Explicit focus on leadership and governance is often neglected when implementing health interventions, including those required to provide quality small and sick newborn care. When problematic policies are adopted or well designed policies are poorly implemented, this is often caused by problems in governance. The Every Newborn Action Plan identified that while 87% of countries have a newborn action plan, only 50% have a national guideline or strategy for small and sick newborn care and only 7% routinely measure key newborn care indicators through their national health information system. Conversely, where significant quality improvement in small and sick newborn care has been successfully implemented, good leadership and governance is always at the heart of progress.

Leadership and governance involves “ensuring that strategic policy frameworks exist and are combined with effective oversight, coalition-building, regulation, attention to system design and accountability[1]”. It is a cross-cutting theme encompassing policy, finance and resource allocation and human resources. Central to effective leadership and governance is accountability. The need for greater accountability arises both from increased funding and a growing demand to demonstrate results. Accountability therefore concerns the management of stakeholders that have the responsibility to finance, monitor, deliver and use health services.

Effective leadership and governance is only possible if the right stakeholders from various disciplines are engaged at national, district and hospital levels. These stakeholders should include key-decision makers and policy-influencers, as well as funders, clinicians, and hospital management. Champions, wnho act as promoters and advocators, should be present across all levels. National policies, standards and strategies for improving the quality of small and sick newborn care should be present, up-to-date and actionable. The presence of organisational, structural and social systems at both hospital and higher levels of the health system ensures buy-in and accountability. Finally, data-based accountability ensures financial and resource allocation, performance measurement and motivation for quality improvement.