1. INTRODUCTION
This report gives an account of the early development of community-based newborn programs in 5 countries (2 in Asia, 3 in Africa), in which post-natal home visits have featured prominently. Efforts are made to draw lessons applicable to similar efforts elsewhere. This documentation was done as background for a multi-partner consultative meeting held at WHO early in 2012. It is based on a combination of document review and field work (as described in more detail in the methods section below). For each of the countries, there is a description of the policy adoption process and early implementation experience. Actual program performance is explored primarily through use of baseline and endline household surveys in a small number of “early implementation districts”; for most of the countries, such data were available only from a single district. It can be expected that such early implementation experiences would be more robustly supported than would be possible for nation-wide roll-out and that observed performance in such settings would therefore over-estimate what could be achieved sustainably at scale. Nevertheless, even in these early implementation districts certain important performance issues came to light. Notably, the proportion of newborns receiving early post-natal home visits was consistently lower than expected.
At the end of the day, the rationale for any new program initiative is to bring about improved population health outcomes. This, in turn, requires achievement of high effective coverage. In early program experiences, when effective coverage is lower than expected this is an important cue that we need to look closely at our assumptions, our design choices, and the quality of our execution. The current report draws out certain lessons but is only a first step in a process that will need further elaboration. Furthermore, the current report is based on information that was available in late 2011 and early 2012. Since that time, community-based newborn programs have further expanded in these countries and have been introduced elsewhere, and more data is now available on how these programs are performing. Building on the learning captured in this report, supplemented by more recent experience, documentation and data, we are now in an even better position to characterize the contribution that such approaches can make but also what are the requirements for such programs actually to deliver. With such guidance, we are better able to make sound, contextually-appropriate design choices.
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