Referral Practices for Sick Newborns with Possible Serious Bacterial Infection in Ethiopia: Lessons for program improvement

Ethiopia’s Community-Based Newborn Care (CBNC) program seeks to reduce newborn mortality and serve the most vulnerable populations by bringing health services closer to communities. Core elements of CBNC include early identification and timely, appropriate management of young infants with possible serious bacterial infection (PSBI). According to the national CBNC implementation guidelines, all PSBI cases must be referred but can be managed at health post (HP) level when a referral is not accepted and/or possible (Box 1). The referral pathway for neonates with suspected PSBI includes identification at the household level and care at HP, health center (HC), and hospital levels (Figure 1). A well-functioning and responsive referral system is required across the continuum of care, coupled with referral adherence by caretakers.

In 2016, Save the Children’s Saving Newborn Lives (SNL) Project undertook a study to assess:

1. The referral adherence1 of caretakers of sick young infants,
2. The barriers and facilitators to adherence, and
3. The quality of care received at referring and referral facilities