Examining the potential for expanding coverage of neonatal care in low and middle income countries through task shifting and task sharing.

Project Overview

Improving newborn survival is essential to overall improvements in child mortality and specific targets have been set as part of the Sustainable Development Goals. It is estimated that effectively implemented packages of essential interventions could reduce neonatal mortality by 80% in low and middle income countries and 70% of this reduction may depend on the provision of high quality facility-based services. In high income settings neonatal care has evolved to be a highly resource intensive and specialist service setting often staffed by a team of specially trained clinicians and a large complement of highly trained nurses (including advanced nurse practitioners) and supporting professions. More widely, systems in such countries have often made efforts to shape the provision of neonatal services in the form of levels of care and employ effective referral mechanisms to enable women and their babies to access the most appropriate peripartum care while promoting efficiency.

Neonatal services in many LMIC, outside tertiary care centres, are in contrast often rudimentary in the public sector that serves the majority poor population. Following the trajectory of high income countries’ neonatal care facilities development is however, unlikely to be affordable and may in fact not even be desirable. With a need to focus on increasing coverage of effective but potentially affordable interventions and the likelihood that much care can be guided by standardised protocols LMIC may have an opportunity to innovate in the provision of neonatal care services. In particular, the scarcity of highly trained medical professionals, their cost and the difficulty of attracting them to and retaining them in more rural areas, suggest that human resource innovations may be particularly important. These could include a number of innovations such as: i) the introduction of specialist neonatal nurses, operating in a similar way to advanced nurse practitioners in the UK, ii) development of a cadre of clinical officers (non-physician clinicians) with specific training in neonatal care, iii) targeted specific short-course training to upskill registered nurses and iv) the introduction of nursery care assistants for example. Selected nurses or non-physicians could potentially lead and manage some levels of neonatal care in the absence of senior, medically trained professionals. They might arguably deliver better services that those led by junior medical staff who only have limited pre-service training, spend only short periods gaining experience in neonatal care and who often get only intermittent supervision from a specialist neonatologist.

To address the possibility that new forms of task sharing and task shifting might support improved access to quality neonatal care the work in this DPhil will likely involve:

This DPhil would be expected to help define human resources for health innovations for possible testing in future intervention studies.

Background literature

  1. Bhutta, Z. A., et al. (2014). "Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost?" The Lancet 384: 347-370.
  2. World Health Organisation (2016). Standards for Improving Quality of Maternal and Newborn Care in Health Facilities. Geneva, WHO.
  3. Glenton, C., et al. (2013). "Barriers and facilitators to the implementation of lay health worker programmes to improve access to maternal and child health: qualitative evidence synthesis." Cochrane Database of Systematic Reviews.
  4. Dovlo, D. (2004). "Using mid-level cadres as substitutes for internationally mobile health professionals in Africa. A desk review." Hum Resour Health 2(1):
  5. Mijovic, H., et al. (2016). "What does the literature tell us about health workers' experiences of task-shifting projects in sub-Saharan Africa? A systematic, qualitative review." Journal of Clinical Nursing

Training Opportunities

Time will be spent learning and conducting literature reviews and developing a solid understanding of prior efforts to introduce task-shifting / sharing arrangements in neonatal care. These reviews will identify lessons learned and help develop a strategic framework that can guide design of possible new programmes aimed at neonatal service provision in LMIC settings. Existing Kenya policies on professional norms and standards, regulation, training and certification / registration will be examined against this framework to identify opportunities for new professional roles. This background work will inform development of a proposal by the DPhil student for empirical work to satisfy the requirements of scientific and ethical review. Where necessary appropriate training in research methods will be provided to enable use of appropriate research methodologies (eg. in qualitative data collection and analysis or in task analysis) and there will be opportunities for engaging with a wider body of researchers in Oxford, and Kenya engaged in organisational and health systems research.  It is anticipated that during the course of the DPhil and primarily linked to the collection of primary data between 6 and 12 months may be spent in Kenya based at the Nairobi offices of the KEMRI-Wellcome Trust Research Programme (www.kemri-wellcome.org).


Tropical Medicine & Global Health


Project reference number: 945

Funding and admissions information


Name Department Institution Country Email
Professor Mike English Tropical Medicine Oxford University, Nairobi KEN menglish@kemri-wellcome.org
Dr Charles Roehr Newborn Services, Women's Centre, John Radcliffe Hospital Oxford University Hospitals' Trust GBR
Professor Debra Jackson Director of the Oxford Institute of Nursing, Midwifery and Allied Health Research Brookes University, Oxford GBR

There are no publications listed for this DPhil project.