Every Newborn: Health-systems bottlenecks and strategies to accelerate scale-up in countries

The fourth paper in the Every Newborn Lancet series analyses common health system problems that prevent newborn survival. It also describes effective strategies employed by countries to accelerate newborn mortality reduction.Much faster progress is needed to reduce newborn mortality, particularly in African countries. While the set of interventions proven to reduce newborn mortality are now well known, they depend on a strong health system to be effective.This article considers which aspects of the health system most constrain the effective delivery of newborn health packages. The health system aspects considered include: leadership and governance, health financing, health workforce, essential medical products and technologies, health service delivery, health information systems, and community ownership and partnership.Using new evidence from workshops held in 8 of the 13 countries with the highest number of newborn deaths in 2011 (Afghanistan, Bangladesh, DRC, India, Kenya, Nigeria, Uganda and Pakistan), it shows that health workforce and health service delivery are seen as the most frequent constraints to newborn survival, across regions and mortality contexts.It then summarises lessons learned from those countries that have successfully accelerated reductions in newborn mortality (including Malawi), presenting country-specific examples of successful strategies as well as a stage by stage guide to strengthening each component of the health system depending on the current mortality context. Main recommendations include: (1) Improving newborn survival needs health workers with the responsibility and the specific skills needed to save babies’ lives. (2) Quality and equity of care are crucial to improve newborn survival  - and perinatal death audits are important tools to improve quality of care for newborns.To read the article, click here. Free registration is required.To read other articles in the series, click here.Dickson, K., Simen-Kapeu, A., Kinney, M., Huicho, L., Vesel, L., Lackritz, E., de Graft Johnson, J., von Xylander, S., Rafique, N., Sylla, M., Mwansambo, C., Daelmans, B., Lawn, J. (2014). Health-system bottlenecks and strategies to accelerate scale-up in countries. The Lancet, (Early online publication).