Developing recommendations for neonatal inpatient care service categories: reflections from the research, policy and practice interface in Kenya
Neonatal deaths contribute a growing proportion to childhood mortality, and increasing access to inpatient newborn care has been identified as a potential driver of improvements in child health. However, previous work by this research team identified substantial gaps in the coverage and standardisat...
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Published in | BMJ global health Vol. 4; no. 2; p. e001195 |
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Format | Journal Article |
Language | English |
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01.03.2019
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Abstract | Neonatal deaths contribute a growing proportion to childhood mortality, and increasing access to inpatient newborn care has been identified as a potential driver of improvements in child health. However, previous work by this research team identified substantial gaps in the coverage and standardisation of inpatient newborn care in Nairobi City County, Kenya. To address the issue in this particular setting, we sought to draft recommendations on the categorisation of neonatal inpatient services through a process of policy review, evidence collation and examination of guidance in other countries. This work supported discussions by a panel of local experts representing a diverse set of stakeholders, who focused on formulating pragmatic, context-relevant guidance. Experts in the discussions rapidly agreed on overarching priorities guiding their decision-making, and that three categories of inpatient neonatal care (standard, intermediate and intensive care) were appropriate. Through a modified nominal group technique, they achieved consensus on allocating 36 of the 38 proposed services to these categories and made linked recommendations on minimum healthcare worker requirements (skill mix and staff numbers). This process was embedded in the local context where the need had been identified, and required only modest resources to produce recommendations on the categorisation of newborn inpatient care that the experts agreed could be relevant in other Kenyan settings. Recommendations prioritised the strengthening of existing facilities linked to a need to develop effective referral systems. In particular, expansion of access to the standard category of inpatient neonatal care was recommended. The process and the agreed categorisations could inform discussion in other low-resource settings seeking to address unmet needs for inpatient neonatal care. |
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AbstractList | Neonatal deaths contribute a growing proportion to childhood mortality, and increasing access to inpatient newborn care has been identified as a potential driver of improvements in child health. However, previous work by this research team identified substantial gaps in the coverage and standardisation of inpatient newborn care in Nairobi City County, Kenya. To address the issue in this particular setting, we sought to draft recommendations on the categorisation of neonatal inpatient services through a process of policy review, evidence collation and examination of guidance in other countries. This work supported discussions by a panel of local experts representing a diverse set of stakeholders, who focused on formulating pragmatic, context-relevant guidance. Experts in the discussions rapidly agreed on overarching priorities guiding their decision-making, and that three categories of inpatient neonatal care (standard, intermediate and intensive care) were appropriate. Through a modified nominal group technique, they achieved consensus on allocating 36 of the 38 proposed services to these categories and made linked recommendations on minimum healthcare worker requirements (skill mix and staff numbers). This process was embedded in the local context where the need had been identified, and required only modest resources to produce recommendations on the categorisation of newborn inpatient care that the experts agreed could be relevant in other Kenyan settings. Recommendations prioritised the strengthening of existing facilities linked to a need to develop effective referral systems. In particular, expansion of access to the standard category of inpatient neonatal care was recommended. The process and the agreed categorisations could inform discussion in other low-resource settings seeking to address unmet needs for inpatient neonatal care. |
Author | Keene, Claire Marriott Aluvaala, Jalemba English, Mike Abuya, Nancy Murphy, Georgina A V Gathara, David |
AuthorAffiliation | 3 Department of Paediatrics and Child Health, College of Health Sciences , University of Nairobi , Nairobi , Kenya 1 Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health , University of Oxford , Oxford , UK 2 Kenya Medical Research Institute-Wellcome Trust Research Programme , Nairobi , Kenya 4 Nairobi City County Government , Nairobi , Kenya 5 School of Nursing and Midwifery , Aga Khan University , Nairobi , Kenya |
AuthorAffiliation_xml | – name: 4 Nairobi City County Government , Nairobi , Kenya – name: 3 Department of Paediatrics and Child Health, College of Health Sciences , University of Nairobi , Nairobi , Kenya – name: 1 Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health , University of Oxford , Oxford , UK – name: 2 Kenya Medical Research Institute-Wellcome Trust Research Programme , Nairobi , Kenya – name: 5 School of Nursing and Midwifery , Aga Khan University , Nairobi , Kenya |
Author_xml | – sequence: 1 givenname: Claire Marriott surname: Keene fullname: Keene, Claire Marriott email: clairekeene@gmail.com organization: Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya – sequence: 2 givenname: Jalemba surname: Aluvaala fullname: Aluvaala, Jalemba email: clairekeene@gmail.com organization: Department of Paediatrics and Child Health, College of Health Sciences, University of Nairobi, Nairobi, Kenya – sequence: 3 givenname: Georgina A V orcidid: 0000-0001-5978-483X surname: Murphy fullname: Murphy, Georgina A V email: clairekeene@gmail.com organization: Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya – sequence: 4 givenname: Nancy surname: Abuya fullname: Abuya, Nancy email: clairekeene@gmail.com organization: Nairobi City County Government, Nairobi, Kenya – sequence: 5 givenname: David surname: Gathara fullname: Gathara, David email: clairekeene@gmail.com organization: School of Nursing and Midwifery, Aga Khan University, Nairobi, Kenya – sequence: 6 givenname: Mike surname: English fullname: English, Mike email: clairekeene@gmail.com organization: Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya |
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SubjectTerms | Childrens health Decision making Global health Health services Infant mortality Low income groups Newborn babies Pediatrics Practice Public health Public sector Strategic planning |
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Title | Developing recommendations for neonatal inpatient care service categories: reflections from the research, policy and practice interface in Kenya |
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