Abstract
Background: Improving the quality of facility based neonatal care is central to tackling the burden of neonatal mortality in Low and Middle Income Countries (LMIC). Quality neonatal care is highly dependent on nursing care but a major challenge facing health systems in LMICs is human resource shortage. In Kenya, task-shifting among professional care cadres is being discussed as one potential strategy of addressing the human resource shortage, but little attention is being paid to the potential for task-shifting in the provision of in-patient sick newborn care. This study identified key neonatal policy-making and implementation stakeholders in Kenya and explored their perceptions of task-shifting in newborn units. Methods: The study was exploratory and descriptive, employing qualitative methods including: document review, stakeholder analysis, observation of policy review process meetings and stakeholder feedback. A framework approach was used for analysis. Results: In Kenya, guidelines for the care of sick neonates exist but there are few specialized neonatal nurses and no policy documents outlining the nurse to patient ratio required in neonatal care or other higher dependency areas. The Ministry of Health, Nursing Council of Kenya and international agencies were identified as playing key roles in policy formulation while County governments, the National Nurses Association of Kenya and frontline care providers are central to implementation. Newborns were perceived to be highly vulnerable requiring skilled care but in light of human resources challenges, most expressed some support for shifting ‘unskilled’ tasks. However, a few of the key implementers were concerned about the use of unqualified staff and all stakeholders emphasized the need for training, regulation and supervision. Conclusions: Task-shifting has the potential to help address human recourse challenge in low-income settings. However, any potential task-shifting intervention in neonatal care would require a carefully planned process involving all key stakeholders and clear regulations to steer implementation.
Highlights
Neonatal mortality currently accounts for over 40% of all child mortality in many countries in sub-Saharan Africa[1]
In addition to carefully planned medical care, providing quality care to sick newborns is highly dependent on the availability and quality of nursing care
In countries such as the UK it is recommended that, even for babies who do not require intensive care, there should be 1 nurse for every 2 to 4 sick babies[7,8] with evidence suggesting higher mortality where such standards are not met[7]. Providing such levels of nursing care is a major challenge in low-income settings where there are considerable deficits in human resources for health[9]
Summary
Neonatal mortality currently accounts for over 40% of all child mortality in many countries in sub-Saharan Africa[1]. In addition to carefully planned medical care, providing quality care to sick newborns is highly dependent on the availability and quality of nursing care In countries such as the UK it is recommended that, even for babies who do not require intensive care, there should be 1 nurse for every 2 to 4 sick babies[7,8] with evidence suggesting higher mortality where such standards are not met[7]. Providing such levels of nursing care is a major challenge in low-income settings where there are considerable deficits in human resources for health[9]. Any potential task-shifting intervention in neonatal care would require a carefully planned process involving all key stakeholders and clear regulations to steer implementation
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