Table 2

Perceptions of quality of care and approaches to improve management of SYIs in primary care settings

Themes of quality of care	Caregiver perception	Provider perception	Effect on managing SYIs	Priority approaches to improve SYI care
Availability of essential physical resources—space and essential medicines.	Availability of drugs and equipment hindered service provision.	Frequent stockout of essential drugs and supplies makes it difficult to offer quality services to SYIs.	Procurement challenges and lack of health system prioritisation of newborn care lead to frequent stockouts and referrals to higher level facilities.	Advocacy for prioritisation of essential medicines. Tracking of stockouts and use of data in the community of practice platform to inform decision makers on commodity needs in facilities. Use of provider network to redistribute medicines to other facilities.
Timely, evidence-based routine practices.	Delays in initiating treatment due to long queues as a result of inadequate providers, absenteeism and complex service architecture.	Inadequate staffing.	Low staffing of PHCs and fragmentation of service structure limit identification of very SYIs for timely care.	Simple triaging mechanism and advocacy for effective human resource management in PHC facilities.
Competent and motivated human resource.	Inadequate provider knowledge and skills to manage SYIs, lack of provider motivation in service delivery.	Complexity in managing SYIs due to their fragility.	Affects service provision of SYIs, necessitates referral leading to congestion in higher level facilities.	Update providers on IMNCI, use of the community of practice platform and encouraging network of providers to enhance exchange learnings.
Respect and preservation of dignity.	Varying perceptions on the respect and dignity from providers—with caregivers being treated with disrespect due to negative provider attitudes among others.	Strenuous and taxing work environment.	Affects care seeking for SYIs—causes delay in care seeking, responsible for other resorts to care.	Advocate for approaches to improve provider–client interactions in PHCs such as community engagement forums.
Functional referral systems.	Lack of ambulances, additional resources (eg, fuel) and appropriate equipment.	Some facilities do not have ambulances that conform to standards required for emergency referral.	Increased burden on caregivers whose babies required referral.	Strategies to equip lower level PHCs with essential equipment and drugs will ensure timely access to treatment for SYIs and reduce unnecessary referrals to higher level facilities.
Effective communication.	Varying perceptions with some caregivers voicing satisfaction with information provided by providers and others pointing out concerns in infant assessment by providers.	Adequate communication strategies with a need for more involvement of CHVs.	Deters care seeking, client–provider interaction and client satisfaction in services provided to SYIs.	Sensitisation of providers on importance of effective communication and involvement of CHVs at the community level on dissemination of information on PSBI.

CHV, community health volunteer; IMNCI, Integrated Management of Neonatal and Childhood Illness; PHC, primary healthcare; PSBI, possible serious bacterial infection; SYI, sick young infant.