The Lancet Neonatal Series at one year of age has anything changed?

Early online publication: Tuesday May 2, 2006. EMBARGO: 6:30pm ET in North America Monday May 1, 2006.

One year after The Lancet published its Neonatal Survival Series, Joy Lawn (Saving Newborn Lives Initiative, Cape Town, South Africa) and colleagues conclude that more urgency is needed if Millennium Development Goal (MDG) 4 for child survival to be reached by 2015.

Since last year's call for action, there have been positive changes in policy and funding. More efforts have been made to include newborn health in global guidelines and national strategies, with UNICEF developing their first guidelines on newborn health programming. More funding has started to come; The Bill and Melinda Gates Foundation has provided a grant of US $60 million to Saving Newborn Lives/Save the Children USA, and the World Bank funding for health-sector reform and strengthening now promotes an emphasis on health for newborn babies as well as mothers and children.

However, much still needs to be done to reduce neonatal deaths and accelerate progress towards MDG 4. In their Viewpoint, the authors restate their call for action from last year, and emphasise four points.

  1. Governments and partners to work together to develop country action plans in all high-mortality countries by the end of 2007 with an overall strategy of how governments plan to reduce deaths in newborn babies.
  2. Improved integration of newborn health with other relevant programmes, such as maternal and child health.
  3. Governmental commitment and leadership to ensure plans are translated into actions, with the support of international partners.
  4. Donors and national governments to invest strategically in maternal, neonatal, and child care as a basis for development and for achieving the MDGs.

There is a demand from countries for technical support in the process of planning and integration for newborn care. After the publication of the series, 20 African countries requested technical assistance from WHO. Strategic planning and integration would benefit not only newborn babies. Indeed, in the countries that have undertaken strategic planning, examination of newborn health can serve as a catalyst to bring maternal and child health groups together, as well as more vertical programmes such as HIV/AIDS and malaria linking maternal, neonatal, and child care, with benefits for mothers and children as well as babies. The biggest challenge is making plans operational for example India needs to train around 300,000 new community health workers to implement their action plan.

While 99% of newborn deaths are in the developing world, less than 1% of the information published on neonatal care relates to low resource settings. A number of important studies have been published or started in the last year, but more applied research is needed especially on how to reach the poor. An Article published today by The Lancet also authored by Dr. Joy Lawn provides new information on stillbirths.

The series authors state: "This goal will need ongoing investment from countries and donors and should be seen for what it is: an investment in the health of the next generation. However, money is not all that is needed. Currently, too few people are involved and too little research is underway, in view of the size of the problem. We need more champions and researchers committed to asking and answering questions that can save many lives".

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Dr Joy Lawn, Saving Newborn Lives Initiative, 11 South Way, Pinelands, Cape Town 7405, South Africa. T) +27 21 532 3494 / +44 7989528724 (UK mobile) E) joylawn@yahoo.co.uk
From May 8: Save the Children/USA, Suite 500, 200 M Street, Washington DC, 20036, USA. T) +01 202 293 4170

Professor Simon Cousens, The London School of Hygiene and Tropical Medicine, Keppel Street London. T) +44 (0)207 927 2422 E) simon.cousens@lshtm.ac.uk

Dr Gary Darmstadt, Johns Hopkins University, Baltimore, Maryland USA. T) +01 443 858 9110 (mobile) E) gdarmsta@jhsph.edu


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