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First ever consultation of countries with highest newborn death rates underlines urgent need for more investment, medicines, and health workers

A pioneering new study, published in The Lancet as part of its Every Newborn Series, identifies for the first time the key obstacles to improving newborn health in some of the countries with the highest burden of newborn and maternal deaths.

A team of global health experts, led by Dr Kim Dickson, at UNICEF, USA, undertook detailed consultations with more than 600 health professionals and policy makers in eight countries - Afghanistan, Bangladesh, Democratic Republic of Congo, India, Kenya, Nigeria, Pakistan, and Uganda – which together accountfor more than half of all newborn and maternal deaths. The consultations, along with detailed analysis of existing studies and other evidence, aimed to uncover the most important constraints (“bottlenecks”) in health care systems affecting newborn and maternal health care in these countries, as well as identifying the factors which have enabled some countries to make progress in recent decades.

While the study uncovered important differences between the countries studied, highlighting the need for continued emphasis on sensitivity to national and regional situations in formulating effective health care policies, several common bottlenecks impeding progress in improving maternal and newborn health were identified.

Lack of skilled and competent healthcare workers was a common problem, lack of funding for newborn care, as was poor quality of care for mothers and their babies. Additionally, the researchers found that problems with Kangaroo mother care, preventing and managing preterm births, providing inpatient care for small and ill babies, and managing infections were important impediments to progress across the countries studied.

According to Dr Dickson, “Our findings show thatincreasing the numbers and skills of health care workers, as well as improving the quality of services available tomothers and their babies in many countries, will need immediate and deliberate attention if newborn health care is to improve in future decades. Equitable access to high-quality, respectful care is a human right. To achieve the basic human right to survival, especially for small and ill babies, and a woman’s right to survival for both herself and her baby, needs a shift in norms to the universal resolve that no woman or baby should die needlessly – every woman, and every baby counts! To translate this shift into reality needs more investment, more medicines, and more health workers, including midwives and nurses with the skills and autonomy to provide the right care for every woman and every newborn baby.”


Health-systems bottlenecks and strategies to accelerate scale-up in countries, Kim E Dickson, Aline Simen-Kapeu, Mary V Kinney, Luis Huicho, Linda Vesel, Eve Lackritz, Joseph de Graft Johnson, Severin von Xylander, Nuzhat Rafique, Mariame Sylla, Charles Mwansambo, Bernadette Daelmans, Joy E Lawn, for The Lancet Every Newborn Study Group, The Lancet, DOI: 10.1016/S0140-6736(14)60582-1, published online 20 May 2014.