1 year after The Lancet Neonatal Survival Series—was the call for action heard?
2006; Elsevier BV; Volume: 367; Issue: 9521 Linguagem: Inglês
10.1016/s0140-6736(06)68587-5
ISSN1474-547X
AutoresJoy E. Lawn, Simon Cousens, Gary L. Darmstadt, Zulfiqar A Bhutta, José Martines, Vinod K. Paul, Rudolf Knippenberg, Helga Fogstad,
Tópico(s)Neonatal Health and Biochemistry
ResumoIn March, 2005, The Lancet published a series of four articles1Lawn JE Cousens S Zupan J 4 million neonatal deaths: When? Where? Why?.Lancet. 2005; 365: 891-900Summary Full Text Full Text PDF PubMed Scopus (2762) Google Scholar, 2Darmstadt GL Bhutta ZA Cousens S Adam T Walker N de Bernis L Evidence-based, cost-effective interventions: how many newborn babies can we save?.Lancet. 2005; 365: 977-988Summary Full Text Full Text PDF PubMed Scopus (1170) Google Scholar, 3Knippenberg R Lawn JE Darmstadt GL et al.Systematic scaling up of neonatal care in countries.Lancet. 2005; 365: 1087-1098Summary Full Text Full Text PDF PubMed Scopus (188) Google Scholar, 4Martines J Paul VK Bhutta ZA et al.Neonatal survival: a call for action.Lancet. 2005; 365: 1189-1197Summary Full Text Full Text PDF PubMed Scopus (229) Google Scholar and two Comments,5Tinker A Hoope-Bender P Azfar S Bustreo F Bell R A continuum of care to save newborn lives.Lancet. 2005; 365: 822-825Summary Full Text Full Text PDF PubMed Scopus (88) Google Scholar, 6Horton R. Newborn survival: putting children at the centre. Lancet 365: 821–22.Google Scholar highlighting a huge number of largely neglected deaths—the 4 million newborn babies who die every year, of whom 99% are born in developing countries.1Lawn JE Cousens S Zupan J 4 million neonatal deaths: When? Where? Why?.Lancet. 2005; 365: 891-900Summary Full Text Full Text PDF PubMed Scopus (2762) Google Scholar 4 million is roughly the number of babies born every year in the USA or in the 23 largest countries of western Europe. It is also roughly the number of AIDS and malaria deaths combined in 1 year. Yet deaths in newborn babies are rarely mentioned in global-health priorities. A misconception has been that highly technical care is needed. On the contrary, our estimates suggest that up to three-quarters of these deaths could be prevented with low-technology interventions at an additional cost of less than US$1 per head for the 75 countries with the highest mortality.2Darmstadt GL Bhutta ZA Cousens S Adam T Walker N de Bernis L Evidence-based, cost-effective interventions: how many newborn babies can we save?.Lancet. 2005; 365: 977-988Summary Full Text Full Text PDF PubMed Scopus (1170) Google Scholar, 4Martines J Paul VK Bhutta ZA et al.Neonatal survival: a call for action.Lancet. 2005; 365: 1189-1197Summary Full Text Full Text PDF PubMed Scopus (229) Google Scholar What is needed is the political will to ensure that these interventions reach the women and babies who need them.3Knippenberg R Lawn JE Darmstadt GL et al.Systematic scaling up of neonatal care in countries.Lancet. 2005; 365: 1087-1098Summary Full Text Full Text PDF PubMed Scopus (188) Google Scholar, 4Martines J Paul VK Bhutta ZA et al.Neonatal survival: a call for action.Lancet. 2005; 365: 1189-1197Summary Full Text Full Text PDF PubMed Scopus (229) Google Scholar 1 year on, we ask: what progress has been made over the past year in policy, in funding, and most importantly, in programmes in high-mortality countries? Before discussing the commitments and events affecting newborn survival since March, 2005, we have a caveat—measuring the effect on policy and practice is complex, and attributing changes to The Lancet series is not possible and is not our aim. Our purpose is to promote and assess progress in reaching mothers and babies most in need. The series booklets have been widely distributed in English (40 000 printed copies) and translated into French, Spanish, and Portuguese.7WHOThe Lancet Neonatal Survival Series.http://www.who.int/child–adolescent–health/publications/NEONATAL/Lancet_NSS.htmGoogle Scholar Indeed, the Mozambican Ministry of Health undertook the Portuguese translation of their own accord. A CD-ROM has been produced to provide the papers, available references, and a toolkit for action with clinical and programmatic implementation guides.7WHOThe Lancet Neonatal Survival Series.http://www.who.int/child–adolescent–health/publications/NEONATAL/Lancet_NSS.htmGoogle Scholar After two launches in London, UK, and Washington, DC, USA, several regional events were held in Pakistan, Egypt, and Peru, in April, 2005, all involving Ministers of Health. In Africa, various regional meetings of different audiences have profiled findings from the series. Mass media coverage of the series included articles in the five largest-circulation US newspapers, coverage in about 150 newspapers worldwide, and several radio interviews. We believe that the answer is yes—but much more can still be done. Panel 15Tinker A Hoope-Bender P Azfar S Bustreo F Bell R A continuum of care to save newborn lives.Lancet. 