Exploring Barriers to Newborn Care

This initiative harnesses multiple tools from the social sciences to elucidate and analyze specific reasons that families living under adverse circumstances across the globe have far greater difficulty accessing adequate newborn health care than do families in the developed world. Evidencing the ethnographic, cultural, economic, historical, and other nonbiological root causes of high neonatal mortality is a critical first step toward devising successful strategies for addressing this highly complex sociological problem. The initiative examines factors endemic to rural, poor community settings as well as to established but underresourced clinical care settings in parts of the Americas, Africa, and Asia.
 

Optimizing Care for Pregnant Women and Newborns in the Home and Community

This initiative builds on early innovative work in India demonstrating the feasibility of training community-based health workers in a core set of clinical competencies, all of which involve caring for the newborn child in the home. Providing home-based newborn care (HBNC)—including basic resuscitation, treatment of sepsis, and the ongoing management of low birth weight and feeding practices—has been proven to be an effective first step in reducing neonatal mortality. Unfortunately, however, HBNC remains controversial, chiefly because it empowers families and communities to take control of their children’s health in situations in which formal systems have failed to engage them. This initiative seeks to expand the reach of effective HBNC to geographic locations in which home birth remains the dominant mode of delivery. It complements other long-term initiatives appropriately designed to encourage pregnant women to receive perinatal and postpartum care within clinical settings.
 

Building Capacity for Advanced Neonatal Health Care in Underresourced Facilities

Although nearly all parents possess the same basic desire to bring home a healthy child, some in the global health arena have questioned the value of building basic neonatal intensive-care platforms (NICUs) in hospitals in the poorest parts of the world. Thus, a great unmet challenge in newborn health care delivery remains building capacity for local clinics and hospital facilities to manage neonates with life-threatening illnesses. Babies who need respiratory support, intravenous medications, closer skilled monitoring, or advanced surgical care have little or no chance of survival in many parts of the world. The reason is not because the human and material resources do not exist, but because few regions of great need have been offered an adequate commitment from those in a position to assist. Given adequate training for nurses and physicians, basic protocols for managing common life-threatening respiratory illnesses, and access to relatively simple devices such as continuous positive airway pressure, tremendous reductions in mortality for neonates within hospitals can be achieved. Experience suggests that building basic NICUs provides models for raising the standard of care for other inpatient services. This initiative requires collaboration among multiple partnering institutions across the Americas, Africa, and Asia in order to demonstrate the feasibility and effectiveness of NICU capacity building.