Workforce Interventions to Deliver Postnatal Care to Improve Neonatal Outcomes in Low- and Lower-Middle-Income Countries

Abstract

Reducing neonatal mortality rates in low- and lower-middle-income countries (LMICs) requires postnatal interventions to be delivered through an appropriately prepared and supported workforce. This review examines health workforce interventions that deliver integrated packages of postnatal care to improve neonatal outcomes in LMICs. We conducted a structured search of peer-reviewed articles published during 2003-2014 that investigated the delivery of postnatal interventions by formal and lay health workers. We selected 13 studies and analyzed them using a narrative synthesis methodology. This review observed a wide divergence among studies regarding the outcomes as well as the approaches and duration of workforce training and staff supervision. Except 4, all studies observed a significant reduction in neonatal mortality. On the other hand, teams of lay health workers appear to be more effective in improving neonatal outcomes. Further improvement in the performance of health care providers may require emphasis on workforce interventions such as competency assessment, the acquisition of appropriate skills, and supervisory guidelines. Nevertheless, the heterogeneity and limited number of studies do not allow us to arrive at definitive conclusions, and we recommend the need for the harmonization of future studies, with uniformity of outcome measures and cost analyses.