2005; 365: 822-825Summary Full Text Full Text PDF PubMed Scopus (88) Google Scholar, 8Freedman LP Waldman RJ de Pinho H Wirth ME Chowdhury AMR Rosenfield A Transforming health systems to improve the lives of women and children.Lancet. 2005; 365: 997-1000Summary Full Text Full Text PDF PubMed Scopus (79) Google Scholar, 9Lawn JE Zupan J Begkoyian G et al.Newborn survival.in: Jamison D Measham A Disease control priorities. 2nd edn. The World Bank and the National Institutes of Health, Washington, DC2006Google Scholar, 10The Partnership for Maternal, Neonatal, and Child Health.http://www.pmnch.orgGoogle Scholar, 11Horton R The coming decade for global action on child health.Lancet. 2006; 367: 3-5Summary Full Text Full Text PDF PubMed Scopus (33) Google Scholar outlines some of the progress we have identified in profile, policy, programmes, and funding. We think deaths in newborn babies are now mentioned more on the health policy agenda, at least in child survival and maternal health circles—as attested to by the attention received at the Countdown to 2015 conference in London, UK, in December, 2005.11Horton R The coming decade for global action on child health.Lancet. 2006; 367: 3-5Summary Full Text Full Text PDF PubMed Scopus (33) Google Scholar However, neither deaths in newborn babies nor in children or mothers appear on the agenda at high-level forums, such as the G8 summit, the Commonwealth Health Ministers meeting, and the World Economic Forum at Davos, Switzerland, in which attention to health tends to focus on HIV/AIDS, malaria, and tuberculosis. The World Health Assembly in 2005 also focused mainly on infectious disease emergencies, such as severe acute respiratory syndrome (SARS).Panel 1Positive changes for health of newborn babies in the past year since publication of The Lancet Neonatal Survival SeriesProfile •The World Health Report 2005 included a chapter on newborn babies and presented cause-of-death data for newborn babies, on the basis of estimates from the Child Health Epidemiology Reference Group used in The Lancet series. In April, 2005, health of newborn babies had a high profile during World Health Day in New Delhi, India, and in the Delhi Declaration, which promoted a major shift from maternal and child health to maternal, neonatal, and child health•The Millennium Task Force report included a prominent section on newborn babies8Freedman LP Waldman RJ de Pinho H Wirth ME Chowdhury AMR Rosenfield A Transforming health systems to improve the lives of women and children.Lancet. 2005; 365: 997-1000Summary Full Text Full Text PDF PubMed Scopus (79) Google Scholar•The Disease Control Priorities Project (National Institutes of Health and World Bank) added a chapter on health of newborn babies, towards the end of revising the second edition9Lawn JE Zupan J Begkoyian G et al.Newborn survival.in: Jamison D Measham A Disease control priorities. 2nd edn. The World Bank and the National Institutes of Health, Washington, DC2006Google Scholar•Leaders of WHO, UNICEF, and World Bank have made public commitments to improving newborn health, including Ann Veneman, new Executive Director of UNICEF, in her maiden speech at the World Health Assembly in 2005•India accounts for almost 30% of neonatal deaths worldwide. On National Newborn Health Day, the Indian Government issued a special stamp highlighting the health of newborn babies (figure) and the Indian Prime Minister has made a commitment to address this "national shame"Policy •UNICEF's new health and nutrition strategy focuses on Millennium Development Goals 4 and 5 and on increasing coverage of essential interventions, recognising the importance of survival of newborn babies for child survival goals. UNICEF previously had no programme guidance on the health of newborn babies, but has developed a policy entitled "Strategic Guidance for Programming for Newborn Health"•WHO ran a workshop to increase capacity of regional and subregional child health advisers to support countries in incorporating newborn health into child health strategies (New Delhi, December, 2005)•Integrated Management of Childhood Illness (IMCI) materials, emergency obstetric care, and many other clinical and programmatic guidelines are being reviewed by various UN organisations and partners to incorporate or strengthen newborn health componentsPartnering •The Partnership for Maternal, Neonatal, and Child Health10The Partnership for Maternal, Neonatal, and Child Health.http://www.pmnch.orgGoogle Scholar was launched after the merger of three partnerships that worked together on the Comments for The Lancet series5Tinker A Hoope-Bender P Azfar S Bustreo F Bell R A continuum of care to save newborn lives.Lancet. 