Generating political priority: The case of newborn survival

In the coming months, HNN will feature a series of blogs highlighting papers examining the state of political priority for newborn survival globally and in 4 low-income countries: Bangladesh, Bolivia, Malawi and Nepal. The case of newborn survival provides insight into what it takes to generate political priority around health issues globally and in country contexts.

Before 2000, few organizations concerned with global health paid much attention to newborn survival. Since that year, a number have come to address the problem, including foundations, UN agencies, bilateral development agencies, governments of low-income countries, and non-governmental organizations. This wave of attention is surprising: there was no sudden increase in the number of babies dying or swift spread of a virus that alarmed citizens of rich countries. The emergence of attention to newborn survival in a short period of time presents an interesting study in how global health issues come to attract priority.

In 2009 and 2010, I conducted research on this subject, analyzing documents and interviewing actors involved in global newborn survival or in a position to comment on efforts. The study was published in a June 2010 issue of the Lancet. The study found that several factors were critical to the emergence of attention, including:

- The creation of a global guiding institution for the issue, the Saving Newborn Lives (SNL) program of Save the Children USA. SNL became an agent of diffusion of the idea that the world had a responsibility to save the lives of newborn babies.

- The formation of an informal network of health professionals, which exercised global leadership on the issue alongside SNL. These individuals had no formal mechanisms for coordination, and did not explicitly refer to themselves as a network. However, they functioned as one, meeting frequently at international gatherings and collaborating on projects. At least one of the core members stood behind nearly all major global initiatives for newborn survival across the decade.

- The emergence of evidence on the problem’s severity and causality. The Child Health Epidemiology Reference Group (CHERG) and the World Health Organization produced several studies during the decade that demonstrated just how widespread newborn deaths were and the particular biomedical causes behind these deaths. This information was critical for convincing global health organizations and governments to act on the issue.

- A shift in the perception of the issue’s tractability. Prior to 2000 few individuals believed that very sick newborn babies in low-income countries could be saved without access to expensive technology. That perception first began to shift as work on community-based care by Indian physician Abhay Bang became known . A series of studies throughout the 2000s built a strong evidence-base to support the idea of tractability. A special Lancet series on newborn survival brought widespread attention to the issue and helped to bring together this evidence.

- A policy window to promote newborn survival created by the child survival Millennium Development Goal. Informal network members and SNL made strategic use of the policy window created by MDG 4, emphasizing the fact that neonatal mortality rates were declining at a much slower pace than were mortality rates in children younger than 5 years, and that MDG 4 could not be achieved without an acceleration in that decline. Several major global health organizations participating in child survival picked up these points, and identified achievement of MDG 4 as a central reason for focusing on newborn survival.

While the rise of global attention has been rapid, it is still circumscribed. No more than a handful of major organizations involved in global health make the issue a central priority, if indicated by the provision of financial and technical resources. Moreover, there is little evidence that pressure from grassroots organizations or the governments of countries with high neonatal mortality had a major role in the emergence of global attention. Perhaps as a result, the extent to which these governments have responded with funding, policies, and programs remains unclear, as does how much difference these global promotional efforts have made in shifting widespread grassroots fatalism surrounding newborn deaths.

Overall it would be fair to say that the issue of newborn survival has emerged from near obscurity to occupy a place among the set of issues being addressed by organizations in global health. However, the fate of newborn health in the next decade depends on the extent to which this agenda reaches beyond global health actors and is successfully pursued within countries.