Evidence-based, cost-effective interventions: how many?

This paper, the second in The Lancet neonatal survival series, reviews evidence for the effectiveness of newborn health interventions in developing countries. It selects 16 simple interventions of proven efficacy (implementation under ideal conditions). These are combined into packages for scaling up within health systems, using three methods of service delivery: outreach, family-community care and facility-based clinical care. Findings show that all packages of care are more cost-effective than a single intervention. The authors estimate that 99 per cent coverage of these interventions could prevent up to 72 per cent of neonatal deaths worldwide (approximately three million). At 90 per cent coverage, a combination of universal outreach and family-community care will avert 18-37 per cent of neonatal deaths, while a 50 per cent reduction or more can be achieved through combined universal outreach, family-community care and facility-based clinical services.

The authors acknowledge that increasing access to skilled, facility-based care is an important long-term goal. However, they conclude that early improvements in neonatal survival can be achieved in settings with high mortality and weak health systems, through outreach and family-community care. They recommend the effective application of these interventions to existing programmes at the country level, alongside the expansion of clinical care.