2005; 365: 822-825Summary Full Text Full Text PDF PubMed Scopus (88) Google Scholar•The International Paediatric Association is launching a global movement of paediatricians for newborn health. At the African Congress of Paediatricians in Benin, in December, 2005, 27 African national paediatric associations signed up to join this movement•The Norwegian Government has committed support for programmes related to Millennium Development Goal 4 in selected south Asian and African countriesFinancial support •World Bank funding for health-sector reform and strengthening now promotes an emphasis on health for newborn babies as well as mothers and children (eg, in a recent $250 million grant for health-system strengthening to Democratic Republic of the Congo)•The Bill & Melinda Gates Foundation has provided grants of $60 million to Saving Newborn Lives/Save the Children-USA and $24 million to the Program for Appropriate Technology and Health (PATH), to advance survival of newborn babies in high-mortality countries•The Global Alliance for Vaccines Initiative (GAVI Alliance) has earmarked $60 million for elimination of neonatal tetanusProgramme monitoring •Inclusion of neonatal mortality rate as a Millennium Development Goal target has been recommended by The Lancet series steering team, and by task force on goals 4 and 5•Tracking Child Survival Report, presented at Countdown to 2015 conference in London, included neonatal health indicators that were proposed in The Lancet series,4Martines J Paul VK Bhutta ZA et al.Neonatal survival: a call for action.Lancet. 2005; 365: 1189-1197Summary Full Text Full Text PDF PubMed Scopus (229) Google Scholar and will be monitored by existing population-based surveys in high-mortality countries11Horton R The coming decade for global action on child health.Lancet. 2006; 367: 3-5Summary Full Text Full Text PDF PubMed Scopus (33) Google Scholar Profile •The World Health Report 2005 included a chapter on newborn babies and presented cause-of-death data for newborn babies, on the basis of estimates from the Child Health Epidemiology Reference Group used in The Lancet series. In April, 2005, health of newborn babies had a high profile during World Health Day in New Delhi, India, and in the Delhi Declaration, which promoted a major shift from maternal and child health to maternal, neonatal, and child health•The Millennium Task Force report included a prominent section on newborn babies8Freedman LP Waldman RJ de Pinho H Wirth ME Chowdhury AMR Rosenfield A Transforming health systems to improve the lives of women and children.Lancet. 2005; 365: 997-1000Summary Full Text Full Text PDF PubMed Scopus (79) Google Scholar•The Disease Control Priorities Project (National Institutes of Health and World Bank) added a chapter on health of newborn babies, towards the end of revising the second edition9Lawn JE Zupan J Begkoyian G et al.Newborn survival.in: Jamison D Measham A Disease control priorities. 2nd edn. The World Bank and the National Institutes of Health, Washington, DC2006Google Scholar•Leaders of WHO, UNICEF, and World Bank have made public commitments to improving newborn health, including Ann Veneman, new Executive Director of UNICEF, in her maiden speech at the World Health Assembly in 2005•India accounts for almost 30% of neonatal deaths worldwide. On National Newborn Health Day, the Indian Government issued a special stamp highlighting the health of newborn babies (figure) and the Indian Prime Minister has made a commitment to address this "national shame" Policy •UNICEF's new health and nutrition strategy focuses on Millennium Development Goals 4 and 5 and on increasing coverage of essential interventions, recognising the importance of survival of newborn babies for child survival goals. UNICEF previously had no programme guidance on the health of newborn babies, but has developed a policy entitled "Strategic Guidance for Programming for Newborn Health"•WHO ran a workshop to increase capacity of regional and subregional child health advisers to support countries in incorporating newborn health into child health strategies (New Delhi, December, 2005)•Integrated Management of Childhood Illness (IMCI) materials, emergency obstetric care, and many other clinical and programmatic guidelines are being reviewed by various UN organisations and partners to incorporate or strengthen newborn health components Partnering •The Partnership for Maternal, Neonatal, and Child Health10The Partnership for Maternal, Neonatal, and Child Health.http://www.pmnch.orgGoogle Scholar was launched after the merger of three partnerships that worked together on the Comments for The Lancet series5Tinker A Hoope-Bender P Azfar S Bustreo F Bell R A continuum of care to save newborn lives.Lancet. 