Who has been caring for the baby?
Nearly a decade ago, The Lancet published the Neonatal Survival Series, with an ambitious call for integration of newborn care across the continuum of reproductive, maternal, newborn, and child health and nutrition (RMNCH). In this first of five papers in the Every Newborn Series, we consider what has changed during this decade, assessing progress on the basis of a systematic policy heuristic including agenda-setting, policy formulation and adoption, leadership and partnership, implementation, and evaluation of effect. Substantial progress has been made in agenda setting and policy formulation for newborn health, as witnessed by the shift from maternal and child health to maternal, newborn, and child health as a standard. However, investment and large-scale implementation have been disappointingly small, especially in view of the size of the burden and potential for rapid change and synergies throughout the RMNCH continuum. Moreover, stillbirths remain invisible on the global health agenda. Hence that progress in improvement of newborn survival and reduction of stillbirths lags behind that of maternal mortality and deaths for children aged 1-59 months is not surprising. Faster progress is possible, but with several requirements: clear communication of the interventions with the greatest effect and how to overcome bottlenecks for scale-up; national leadership, and technical capacity to integrate and implement these interventions; global coordination of partners, especially within countries, in provision of technical assistance and increased funding; increased domestic investment in newborn health, and access to specific commodities and equipment where needed; better data to monitor progress, with local data used for programme improvement; and accountability for results at all levels, including demand from communities and mortality targets in the post-2015 framework. Who will step up during the next decade to ensure decision making in countries leads to implementation of stillbirth and newborn health interventions within RMNCH programmes?
Global Development Division, Bill & Melinda Gates Foundation, Seattle, WA, USA. Electronic address: Gary.Darmstadt@GatesFoundation.org.
Gary L
GL
Darmstadt
Saving Newborn Lives/Save the Children, Cape Town, South Africa.
Mary V
MV
Kinney
UNICEF, New York, NY.
Mickey
M
Chopra
Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK; Centre for Maternal Reproductive and Child Health, London School of Hygiene & Tropical Medicine, London, UK.
Simon
S
Cousens
United States Agency for International Development, Washington, DC, USA.
Lily
L
Kak
All India Institute of Medical Sciences, New Delhi, India.
Vinod K
VK
Paul
Department of Maternal, Newborn, Child and Adolescent Health, WHO, Geneva, Switzerland; Centre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen, Bergen, Norway.
Jose
J
Martines
Center for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada; Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan.
Zulfiqar A
ZA
Bhutta
Saving Newborn Lives/Save the Children, Cape Town, South Africa; Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK; Centre for Maternal Reproductive and Child Health, London School of Hygiene & Tropical Medicine, London, UK; Research and Evidence Division, Department for International Development, London, UK.
Joy E
JE
Lawn
D006291:Health Policy; D006801:Humans; D007223:Infant; D007224:Infant Care / Q000458:organization & administration* / Q000592:standards / Q000639:trends; D007226:Infant Mortality; D007231:Infant, Newborn; D007400:Interprofessional Relations; D007857:Leadership; D010347:Patient Care Planning; D047928:Premature Birth / Q000401:mortality / Q000628:therapy