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India’s National Response to Tackle Neonatal Morality

A decade of bold & effective investment in facility-based newborn care.


Dr. Gagan Gupta addressing NEST360’s annual meeting this week in Houston.

Photo credit: Patrick Slavin.


HOUSTON (by Patrick Slavin) — At the NEST360 team meeting at Rice University last week, a standing ovation greeted Dr. Gagan Gupta’s presentation on how India is rapidly improving health facility-based newborn care, potentially saving hundreds of thousands of the youngest lives.


“A dream is not something you see in your sleep,” said Dr. Gagan, quoting former President of India Dr. A.P.J Abdul Kalam, to an inspired audience of NEST360 global staff, medical professionals, and Rice students.

“Dream is something that does not let you sleep. Let us live this dream once again together and we will make the change together in Africa.”

Dr. Gagan, the Maternal and Newborn Health Specialist at the United Nations Children’s Fund’s (UNICEF) headquarters in New York City, shared his story about how a UNICEF team partnered with the Government of India to establish 18 Special Newborn Care Units (SNCU) during a two-year pilot stage from 2008-10. Based on the learnings from these groundbreaking SNCUs, the Government went on to scale-up the project nationwide reaching 844 SNCUs in 2019. Eight two percent of India’s territorial districts now have SNCUs. Annual admissions at SNCUs jumped from 247,576 in 2014 to 1,165,020 in 2019.


“In 2005, every second woman delivered at home. In 2015, eight out of 10 mothers delivered at health facilities, the change of place of birth from home to hospital further warranted the need to invest in Special newborn care,” said Dr. Gupta.

“This is just amazing progress,” commented Dr. Barbara Stoll, Dean of the McGovern Medical School at the University of Texas Health Science Center at Houston. “I started my career in Bangladesh and I never thought then we could reach this level of progress so quickly and systematically.”


“The project today uses data to monitor performance in a real-time analysis of 250 parameters,” said Dr. Gupta. This represents the largest online newborn data set globally and will allow India to take targeted action to continue to improve newborn outcomes.


Dr. Gagan said there were four key strategies to jumpstart the program:


  • Ensure deliveries occurred in hospitals;

  • Early and exclusive breastfeeding practiced by mothers and newborns;

  • Specialized care services provided for the small and sick;

  • Water and Sanitation (WASH) services functional at all health facilities.


This progress was achieved primarily using domestic budget with nearly $500 million in resources provided by the Government of India for sustainable scale up.


Another key component of this success story was budgeting for new equipment as one of five core areas for project financing, according to Dr. Gupta.


“This really connects to the mission of NEST360,” said Dr. Rebecca Richards-Kortum, Director of Rice University’s Rice 360° Institute for Global Health.

“In partnership with local clinicians, hospitals, and governments, NEST is advancing a comprehensive model for sustainable newborn care in Africa. We are working to strengthen health systems—helping develop policy, advocating for investment in newborn care and building a sustainable system to deliver and maintain a bundle of technologies for high-quality, hospital-based care of small and sick newborns at national levels.”

Said Dr. Maria Oden, Co-Director of Rice University’s Rice 360° Institute for Global Health, “Every year, nearly 1 million newborns die in sub-Saharan Africa, most from preventable causes. Aligned with the World Health Organization and country goals, NEST aims to reduce newborn deaths in African hospitals by 50 percent.”