In this second article of the neonatal survival series, we identify 16 interventions
with proven efficacy (implementation under ideal conditions) for neonatal survival
and combine them into packages for scaling up in health systems, according to three
service delivery modes (outreach, family-community, and facility-based clinical care).
All the packages of care are cost effective compared with single interventions. Universal
(99%) coverage of these interventions could avert an estimated 41-72% of neonatal
deaths worldwide. At 90% coverage, intrapartum and postnatal packages have similar
effects on neonatal mortality--two-fold to three-fold greater than that of antenatal
care. However, running costs are two-fold higher for intrapartum than for postnatal
care. A combination of universal--ie, for all settings--outreach and family-community
care at 90% coverage averts 18-37% of neonatal deaths. Most of this benefit is derived
from family-community care, and greater effect is seen in settings with very high
neonatal mortality. Reductions in neonatal mortality that exceed 50% can be achieved
with an integrated, high-coverage programme of universal outreach and family-community
care, consisting of 12% and 26%, respectively, of total running costs, plus universal
facility-based clinical services, which make up 62% of the total cost. Early success
in averting neonatal deaths is possible in settings with high mortality and weak health
systems through outreach and family-community care, including health education to
improve home-care practices, to create demand for skilled care, and to improve care
seeking. Simultaneous expansion of clinical care for babies and mothers is essential
to achieve the reduction in neonatal deaths needed to meet the Millennium Development
Goal for child survival.