SeriesSystematic scaling up of neonatal care in countries
Section snippets
Step 1: assess situation and create good policy environment
Neonatal survival does not have a one-size-fits-all solution.14 There is variation between and even within countries; the numbers and causes of neonatal deaths, the capacity of the health system, and the obstacles faced and resources available vary greatly.
Step 2: achieve optimum neonatal care within system constraints
Programmes at any level—local, national, or international—depend on effective management.9 Amounts of maternal and neonatal health funding are inadequate for the size of the problem, further emphasising the need for data-driven prioritisation and efficient programme management. A phased approach to building a health system starts with the most achievable mortality reduction strategies, such as outreach campaigns for tetanus toxoid coverage, and progresses to more comprehensive community and
Step 3: Systematically scale up neonatal care
If only family-community and outreach interventions are scaled up, without attention to clinical care, the final effect is predicted to be much lower (20–35% vs >50%; panel 3).2 Hence, in the medium term and long term, focus should move to quality and equity of skilled care within a stronger health system, including emergency obstetric and neonatal care; the development of which is more challenging, costly, and time consuming. Supply and demand obstacles should be systematically identified and
Step 4: monitor coverage and measure effect and cost
Programme management information systems should include periodical assessments of coverage of neonatal interventions, since in most high-mortality countries changes in NMR are usually measurable only on a periodic—eg, 5-year—basis, through costly and labour-intensive household surveys. Systematic attention to equity assessment, in addition to overall population coverage, is important if high coverage is to be achieved for the poor.54 Locally important obstacles to demand for and supply of care
Conclusion
In the very countries with the highest burden of neonatal deaths, coverage of cost-effective interventions is low, inequitable, and slow to progress. There is no one solution to these problems: individual solutions need to be designed that take into account local obstacles and opportunities. The phasing-in of strategies is an important management approach, facilitating the strengthening of systems in the long term, while saving newborn lives now. Even with a weak health system, measurable
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