Benchmarks to measure readiness to integrate and scale up newborn survival interventions.

Neonatal mortality accounts for 40% of under-five child mortality. Evidence-based interventions exist, but attention to implementation is recent. Nationally representative coverage data for these neonatal interventions are limited; therefore proximal measures of progress toward scale would be valuable for tracking change among countries and over time. We describe the process of selecting a set of benchmarks to assess scale up readiness or the degree to which health systems and national programmes are prepared to deliver interventions for newborn survival. A prioritization and consensus-building process was co-ordinated by the Saving Newborn Lives programme of Save the Children, resulting in selection of 27 benchmarks. These benchmarks are categorized into agenda setting (e.g. having a national newborn survival needs assessment); policy formulation (e.g. the national essential drugs list includes injectable antibiotics at primary care level); and policy implementation (e.g. standards for care of sick newborns exist at district hospital level). Benchmark data were collected by in-country stakeholders teams who filled out a standard form and provided evidence to support each benchmark achieved. Results are presented for nine countries at three time points: 2000, 2005 and 2010. By 2010, substantial improvement was documented in all selected countries, with three countries achieving over 75% of the benchmarks and an additional five countries achieving over 50% of the benchmarks. Progress on benchmark achievement was accelerated after 2005. The policy process was similar in all countries, but did not proceed in a linear fashion. These benchmarks are a novel method to assess readiness to scale up, an important construct along the pathway to scale for newborn care. Similar exercises may also be applicable to other global health issues.

The construction of community participation: village family planning groups and the Indonesian state.

Indonesia's family planning program has been one of the most effective in the developing world in promoting contraceptive use and contributing to fertility transition. In evaluating why the program has worked, analysts have given much credit to a network of village family planning groups that developed from the 1970s to the 1990s and that blanketed the archipelago. These groups, composed primarily of female volunteers, made contraception available to women in even the most remote parts of the country, and acted as agents of family planning motivation. They have been labeled by the Indonesian state family planning agency as an example of effective community participation on a national scale. In this paper, I investigate this claim and find it to be simplistic. I provide extensive evidence that the creation of this network was orchestrated by the Indonesian state. On the other hand, I show that these groups are not fully state entities, as they have several characteristics that mark them as socially embedded institutions. They are best labeled as unusual state-society hybrids. In my investigation I draw on one of the newest paradigms in the discipline of political science--the state-society approach--to uncover the odd nature of this family planning network. More deeply, I argue that the state-society approach ought to be adopted in family planning analysis on a comprehensive basis. The traditional organizational and social-demographic approaches that have dominated the field offer only limited understanding of the nature of family planning programs in developing countries. The state-society approach is ideally suited to identifying how family planning programs are institutions of a political nature, embedded in states and societies, and transformed by and transformative of each.