Health Services that Delivery: Improving care for sick newborns (HSD-N) (360G-Wellcome-106475_Z_14_Z)

Neonatal mortality now accounts for over 40% of all child mortality in many countries. Yet prior research in low-incomesettings suggest that sick newborns often do not receive the interventions they need to ensure their disability free survival.Sick newborns require multiple interventions, given repetitively for multiple days and so their care is especially sensitive tothe major deficit in the nursing workforce found in the majority of low-income countries. To reduce this deficit and constrainworkforce costs task-shifting, moving responsibility for delivering interventions from professional to lower level workers,may be a solution. Particularly as the interventions delivered may be time consuming but not complex (eg. assistedfeeding). Yet such apparently rational approaches may be poorly designed or implemented leading to their rejection inpolicy or practice.Our overarching objective, employing frameworks to guide development of complex interventions, is to undertake researchMR/M002772/1 Page 3 of 7 Date Saved: 14/01/2014 14:57:31Date Printed: 14/01/2014 15:36:21SummaryIn simple terms please describe your proposed research in a way that it could be publicised to a general audience [up to4000 characters].with key Kenyan stakeholders to design a contextually appropriate and feasible task-shifting intervention to improvedelivery of essential neonatal interventions in facilities. This new arena for research on task-shifting in low-income settingswill demand use of innovative methods and an integrated, multi-disciplinary approach. In parallel we will focus on buildingcapacity for health systems research in Kenya enhanced by the creation of new academic partnerships spanning businessschools to clinical epidemiology. Learning lessons from this approach we aim to develop this participatory research modelfor work on other questions and in other settings.We will develop 4 broad areas of work that inform each other during design, conduct, analysis and interpretation. These willspan: stakeholder engagement and analysis; assessing existing capacity and future needs for interventions for a populationof 5 million; exploration of what is actually required of the workforce to deliver interventions and opportunities for taskshifting;and examination of the regulatory, professional and social context within which task-shifting might be introduced.This programme of work will strengthen researcher - policy maker engagement, result in at least 3 Kenyan PhDs, developinnovative methodological approaches through new partnerships, and generate considerable generalisable knowledge. Ourspecific objectives (indicative of planned outputs) are:1. To examine the regulatory environment and position and influence of key stakeholders on task-shifting debates inneonatal care at the start of the project and explore how such positions change with participation over the lifetime of theproject2. To define with government and key stakeholders a core package of services for sick newborns requiring facility basedcare in Kenya3. To assess current capacity to provide this package in Nairobi County facilities (in all sectors) and to estimate current useof services and contrast this with estimated need derived from epidemiological models at a population level (Gap 1)4. To quantify which interventions needing delivery by nurses are provided safely in representative facilities (Gap 2)5. To characterise neonatal nursing task frequency and duration and the skill level required for delivery to identify thosesuitable for task-shifting6. To explore workplace contexts and managers', professionals' and parents' perspectives to further inform design of anacceptable task-shifting strategy7. To develop illustrative models of the human resource costs of delivering agreed interventions for Nairobi County (closingGap 1 and Gap 2) while varying coverage and task-shifting options to inform stakeholder discussions on design of a taskshiftingintervention that considers affordability, feasibility, access and equity8. To draw lessons on how researchers can engage in a dynamic collaboration to inform improvements in health systems