Systematic scaling up of neonatal care: what will it take in the reality of countries??

This paper, the third in The Lancet neonatal survival series, argues that up to 70 per cent (approximately three million) of all neonatal deaths could be prevented if proven interventions were effectively implemented where they are needed most. However, the authors point out that even with major investment, achieving universal coverage is impossible in the short term. Meanwhile, most neonatal deaths continue to occur in underserved and poor communities – those with the least access to skilled care. Four key steps for scaling up newborn care are identified: (1) assess the situation and create a good policy environment; (2) achieve optimum neonatal care within health system constraints; (3) systematically scale-up neonatal care; and (4) monitor coverage and measure cost and effect.

To achieve systematic scale-up, the authors call for a dual process using both evidence-based decision-making and a rights-based approach to ensure accountability. They recommend the integration of newborn care into existing programmes such as safe motherhood or integrated management of childhood illness. They argue that community and clinical care should be linked, and advocate phased programme planning, outreach and family-community care to ensure that the poor have access to basic services while clinical health systems are strengthened and made more equitable.