Improving the ability of health systems to deliver essential, hospital services - Examining strategies targeting seriously ill children and newborns in Kenya. (360G-Wellcome-097170_Z_11_Z)

Work in my previous senior fellowship established that a multi-faceted intervention can improve paediatric care in rural Kenyan hospitals and began to develop the capacity within Kenya to undertake multi-methods research around a founder quantitative trial. The close working relationship established with government and other local institutions has seen basic components of the intervention being taken to scale. To assess new, adaptable and scalable models that further promote uptake of best-pract ices and improve delivery of essential services I will use a multi-level, multi-method, longitudinal health systems research framework to: 1. Provide comprehensive information on basic inputs, service provision and outcomes related to paediatric and neonatal care in 10 hospitals over 4 years 2. Examine with an experimental design whether paediatric and neonatal care is improved by providing specific performance feedback linked to basic mentorship and peer to peer support for relevant clinical and nursing managers 3. Examine whether a nurse practice leader role enhances implementation success for neonatal care in a nested, randomised sub-study 4. Examine the process and evolution of intervention implementation within Kenya's health system and explore reasons for variability in intervention success