2005; 365: 822-825Summary Full Text Full Text PDF PubMed Scopus (88) Google Scholar•The International Paediatric Association is launching a global movement of paediatricians for newborn health. At the African Congress of Paediatricians in Benin, in December, 2005, 27 African national paediatric associations signed up to join this movement•The Norwegian Government has committed support for programmes related to Millennium Development Goal 4 in selected south Asian and African countries Financial support •World Bank funding for health-sector reform and strengthening now promotes an emphasis on health for newborn babies as well as mothers and children (eg, in a recent $250 million grant for health-system strengthening to Democratic Republic of the Congo)•The Bill & Melinda Gates Foundation has provided grants of $60 million to Saving Newborn Lives/Save the Children-USA and $24 million to the Program for Appropriate Technology and Health (PATH), to advance survival of newborn babies in high-mortality countries•The Global Alliance for Vaccines Initiative (GAVI Alliance) has earmarked $60 million for elimination of neonatal tetanus Programme monitoring •Inclusion of neonatal mortality rate as a Millennium Development Goal target has been recommended by The Lancet series steering team, and by task force on goals 4 and 5•Tracking Child Survival Report, presented at Countdown to 2015 conference in London, included neonatal health indicators that were proposed in The Lancet series,4Martines J Paul VK Bhutta ZA et al.Neonatal survival: a call for action.Lancet. 2005; 365: 1189-1197Summary Full Text Full Text PDF PubMed Scopus (229) Google Scholar and will be monitored by existing population-based surveys in high-mortality countries11Horton R The coming decade for global action on child health.Lancet. 2006; 367: 3-5Summary Full Text Full Text PDF PubMed Scopus (33) Google Scholar A specific change called for was that the neonatal mortality rate be added as an indicator under Millennium Development Goal 4 for child survival.4Martines J Paul VK Bhutta ZA et al.Neonatal survival: a call for action.Lancet. 2005; 365: 1189-1197Summary Full Text Full Text PDF PubMed Scopus (229) Google Scholar Despite ongoing discussions and recommendations by the Millennium Task Force, this inclusion has yet to happen. However, the neonatal mortality rate was included as an indicator to be tracked as part of the Countdown to 2015 series of meetings planned for the next decade.11Horton R The coming decade for global action on child health.Lancet. 2006; 367: 3-5Summary Full Text Full Text PDF PubMed Scopus (33) Google Scholar Increasing efforts have been made to include newborn health in global guidelines and national strategies, plans, and monitoring for maternal, neonatal, and child health. UNICEF has led the development of draft guidelines for newborn health programming (panel 1). UNICEF has been fast in changing policy, and this has resulted in a high demand from countries for technical support, which requires the strengthening of the capacity of regional and New York headquarters staff to meet this demand. Ongoing progress is being made to adapt several important global strategies and programmes. The Integrated Management of Childhood Illness (IMCI) strategy, which did not previously address children aged less than 7 days, has new guidelines for the care of sick newborn babies, which are nearing completion. The Indian version of IMCI, the IMNCI (N for neonatal),4Martines J Paul VK Bhutta ZA et al.Neonatal survival: a call for action.Lancet. 2005; 365: 1189-1197Summary Full Text Full Text PDF PubMed Scopus (229) Google Scholar is being adapted by several other countries in Africa and south Asia. There is wider recognition that midwifery training should include training in simple care and resuscitation of newborn babies, although challenges remain in health-system roll-out, including a shortage of competency-based training, a lack of supervision, few resuscitation dummies for training, and insufficient supplies of bags and masks. A companion volume on neonatal deaths and stillbirths is being added to WHO's maternal audit guide, Beyond the numbers. Work continues to improve the ability of verbal autopsy instruments in capturing deaths in newborn babies and identifying the causes of death. However, many issues remain unresolved in postnatal care—there is no international consensus on the where, who, and what of care provided to mothers and babies in the first week after birth, when the risk of death for both is the highest. In view of the size of the problem, newborn, child, and maternal deaths receive relatively little funding, especially if compared with the resources allocated to the Global Alliance for Vaccines Initiative (GAVI Alliance) and the Global Fund to Fight AIDS, Tuberculosis and Malaria.12Costello A Osrin D The case for a new Global Fund for maternal, neonatal, and child survival.Lancet. 2005; 366: 603-605Summary Full Text Full Text PDF PubMed Scopus (28) Google Scholar Nevertheless, there are some encouraging signs. Interventions for newborn babies are now more commonly regarded as part of the funding for general health systems. For example, the World Bank is providing $250 million to the Democratic Republic of the Congo for health system rehabilitation, and interventions for newborn babies are part of the national package. The Department for International Development (DfID) and the US Agency for International Department (USAID) have funded maternal and newborn health programmes in Pakistan with about $250 million over 5 years. Spurred by a health policy review13Bhutta ZA Maternal and child health in Pakistan: challenges and opportunities. Oxford