Reducing global neonatal mortality is crucial. In low-income countries, most births and deaths occur at home. Obstacles to improving survival include: many newborn infants are invisible to health services; care-seeking for maternal and newborn ailments is limited; health workers are often not skilled and confident in caring for newborn infants; and there are inequalities across all these factors. The best community-based approach is a combination of community mobilization and home visits by community-based workers. Both timing of visits and treatment interventions are critical. It is not clear how community-based approaches should be balanced, and whether they are effective outside South Asia and when introduced into public sector systems. Operational challenges include integrating community-based activities into public health systems, and questions of how to achieve coverage at scale. The possibility of partnership between the public and nongovernment sectors should be explored, particularly in terms of novel large-scale collaborations.
PLoS Medicine (2010) 7 (4) e1000246 [doi:10.1371/journal.pmed.1000246].