Neonatal survival: a call for action

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To achieve the Millennium Development Goal for child survival (MDG-4), neonatal deaths need to be prevented. Previous papers in this series have presented the size of the problem, discussed cost-effective interventions, and outlined a systematic approach to overcoming health-system constraints to scaling up. We address issues related to improving neonatal survival. Countries should not wait to initiate action. Success is possible in low-income countries and without highly developed technology. Effective, low-cost interventions exist, but are not present in programmes. Specific efforts are needed by safe motherhood and child survival programmes. Improved availability of skilled care during childbirth and family/community-based care through postnatal home visits will benefit mothers and their newborn babies. Incorporation of management of neonatal illness into the integrated management of childhood illness initiative (IMCI) will improve child survival. Engagement of the community and promotion of demand for care are crucial. To halve neonatal mortality between 2000 and 2015 should be one of the targets of MDG-4. Development, implementation, and monitoring of national action plans for neonatal survival is a priority. We estimate the running costs of the selected packages at 90% coverage in the 75 countries with the highest mortality rates to be US$4·1 billion a year, in addition to current expenditures of $2·0 billion. About 30% of this money would be for interventions that have specific benefit for the newborn child; the remaining 70% will also benefit mothers and older children, and substantially reduce rates of stillbirths. The cost per neonatal death averted is estimated at $2100 (range $1700—3100). Maternal, neonatal, and child health receive little funding relative to the large numbers of deaths. International donors and leaders of developing countries should be held accountable for meeting their commitments and increasing resources.

Many policymakers and health professionals are unaware that more than 10 000 newborn babies die every day, mostly from preventable causes. The Millennium Development Goal for child survival (MDG-4)—to reduce childhood mortality by two-thirds between 1990 and 2015—will not be met without substantial reductions in neonatal mortality.1 Low-cost interventions could reduce neonatal mortality by up to 70% if provided universally.2 Although these interventions are inexpensive and feasible, their coverage rates are extremely low in the highest-mortality settings. Overcoming health-system constraints to provide such interventions at scale is possible, and practical examples of how countries can do so have been described within this series.

Here, we address common misconceptions that have restricted implementation of interventions to improve neonatal health in many low-income countries. We discuss national and global action needed to improve neonatal survival, and show the estimated cost associated with the packages proposed. Saving lives of newborn children is affordable, but depends on political commitment and leadership at national and international levels.

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