ORIGINAL ARTICLE Barriers to neonatal care in developing countries: Parents’ and providers’ perceptions Alma M Martinez, 1 Dung Thi Khanh Khu, 2 Nem Yun Boo, 3 Leakhena Neou, 4 Bounnack Saysanasongkham 5 and John Colin Partridge 1 1 Departments of Pediatrics, University of California, San Francisco, California, United States, 2 National Hospital of Pediatrics, Hanoi, Vietnam, 3 Universiti Tunku Abdul Rahman, Selangor, Malaysia, 4 Angkor Hospital for Children, Siem Reap, Cambodia and 5 Mother and Child Health Hospital, Vientiane, Lao PDR Aim: Hospital care and advanced medical technologies for sick neonates are increasingly available, but not always readily accessible, in many countries. We characterised parents’ and providers’ perceptions of barriers to neonatal care in developing countries. Methods: We interviewed parents whose infant was hospitalised within the first month of life in Cambodia, Malaysia, Laos and Vietnam, asking about perceived barriers to obtaining newborn care. We also surveyed health-care providers about perceived barriers to providing care. Results: We interviewed 198 parents and 212 newborn care providers (physicians, nurses, midwives, paediatric and nursing trainees). Most families paid all costs of newborn care, which they reported as a hardship. Although newborn care is accessible, 39% reported that hospitals are too distant; almost 20% did not know where to obtain care. Parents cited lack of cleanliness (46%), poor availability of medications (42%) or services (36%), staff friendliness (42%), poor infant outcome (45%), poor communications with staff (44%) and costs of care (34%) as significant problems during prior newborn care. Providers cited lack of equipment (74%), lack of staff training (61%) and poor infrastructure (51%) as barriers to providing neonatal care. Providers identified distance to hospital, lack of transportation, care costs and low parental education as barriers for families. Conclusions: Improving cleanliness, staff friendliness and communication with parents may diminish some barriers to neonatal care in developing countries. Costs of newborn care, hospital infrastructure, distance to hospital, staffing shortages, limited staff training and limited access to medications pose more difficult barriers to remedy. Key words: barrier; developing country; health-care access; low-resource country. Many technical innovations that can improve neonatal health outcomes are increasingly available in low-resource countries. 1–5 However, they are often not easily available in centres that lack technology, provider experience or economic means to implement and sustain interventions routinely utilised in the developed world. 6,7 Parents’ perceptions of barriers to care also adversely impact the effectiveness of neonatal care pro- grams developed for low-income countries. 8–10 We interviewed parents regarding their prior experiences and perceptions of potential barriers to accessing newborn care locally. We surveyed newborn care providers’ perception of barriers to providing care and those that they believe families Correspondence: Dr John Colin Partridge, Department of Pediatrics, Uni- versity of California San Francisco, Mailstop 6E, Pediatrics, San Francisco General Hospital, 1001 Potrero Avenue, San Francisco, CA 94110, USA. Fax: +1415 206 3686; email: cpartridge@sfghpeds.ucsf.edu Accepted for publication 20 May 2012. What is already known on this topic 1 Improved technology can improve neonatal outcomes in resource-limited countries where access is feasible. 2 Providers in many developing countries may have insufficient training and experience to utilise new methods of neonatal intensive care. 3 Parents’ perceived barriers to care may limit access to or effec- tiveness of neonatal intensive care techniques. What this paper adds 1 Parents in these four Southeast Asian sites perceive deficiencies in neonatal intensive care unit conditions and practices that are amenable to low-cost improvement measures. 2 Providers in these four Southeast Asian sites perceive limita- tions in equipment, training and infrastructure as barriers to care and limitations to their ability to provide higher level of care. These barriers will be more difficult to remedy with low- cost improvements. 3 Perceived barriers differ by site suggesting that hospital quality improvement efforts should begin with an analysis of barriers to care relevant to practice in differing locales. doi:10.1111/j.1440-1754.2012.02544.x Journal of Paediatrics and Child Health 48 (2012) 852–858 © 2012 The Authors Journal of Paediatrics and Child Health © 2012 Paediatrics and Child Health Division (Royal Australasian College of Physicians) 852