University Press, Karachi2004Google Scholar and the launch of The Lancet Neonatal Survival Series in Islamabad, the Government of Pakistan is launching a new 5-year programme on maternal, neonatal, and child health under a new cell in the Ministry of Health. In Bangladesh, a comprehensive national policy now supports newborn health, newborn health-indicators are included in the national health-information system, and 11% of the national budget for health training is allocated to care of newborn babies. India has increased spending on public health in 2006 from 0·9% of the gross domestic product to 2–3% in 4 years, with most ploughed into the National Rural Health Mission to reduce the infant mortality rate and maternal mortality ratio. In several African countries, health of newborn babies has been included in national sector-wide planning and allocated resources by linking to initiatives to accelerate maternal mortality reduction (panel 2).Panel 2Care of newborn babies in Africa—action in countries and led by countriesSub-Saharan Africa has 46 countries with great variation, together accounting for more than 1 million neonatal deaths and including 16 of the 20 countries with the highest neonatal mortality rates. The third article in The Lancet series called for action in countries and led by countries. •Within 1 month of publication of the series, at least eight African countries requested technical assistance from WHO to integrate and scale up health in newborn babies, and another 12 have since requested support•Policy and programme changes have already begun in countries, which include: In July, 2005, the Ugandan Government added a newborn health team to their cluster for maternal and child health in the next 5-year Health Sector Reform Plan, attaching specific interventions, a dedicated budget line, and a yearly review processTanzania has seen a 25% reduction in mortality in children younger than 5 years during past 5 years; however, the reduction in neonatal mortality has been less striking, with the government and the maternal, newborn, and child national partnership reviewing strategies to address deaths in newborn babiesIn Ethiopia, scaling-up of community-based care, including newborn care,3Knippenberg R Lawn JE Darmstadt GL et al.Systematic scaling up of neonatal care in countries.Lancet. 2005; 365: 1087-1098Summary Full Text Full Text PDF PubMed Scopus (188) Google Scholar is in progress, with almost 10 000 health-extension workers graduating in 2005 and another 30 000 in training •The Road Map for Accelerating the Reduction of Maternal Deaths is a continent-wide policy process approved by the African Union, and now includes survival of newborn babies. The Road Map uses a systematic, stepwise approach to develop, accept, fund, and implement a national plan. Since its launch in 2004, at least 32 African countries have begun the process, and plans have been adopted in 12 countries, overseen by a regional task force. In some countries, health components for newborn babies could need review and strengthening, but the recognition and inclusion of care for newborn babies is an essential first step•A large group of partners are working together to develop programme and policy guides, adapting approaches, and building capacity in organisations and countries. A publication, Opportunities for Africa's Newborns, is in preparation. This monograph will detail eight opportunities to integrate newborn care in existing programmes and provide profiles of 46 countries, plus a CD-ROM of relevant information•In July, 2005, the African Union declared the acceleration of child survival, including that of newborn babies, to be priority•Meeting of the First Ladies of West Africa at the end of 2005 included a presentation on survival of newborn babies Sub-Saharan Africa has 46 countries with great variation, together accounting for more than 1 million neonatal deaths and including 16 of the 20 countries with the highest neonatal mortality rates. The third article in The Lancet series called for action in countries and led by countries. •Within 1 month of publication of the series, at least eight African countries requested technical assistance from WHO to integrate and scale up health in newborn babies, and another 12 have since requested support•Policy and programme changes have already begun in countries, which include: In July, 2005, the Ugandan Government added a newborn health team to their cluster for maternal and child health in the next 5-year Health Sector Reform Plan, attaching specific interventions, a dedicated budget line, and a yearly review processTanzania has seen a 25% reduction in mortality in children younger than 5 years during past 5 years; however, the reduction in neonatal mortality has been less striking, with the government and the maternal, newborn, and child national partnership reviewing strategies to address deaths in newborn babiesIn Ethiopia, scaling-up of community-based care, including newborn care,3Knippenberg R Lawn JE Darmstadt GL et al.Systematic scaling up of neonatal care in countries.Lancet. 