Conclusions
Reductions in neonatal mortality are necessary to meet the fourth MDG. High-impact, low-cost, feasible interventions are available. They could avert approximately 70 percent of the world's 4 million neonatal deaths, according to analysis presented here, an estimate similar to the estimates in the Lancet neonatal series (Darmstadt and others 2005). Large gains in neonatal survival are linked to other health gains, such as reduced childhood morbidity and disability, prevention of stillbirths, and improved maternal survival, thus contributing also to the achievement of the fifth MDG.
The success of some low-income countries is encouraging, but in South Asia and Sub-Saharan Africa, coverage is generally low, progress is slow, and inequity is high. While countries continue to move toward a more comprehensive health care system, simpler approaches at family-community level and through outreach services can save many lives now, even in the poorest settings. Well-known interventions, such as neonatal resuscitation and case management of infections, can be added to other programs, particularly safe motherhood and IMCI programs, at low marginal cost. However, to reach the MDGs, skilled care is required. Scaling up coverage to ensure professional midwives reach those in underserved areas will require major new investment to generate and retain more skilled staff members, along with the necessary supportive infrastructure. This investment will involve increased spending, which—as shown here—may double current national health expenditures per capita in Asia and triple them in many African countries. Even if poor countries spend more and spend better, outside funding will be required.
Current investment in MNCH by most national governments and international donors is utterly inadequate compared with investment in conditions that have higher profiles yet lower mortality rates. The deaths of 10,000 newborns each day are unconscionable when most could be saved now at relatively low cost if the political will to do so existed.
