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While the number of maternal and child deaths almost halved between 1990 and 2013, progress on neonatal mortality has noticeably lagged behind.
Consider this:

  • Every year, more than 1 million babies die on their first day of life.
  • Newborns account for 44 percent of deaths in children under five years old.
  • 2.9 million newborns die from mostly preventable causes.
  • Another 2.6 million are stillborn.
     

 An "RBF" baby in Zimbabwe

These startling statistics are garnering attention from country governments and development partners such as the Children’s Investment Fund Foundation, UNICEF, the World Bank, and the World Health Organization. Now, there is a sense of urgency to act and accelerate progress on newborn health.

The Lancet, through the Every Newborn Series, has provided compelling evidence to support a global strategy for saving the lives of newborn babies.

The authors note that the three main causes of death among newborns are infections, asphyxia, and low birth weight—all of which are preventable and can be avoided through simple, low-cost interventions.

These include:

  • Family planning to delay and space pregnancies allowing mothers to recoup their health before starting to care for a newborn
  • Antenatal care services of appropriate quality, including immunization; prevention, screening and management of infections such as malaria and HIV; and provisions of nutrition enrichment, if needed to ensure a healthy mother
  • Quality skilled birth attendance, particularly hygienic care at birth and proper care of the umbilical cord
  • High quality newborn care, including interventions to prevent hypothermia such as skin-to-skin care and the recognition and appropriate management of neonatal infections, including pneumonia, sepsis and meningitis
  • Early initiation and exclusive breastfeeding
     

A mother and her baby at a hospital in Argentina

The Lancet argues that by increasing the quality and coverage of these services, 54 percent of maternal deaths, 33 percent of stillbirths, and 71 percent of newborn deaths could be averted.

WHO and UNICEF have spearheaded the effort to create Every Newborn: an action plan to end preventable deaths (ENAP), which helps address the inequities in health care for mothers, newborns and children, and provides a joint action platform for the reduction of preventable newborn mortality.

What will it take?
As stakeholders get closer to agreeing on a collective plan for ending preventable newborn deaths, a results focus should be at the fore, along with other proven solutions, as a way to deliver high-impact, cost-effective interventions that improve health access and outcomes.

Argentina’s Plan Nacer presents a compelling success story of the role results-based financing can play in helping newborns survive and thrive.

The program provides health coverage for uninsured low-income pregnant women and children under six years old. Through an innovative pay-for-performance model at the provincial and health-facility levels of the health care system, the program incentivizes provinces and health facilities for providing pregnant women and children with critical prenatal and child care services.

Health tracer indicators were used to pay provinces based on their results. These indicators included the share of newborns with low birth weight (<2,500); those with APGAR scores greater than six; the number of mothers who sought prenatal care in the first 20 weeks of pregnancy; and the number of mothers who received reproductive health counseling within 45 days of delivery. The provinces then contracted health facilities to provide the essential health services to the pregnant women and children. The results were very impressive. Overall, Plan Nacer reduced the neonatal mortality by 74 percent, stillbirths by 30% and low birth weight by 19 percent.[1] Read the World Bank Policy Research Working Paper

Approximately 50% of the reduction of neonatal deaths was as a result of improved prenatal care, which reduced low birth weight; the other half is attributed to better post-natal care.

The Argentina experience is a good example of how RBF can impact newborn health outcomes. It provides a very relevant model for some African countries, where neonatal mortality rates are noticeably high.

A mother holds her newborn baby at a hospital in Argentina

Zimbabwe is an example of a country that is exploring the opportunity to include newborn care in the RBF package of services. The country is specifically looking at improving the quality of services delivered to mothers and newborns that could prevent conditions that account for most newborn deaths such as infection and asphyxia. Through such an approach, Zimbabwe would provide incentives for best practices, including early initiation and exclusive breastfeeding and appropriate management of neonatal infections.

Achieving results for #EveryNewborn
Across the globe, governments, donors, and global health stakeholders have been uniting around the issue of newborn health.

High-level forums have helped put a spotlight on neonates, whose survival and wellbeing should no longer be overshadowed.

With an action plan in place, and the knowledge of what needs to be done to protect this vulnerable group, the world stands at a critical juncture. Collectively, we must seize the opportunity to do more for newborns now.

With 38 programs in 32 countries under implementation, RBF programs are one of the possible ways to leverage the existing service delivery platform to include a stronger emphasis on newborn care.

With early evidence showing the positive impact that can be made when the focus shifts from inputs to outputs—better health for the most vulnerable groups, including neonates, and stronger, more efficient health systems—RBF mechanisms should significantly strengthen the hands of health planners and managers.

With the global community’s efforts now focused on doing more for neonatal health, the moment is ripe for RBF to play a pivotal role in this movement to ensure every newborn survives and lives to be a productive citizen of this world.

[1] Gertler, Paul , Giovagnoli, Paula, Martinez, Sebastian. 2014, “Rewarding Provider Performance to Enable a Healthy Start to Life: Evidence from Argentina’s Plan Nacer.” The World Bank Policy Research Working Paper 6884.

Resource Information

Author/s: Sueann Tannis
Countries: Argentina, Zimbabwe
Date of Publication: July 2014

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