Measuring ENAP interventions for small and/or sick newborns in routine health information systems: indicators and considerations from a WHO expert consultation

Background: Current trends indicate 63 low- and middle-income countries (LMICs) are not on track to achieve the 2030 Sustainable Development Goal 3.2 target of a neo-natal mortality rate ≤12 per 1000 live births. The Every Newborn Action Plan (ENAP) prioritised four life-saving interventions for small and/or sick newborns (SSN) in health facilities: neonatal resuscitation, kangaroo mother care, antibiotic treatment of possible serious bacterial infections, and antenatal corticosteroids for women at risk of preterm birth at <34 weeks of gestation. Limited indicator reporting on the use of these interventions in routine health information systems (RHIS) is a barrier to scaling up SSN care. Methods: The World Health Organization (WHO) led a multi-step process to agree coverage indicators for the four SSN interventions, which included a rapid review of existing research and programme reports; expert consultation to review available evidence, deliberate and propose coverage indicators, assess feasibility in RHIS, and identify research gaps. Results: Expert working groups discussed and recommended definitions for each of the four coverage indicators. After considering feasibility and challenges, potential sources of data for each indicator were appraised. Data for these indicators is not always routinely collected in registers, requiring information from clinical case records, which can be challenging in resource-constrained health systems. The proposed indicators were also assessed against established indicator assessment criteria. The need for testing the indicators was emphasised and other research gaps were also identified. Conclusions: Reporting and monitoring the life-saving SSN interventions in routine health information systems (RHIS) is crucial for improving newborn care in LMICs. Urgent consideration must be given to how this data can be collected from health facilities and subsequently reported in RHIS. Improved RHIS measures for these interventions will enable programme managers and policy makers to scale up their use, accelerating reductions in preventable neonatal morbidity and mortality.