Background The Sustainable Development Goals (SDGs) aim to reduce Neonatal Mortality Rate (NMR) to 12 deaths per 1000 live births by 2030. Although India has made substantial progress in the last few decades in improving child health, achieving NMR targets remains a challenge.

Methods We conducted an overview of Systematic Reviews(SRs) published in the last three years which evaluated health systems (HS) interventions to reduce NMR. We searched two electronic databases and used the Cochrane Effective Practice and Organisation of Care (EPOC) classification to define HS intervention. Two reviewers independently conducted screening, full-text evaluation, data extraction and quality assessment (through AMSTAR-2). Disagreements were resolved by consensus. A narrative synthesis was conducted.

Findings We identified 20 SRs and two overviews of SRs meeting eligibility criteria. About half(n=10) of the SRs appraised were of critically low confidence as per AMSTAR-2 Criteria. Evidence on HS interventions was available for delivery arrangements domain(n=12,54%), implementation strategies(n=9,40.9%), one SR on multi-component interventions and none on governance and financial arrangement interventions. Community-based programmes of newborn care(1 SR, 5 studies), home visits by community health workers(1 SR, 9 studies), inter-professional education to healthcare providers (2 SRs, 20 studies), community mobilisation(1 overview, 7 studies), training in emergency obstetric care(1 overview, 5 studies) were found to decrease NMR. Interventions like self-management using home-based records(1 SR, 2 studies), targeted client communication via mobile(1 SR, 4 studies), hospitalisation in single family rooms vs common bay rooms(1 SR, 7 studies), clinical practice guidelines(1 SR, 5 studies),clinical incident reporting(1 SR, 4 studies) were reported to not have any significant impact on NMR.

Conclusion The overview identified HS interventions which might be used to decrease NMR although many SRs were of low quality. There is a need for more high quality updated SRs which can inform policy and practice to achieve the NMR SDG.