Health Services that Deliver for Newborns (HSDN) is a multidisciplinary project engaging policy-makers and practitioners in Kenya. Newborn deaths account for 40% of all deaths among children under 5 in Kenya. This high neonatal mortality is a major reason why Kenya is not succeeding in its battle to reduce child deaths. Sick or vulnerable newborns often require inpatient care in referral facilities from skilled workers with access to basic technologies. Shortage of skilled health workers often means these services are inadequately delivered, potentially delaying or preventing recovery.
Health Services that Deliver for Newborns
Efforts to reduce child mortality have been a national and global policy concern for a long time and the global Sustainable Development Goals expressly state that reducing neonatal mortality to below 12 deaths per 1,000 live births is a health goal. In Kenya, reducing neonatal mortality from an average 22/1000 live births is part of the government’s efforts to achieve Universal Health Coverage. Globally it has been estimated that over 60% of neonatal deaths might be prevented by good quality, basic hospital care. However, in Nairobi City County there is little data on where inpatient neonatal care is provided and whether it is good quality. Researchers at the KEMRI-Wellcome Trust working with expert groups and multiple partners started the HSDN project to provide this information. Our research suggests:
- 45% of all under-five deaths happen in the first 28 days of life in Kenya. Compared to the national average of 22/1000 live births, Nairobi experiences the highest neonatal mortality in the country of 39/1,000 live births.
- Only about 24% of babies born in Nairobi requiring inpatient newborn care for serious illness reach a facility ready to provide the high quality care they need to survive; over 44% of seriously ill newborns may not reach a suitable facility at all.
- In Nairobi, 4 public hospitals provide 71% of all inpatient neonatal care, to improve access to high quality care for all and especially the poor the county should consider upgrading some facilities so they can provide standard category neonatal care, strengthening the existing hospitals so they can reliably provide intermediate category care, and establishing a county wide referral strategy and system.
Role of nursing research in improving quality of care
Nurses form the largest component of the health professional workforce and are recognized as essential to the delivery of safe and effective care. However, nurses’ 'voice' in discussion on major human resource issues and on quality of care has been shown to be often lacking. In Kenya we don’t have a good understanding of what nursing care is currently being provided, what tasks are nurses actually engaged in and what is the quality of the care provided.
Our research shows that not all care that is planned is delivered, with shortage of human resources as the main reason reported for this. More care is left undone in the public sector and where there are high nurse patient ratios. Task sharing is already being practiced, and improving neonatal care requires an expansion of appropriate human resources for health and re-thinking of the tasks done by nurses
We believe that in actively engaging nurses in evidence-based research we can improve routine provision of care and informing policy as part of broader efforts to tackle the global workforce challenge.
Podcast interviews with HSDN researchers
Insufficient nurses caring for sick babies on hospitals’ neonatal units in Kenya seriously undermine efforts to deliver high quality, safe care and make reducing neonatal mortality rates very difficult new research findings suggest. The Kenyan and Oxford team conducted the first ever direct observational study of which tasks nurses were able to perform and quantified how much care is missed. Previous work on missed nursing care largely conducted in rich countries has relied on questionnaires so this new work is an important advance.
An ethnography work on neonatal nursing, led by Jacinta Nzinga in Nairobi, shows that to cope with incredibly high workloads, informal task shifting is already happening where non-clinical tasks are delegated to students, mothers and support staff. However, nurses are anxious about professional boundaries and the added responsibilities of supervising a potential new cadre.