2005; 365: 1087-1098Summary Full Text Full Text PDF PubMed Scopus (188) Google Scholar is in progress, with almost 10 000 health-extension workers graduating in 2005 and another 30 000 in training •The Road Map for Accelerating the Reduction of Maternal Deaths is a continent-wide policy process approved by the African Union, and now includes survival of newborn babies. The Road Map uses a systematic, stepwise approach to develop, accept, fund, and implement a national plan. Since its launch in 2004, at least 32 African countries have begun the process, and plans have been adopted in 12 countries, overseen by a regional task force. In some countries, health components for newborn babies could need review and strengthening, but the recognition and inclusion of care for newborn babies is an essential first step•A large group of partners are working together to develop programme and policy guides, adapting approaches, and building capacity in organisations and countries. A publication, Opportunities for Africa's Newborns, is in preparation. This monograph will detail eight opportunities to integrate newborn care in existing programmes and provide profiles of 46 countries, plus a CD-ROM of relevant information•In July, 2005, the African Union declared the acceleration of child survival, including that of newborn babies, to be priority•Meeting of the First Ladies of West Africa at the end of 2005 included a presentation on survival of newborn babies Neonatal tetanus still accounts for more than 200 000 deaths a year, despite a second global-elimination goal for 2005.1Lawn JE Cousens S Zupan J 4 million neonatal deaths: When? Where? Why?.Lancet. 2005; 365: 891-900Summary Full Text Full Text PDF PubMed Scopus (2762) Google Scholar The GAVI Alliance has allocated $60 million to the elimination of maternal and neonatal tetanus (panel 1), and has recently announced a commitment to wider health-systems strengthening with a "pot" of $500 million. Since interventions for maternal, newborn, and child health are a well-recognised marker of an effective health system, the Alliance grants will hopefully contribute to scaling-up of MNCH interventions. The Bill & Melinda Gates Foundation has allocated $84 million to newborn health through two initiatives—Saving Newborn Lives/Save the Children-USA and Sure Start (PATH, Program for Appropriate Technology and Health; panel 1). For the next 6 years, Saving Newborn Lives will work with countries and partners to increase the coverage of effective interventions and to expand operations research relating to scaling-up of newborn care. Special emphasis will be on action in Africa. Because of the need to integrate newborn-health interventions with maternal and child-health programmes, the separate tracking of resource flows for newborn health at the macro-level is difficult, and makes little sense to attempt. At the Countdown to 2015 conference in London, new work to develop a tracking method for resource flows for maternal and child health was presented. Improved tracking during the next few years is aimed to improve accountability of donor and local governments for their investments in maternal, newborn, and child health.11Horton R The coming decade for global action on child health.Lancet. 2006; 367: 3-5Summary Full Text Full Text PDF PubMed Scopus (33) Google Scholar Reductions in the global burden of neonatal deaths depend on effective action in individual countries, especially in those with the highest burden of deaths in newborn babies. In several large Asian countries, groups have been actively working to improve newborn health; for example, the highly influential National Neonatalogy Forum in India has more than 2000 members. In many African countries, newborn health (and maternal, neonatal, and child health in general) has received little attention or leadership so far, with public-health action focused on HIV/AIDS, malaria, and immunisation. This emphasis is changing (panel 2). In the past year, at least 20 African countries have requested technical assistance from WHO to integrate and scale up newborn health care. The Kenyan Paediatric Society has called for a national newborn-survival group and is planning specific actions.14Were FN Newborn survival revolution.East Afr Med J. 2005; 82: 545-546PubMed Google Scholar Other countries, such as Uganda, have incorporated newborn care into their 5-year health-sector plan (panel 2). Major challenges still remain in Asia and Africa. To seize opportunities and respond to country demand, there is a need for more people to be funded to provide technical support, increase capacity, and work with ministries of health to institutionalise newborn care in existing country programmes—developing, implementing, and monitoring integrated, strategic plans, especially in Africa. Many countries have teams for HIV, malaria, and vaccines, but have no one in the ministries of health specifically to inte
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