Since the 1990s, neonatal deaths have accounted for more and more childhood deaths globally. Countries with soaring neonatal mortality rates (per 1000 live births) include Pakistan (46), Angola (49), and the Central African Republic (43). Interestingly enough, there isn’t a direct correlation between these deaths and income; other low-middle income countries like Guatemala and Bangladesh have significantly lower death rates than Pakistan, Angola, and CAR. Reasons for this difference in numbers can be attributed to recent innovations in health financing and governance in a handful of low-middle income countries.
Guatemala and Bangladesh have been shown to have exceptionally more diverse financing services than some of their neighbors. Both countries seek revenue through general tax revenues and employee-employer contributions, and rely considerably on government management for the total health budget and less on donor assistance. In Bangladesh, the Ministry of Health and Family Welfare (MOHFW) recently implemented a healthcare financing strategy dedicated to promoting financial risk pooling. The strategy includes implementing a social compulsory insurance scheme for the entire population, with the desired outcome of generating more health resources. This strategy, while already in place in developed countries like France and Germany, would be one of the first of its kind in a developing country like Bangladesh. This strategy has already shown promising results so far, with an increase in fiscal accountability and decrease in corruption and dependence on foreign aid. By 2032, the government hopes to diversify financing sources to 32% social protection scheme, 30% government spending, and only 5% donor funds.
Guatemala has also shown innovation in their health strategy, particularly in leadership and governance. Since 1995, the country has decreased its neonatal mortality rate by 48%, mainly due to the implementation of a two-phase program in 2005 called Programa de Extension de Cobertura (PEC). The first phase of the program sought to expand health coverage to 41 rural municipalities and the second phase, funded by the World Bank, featured a five-year Maternal-Infant Health and Nutrition Project (MIHNP). Some of the goals of the project included increasing health promotion at the community level, strengthening the referral system, creating “maternal homes” for increased access to safe delivery, and strengthening secondary-level health facilities. Some of the outcomes of PEC have been an expanded maternal and child health services coverage to over 100 municipalities, a 20% hike in institutional deliveries since 2006, and a 10% decline in chronic malnutrition among children.