Saving 1 million lives

I recently visited [Ekjut](http://www.ekjutindia.org/main.html), an organization reducing neonatal mortality by engaging women groups in tribal areas of East India (office pictured at right). With home-based care and specialized facilities, community group mobilization is one of three key ways that public health programs can deliver neonatal interventions.

Every year, over one million children born in India do not live for more than four weeks. In India, neonatal deaths account for more than 60 percent of deaths within the first year of life. Hence, to make a significant dent in India’s Infant Mortality Rate, the issue of neonatal survival needs immediate attention.

The organization Ekjut carried out cluster randomized control trials in Jharkhand and one district of Orissa, finding a positive correlation between sustained engagement with women groups and reduction in neonatal mortality. [Findings from the study](http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2809%2962...) were published in The Lancet.

The nonprofit organization [SEARCH](http://healthmarketinnovations.org/program/society-education-action-and-...) raised the problem of high neonatal mortality in the late eighties. The organization works in the backward [undeveloped] tribal area of Gadchiroli in Maharashtra state. Their approach was not to enforce their ideas on the community but to assess what were the main health problems of the community. Their home-based neonatal care has proven extremely successful. The results of trials have been published in many peer-reviewed articles.

Like SEARCH, many developmental organizations have been scientifically demonstrating the effectiveness of different approaches to deal with the issue. SEARCH, Ekjut and other NGOS studying neonatal interventions use rigorous scientific approaches, including robust study design, dedicated workforce, and adequate sample size of population included in the intervention (scattered population usually less than 300,000), simple monitoring and feedback mechanism.

I believe that only a combination of all the three neonatal survival intervention delivery mechanisms will for sure lead to a substantial reduction in neonatal deaths. [A paper in the Lancet](http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2805%2971...) on neonatal survival series published in 2005 mentions that with 90 percent coverage of the community based, home based care and facility based interventions, Neonatal Mortality Rate (NNR) can be reduced by almost 50 percent, in populations with NMR > 45.

The question is, can such approach be scaled up? Can it be integrated with the public health programs or can it be implemented by government departments/agencies? Do we have dedicated work force to implement such interventions? There is some evidence of getting similar results on scaling up of such approaches, but again all of them have been carried out by NGO’s.