| Summary: | <p>In Kenya and many resource-constrained low and middle-income countries (LMICs), there is a drive to make Level 2 neonatal unit services more accessible to the populace to reduce neonatal mortality. This has led national governments and development partners to equip such units with the necessary technology. However, inadequate investment in commensurate human resources for health in Kenya and other LMICs may limit any benefits of upgrading neonatal units. It is, therefore, timely to evaluate if improving nurse staffing numbers by a modest amount in contexts supported to provide Level 2 neonatal care results in improved quality of care. I used literature reviews and quantitative research methods to answer this question. Using cross-sectional data and a before and after design, I collect data on care provision in eight Level 2 neonatal units in Kenya and prospectively explore changes in nursing time and care provision following adding extra nurses in four of them.</p>
<p>I found that nurse staffing was extremely poor in the eight Level 2 neonatal units in Kenyan public hospitals. On average, using one measure of nurse input, nurses had 30 minutes per patient per 12-hour shift. As a result, they could only manage a third of all measured nursing tasks. A third of tasks were missed, and another third were informally delegated to nursing students and caregivers, including technical nursing care items, which raises possible patient safety concerns. The nurse staffing intervention resulted in a 4.2% change in measured bedside nurse-delivered care but no change in total measured neonatal care. This, in part, was linked to challenges in achieving full fidelity of the workforce intervention, which resulted from many nurses going on leave and nurse transfers out of the neonatal unit.</p>
<p>The findings suggest that for Kenya to meet the Sustainable Development Goal of reducing neonatal mortality to 12 per 1000 live births, more significant investments must be made in the nursing workforce and other human resources for health. Such investments must be holistic across the public health system, not just for neonatal services alone.</p>
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