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dc.contributor.authorEnglish, Mike
dc.contributor.authorGathara, David
dc.contributor.authorNzinga, Jacinta
dc.contributor.authorKumar, Pratap
dc.contributor.authorWere, Fred
dc.contributor.authorWarfa, Osman
dc.contributor.authorTallam-Kimaiyo, Edna
dc.contributor.authorNandili, Mary
dc.contributor.authorObengo, Alfred
dc.contributor.authorAbuya, Nancy
dc.contributor.authorJackson, Debra
dc.contributor.authorBrownie, Sharon
dc.contributor.authorMolyneux, Sassy
dc.contributor.authorJones, Caroline Olivia Holmes
dc.contributor.authorMurphy, Georgina A
dc.contributor.authorMcKnight, Jacob
dc.date.accessioned2020-05-14T23:58:16Z
dc.date.available2020-05-14T23:58:16Z
dc.date.issued2020
dc.identifier.issn2059-7908en_US
dc.identifier.doi10.1136/bmjgh-2019-001937en_US
dc.identifier.urihttp://hdl.handle.net/10072/393889
dc.description.abstractThere are global calls for research to support health system strengthening in low-income and middle-income countries (LMICs). To examine the nature and magnitude of gaps in access and quality of inpatient neonatal care provided to a largely poor urban population, we combined multiple epidemiological and health services methodologies. Conducting this work and generating findings was made possible through extensive formal and informal stakeholder engagement linked to flexibility in the research approach while keeping overall goals in mind. We learnt that 45% of sick newborns requiring hospital care in Nairobi probably do not access a suitable facility and that public hospitals provide 70% of care accessed with private sector care either poor quality or very expensive. Direct observations of care and ethnographic work show that critical nursing workforce shortages prevent delivery of high-quality care in high volume, low-cost facilities and likely threaten patient safety and nurses’ well-being. In these challenging settings, routines and norms have evolved as collective coping strategies so health professionals maintain some sense of achievement in the face of impossible demands. Thus, the health system sustains a functional veneer that belies the stresses undermining quality, compassionate care. No one intervention will dramatically reduce neonatal mortality in this urban setting. In the short term, a substantial increase in the number of health workers, especially nurses, is required. This must be combined with longer term investment to address coverage gaps through redesign of services around functional tiers with improved information systems that support effective governance of public, private and not-for-profit sectors.en_US
dc.description.peerreviewedYesen_US
dc.languageEnglishen_US
dc.language.isoeng
dc.publisherBMJ Publishing Groupen_US
dc.relation.ispartofpagefrome001937:1en_US
dc.relation.ispartofpagetoe001937:8en_US
dc.relation.ispartofissue1en_US
dc.relation.ispartofjournalBMJ Global Healthen_US
dc.relation.ispartofvolume5en_US
dc.subject.keywordsScience & Technologyen_US
dc.subject.keywordsLife Sciences & Biomedicineen_US
dc.subject.keywordsPublic, Environmental & Occupational Healthen_US
dc.subject.keywordschild healthen_US
dc.subject.keywordsepidemiologyen_US
dc.titleLessons from a Health Policy and Systems Research programme exploring the quality and coverage of newborn care in Kenyaen_US
dc.typeJournal articleen_US
dc.type.descriptionC1 - Articlesen_US
dcterms.bibliographicCitationEnglish, M; Gathara, D; Nzinga, J; Kumar, P; Were, F; Warfa, O; Tallam-Kimaiyo, E; Nandili, M; Obengo, A; Abuya, N; Jackson, D; Brownie, S; Molyneux, S; Jones, COH; Murphy, GA; McKnight, J, Lessons from a Health Policy and Systems Research programme exploring the quality and coverage of newborn care in Kenya, BMJ Global Health, 2020, 5 (1), pp. e001937:1-e001937:8en_US
dcterms.dateAccepted2019-12-22
dcterms.licensehttps://creativecommons.org/licenses/by/4.0/en_US
dc.date.updated2020-05-14T23:53:53Z
dc.description.versionVersion of Record (VoR)en_US
gro.rights.copyright© Author(s) (or their employer(s)) 2020.This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.en_US
gro.hasfulltextFull Text
gro.griffith.authorBrownie, Sharon M.


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