**1. Introduction**

Globally, about 15 million neonates are born preterm, the majority of which are in Sub-Saharan Africa [1]. The survival of these pre-term babies depends on which part of the world they are born from [1]. This chapter is meant for neonatal care deliverers in third world economies where subsistence farming managed by women is the backbone, where women engaged in other occupations are scarce, majority of the populations are in the lowest economic quantiles, access to quality education and health services are poor, access to family planning information and services is low and where teenage pregnancy rates have remained notoriously high. Such are the economies that present the highest numbers of preterm births in the global records and yet also present poor health systems with high rates of home deliveries and high rates of perinatal deaths [2]. The knowledge, expertise and the technology required for the preterm babies to survive is limited in these economies.

The survival of preterm babies has significantly improved over the last several decades in the high-income countries because of the availability of Neonatal

Intensive Care Units (NICU's) in both large and small hospitals, presence of specially trained physicians, nurses, and other health care personnel with easy access to sophisticated equipment [3]. However, the bigger public health advances that saw improvements in socio-economic status of the populations, improvements in education and sanitation conditions and reductions in malnutrition and rates of infectious diseases were probably the main reasons for this improved survival rates for preterm neonates [4]. The countries in low-resource regions are currently at different stages of economic growth and health system development and will see similar improvements at some point. But strengthened political will, increased community participation in and awareness of their health are necessary for larger strides in the desired improvements. Strategic research focused on prevention of preterm births and implementation of innovative interventions at the community level is also crucial.

There is need for programmatic innovation to close the gaps in coverage, equity and quality of care left by the health facility based preterm neonatal care interventions and focus on integration and scale up. Health care packages can be linked through the lifetime of individuals (adolescent, woman, mother, newborn and child) and across health levels in the system (at home, primary health care center, district/regional hospitals) using the continuum of care principle.
