Introduction: Neonatal mortality in the pastoralist areas of Ethiopia is higher than the national average. There is much disparity in availability and use of key services in these areas and services at health centers and health posts are variable and low. Objectives: This paper describes the development and adaptation of a community based newborn care model for the pastoralist areas of Ethiopia. Methods: Data were assembled from studies and surveys conducted in Afar region including a health facility assessment, baseline surveys and formative research with health workers and communities. Guidelines and lessons learned were drawn from review of manuals, strategy documents and plans including the National Newborn and Child Survival Strategy (NNCSS), the Health Extension Program, social mobilization documentation, and national Community-Based Newborn Care and pastoralist integrated community case management implementation plans. Other learning was distilled from a desk review of project documents for the Maternal Newborn Health and Nutrition model for pastoralist regions including training, coaching, supervision, and review meeting documents. Results: There has been low access, quality, and utilization of Community-Based Newborn Care services in the pastoralist communities of the Afar region. In pastoralist communities there are multiple and unique barriers to demand for care that include scattered settlements, mobile lifestyles, and traditional practices. As a result, the Federal Ministry of Health service delivery strategies such as the Health Extension Program do not work as was designed for more densely settled agrarian regions, all of which require adaptation or redesign of programs such as Community-Based Newborn Care. Previously, the Afar Regional Health Bureau and Emory University adapted the maternal newborn health and nutrition model for the regional context that was associated with significant improvements to care. This model and Community-Based Newborn Care national guidelines have been further adapted to the context and are being tested for effectiveness in improving newborn health in pastoralist regions. Drawing from the Community-Based Newborn Care the model aims to reach 'every woman and baby, in-time, every time' and consists of the four interrelated interventions of capacity building, demand creation, quality improvement, and monitoring, evaluation and research. Conclusion: In order for Community-Based Newborn Care to succeed at national level, adapted models are needed for different populations such as pastoralists in emerging regions. The adaptation process included local data gathering to inform the adaptation process and community participation combined with application of program guidelines. This process is considered feasible by the Federal Ministry of Health, Afar Regional Health Bureau and partners, thus the adapted Community-Based Newborn Care C model can be implemented for further evaluation and refinement to be scaled up to other pastoralist areas.
