Program in Global Newborn Health and Social Change
Sadath Sayeed, JD, MD, Program Director
Newborns are perhaps the most vulnerable patient population in the world. Not only are they biologically immature and therefore uniquely susceptible to a range of life-threatening illnesses, they are also wholly dependent on others to advocate for their health and welfare. Perhaps no other statistic testifies to the newborn child’s precarious biosocial position than this: every year, nearly 4 million babies die before reaching the age of one month. These deaths exceed the death toll due to any single human infectious disease, including HIV/AIDs, yet they remain largely outside the consciousness of the global- health community.
Not surprisingly, 99 percent of these tragically early deaths occur in disadvantaged settings around the globe. When babies are born into poverty, they die most often of treatable conditions, including pneumonia and prematurity. As many as 70 percent of neonatal deaths could be prevented with known, simple, nonintensive interventions: basic resuscitation, management of low birth weight, and treatment of sepsis. Yet such low-cost, proven treatments remain difficult to implement in resource-poor settings, a reality that speaks to the pressing need for professionals with an interest in reducing global health disparities to address the “97/3” gap: of the scarce research funds aimed at reducing child mortality, 97 percent are directed at the development of new technologies, while only 3 percent are spent on operational research to determine how to best deliver existing interventions to mothers and children who need them most.
The Program in Global Newborn Health and Social Change, housed within the Department of Global Health and Social Medicine at Harvard Medical School, is an interdisciplinary initiative that seeks not merely to understand, but also to solve, some of the most pressing health-related challenges facing infants born into adverse social circumstances. The Program offers opportunities for students, residents, fellows, and faculty from across Harvard University and elsewhere to think critically both about the needs of society’s least-visible population and about the current inadequacy of our collective response. Although the Program aims to complement other initiatives at Harvard focused on child health and welfare, it is distinctive in its focus on improving the quality of newborn health care delivery.
Projects undertaken by the Program in Global Newborn Health and Social Change are linked to ongoing clinical, research, and advocacy efforts in the Americas, Africa, and Asia. Program objectives include:
- Creating and launching fundable research projects to cast light on the nonbiological barriers to successfully delivering newborn health care in underserved parts of the world and, subsequently, translating study findings into action plans that yield measurable outcomes and improve upon them.
- Training medical students, residents, and fellows in an interdisciplinary manner that encourages development of skills to address the biosocial determinants of newborn health and illness.
- Providing intensive training opportunities in the field for pediatric specialists with a dedicated long-term interest in neonatal medicine.
- Developing the academic careers of faculty members who are interested in committing their life’s work to addressing inequities in global health delivery.
Featured InitiativesExploring 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.
The Program in Global Newborn Health and Social Change is dedicated to developing strong ties with institutions and organizations that share its goals. Current affiliations include Children’s Hospital Boston, Partners In Health, the International Pediatric Outreach Project, and the University of California, San Francisco. Program leaders anticipate establishing new projects in Haiti and Rwanda.