Although remarkable progress to reduce U5 mortality in Ethiopia has been achieved, neonatal mortality remains (NMR) unchanged. NMR now accounts for 42% of under-5 child deaths. In order for Ethiopia to attain MDG 4, the high number of neonatal deaths (120,000 annually) must be addressed. Effective, low-cost maternal and newborn interventions exist to prevent and treat newborn deaths; however, there are critical barriers that impede access to and use of these life-saving interventions. The high level of home deliveries (90%) in Ethiopia’s rural communities, demands approaches that assure access to mothers and newborns during the early postnatal period at which the risk of death is highest. An estimated 50% of neonatal deaths occur within 24 hours of delivery, with 75% within the first week of life. In order to address the high number of neonatal deaths solutions are required that can be applied at scale within the existing national health system. The Health Extension Program, with more than 34,000 female health extension workers deployed to rural communities, provides a platform to provide care and promote optimal care practices within the home during the early postnatal period. Participants in this proposed session have implemented community-based approaches within national programs that address barriers to early support and care of mothers and newborns during the first week of life.