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Developing recommendations for neonatal inpatient care service categories: reflections from the research, policy and practice interface in Kenya
  1. Claire Marriott Keene1,2,
  2. Jalemba Aluvaala2,3,
  3. Georgina A V Murphy1,2,
  4. Nancy Abuya2,4,
  5. David Gathara2,5,
  6. Mike English1,2
  7. On behalf of the Health Services that Deliver for Newborns Expert Group
  1. 1 Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
  2. 2 Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
  3. 3 Department of Paediatrics and Child Health, College of Health Sciences, University of Nairobi, Nairobi, Kenya
  4. 4 Nairobi City County Government, Nairobi, Kenya
  5. 5 School of Nursing and Midwifery, Aga Khan University, Nairobi, Kenya
  1. Correspondence to Dr Claire Marriott Keene; clairekeene{at}


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.

  • child health
  • health policy
  • health systems
  • paediatrics
  • public health

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  • Handling editor Seye Abimbola

  • Collaborators Health Services that Deliver for Newborns Expert Group: Prof Aggrey Wasunna (University of Nairobi), Prof Fred Were (University of Nairobi), Dr Catherine Mutinda and Dr Beth Maina (Pumwani Maternity Hospital), Dr Cecilia Mutiso (Mama Lucy Kibaki Hospital), Dr David Githanga (Kenya Paediatric Association), Dr David Kimutai (Mbagathi District Hospital), Prof Rachel Musoke (University of Nairobi), Dr Roseline Ochieng (Aga Khan University), Prof William Macharia (Aga Khan University) and Dr Rachel Nyamai (Ministry of Health)

  • Contributors CMK, ME and JA designed the workshop. CMK prepared the report and evidence used in the workshop with input from ME, JA, GAVM, NA, DG and others at the KEMRI Wellcome Trust. JA facilitated the workshop with assistance from CMK. CMK compiled the reflections and wrote the manuscript, with support from ME and JA. All authors reviewed and provided input into the final version of the manuscript. Health Services that Deliver for Newborns Expert Group: Dorothy Agedo (Kenyatta National Hospital School of Nursing), Dr Celia Wanda Muturi (Mama Lucy Hospital), Dr Ester Ogola (Pumwani Hospital), Francis Muma (MoH DHSQAR), Leah Jepchumba Rutto (Ministry of Health), Lister Onsongo (Kenyatta University School of Nursing), Margret Mbaire (Kenya Medical Training College), Mary Kamau (Coptic Hospital) and Maryline Chebii (NCK).

  • Funding This work was supported by a Health Systems Research Initiative joint grant provided by the Department for International Development, UK (DFID); Economic and Social Research Council (ESRC); Medical Research Council (MRC); and Wellcome Trust, grant number MR/M015386/1. ME and MCK were supported by a Wellcome Trust Senior Fellowship (no. 097170) awarded to ME.

  • Competing interests ME advises the Kenyan Paediatric Association and sits on the Ministry of Health (Kenya) Advisory Group.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data sharing is not applicable to this article as no datasets were generated or analysed during the current study. All materials developed to support the workshop discussions are available in the appendix or on request to the corresponding author.

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