patients, including utilizing private sector resources, is critical.