Staffing strategies for quality maternal and newborn care

Newborn units in resource-constrained low-middle-income countries (LMICs) often have high mortality. Programmes to improve care quality often accept understaffing that directly affects care in these settings as a norm. To address a major evidence gap, we examined the effects on quality of care of improving nurse staffing in four intermediate-level Kenyan newborn units. We introduced three additional nurses to newborn units in Kenya, which had between 8 and 17 existing nurses. We measured nursing care provision for small and sick newborns using direct bedside observations with a validated structured checklist before and 6 months after the intervention. Our intervention was associated with a 4.2% increase in our primary outcome, total nurse-delivered care, and a 7.2% increase in the delivery of 10 tasks nurses prioritise. This study provides strong evidence for policymakers on the benefits of improving neonatal nursing staff numbers on patient quality of care.

Human resources are essential, and main cost for small and sick newborn care. We modelled and costed nurse to baby ratios scale-up scenarios, considering levels of CPAP need, using primary data from 66 neonatal units in Kenya(n=13), Malawi(n=36), Nigeria(n=9), and Tanzania(n=7). Three costed scenarios were developed considering specialised nursing for complex cases, onsite skills training, and ratios. Scenarios A-C included most optimal to least optimal scenarios. For new 40 bed unit, Scenario A requires six specialist and 17 general nurses with annual mean cost of: $225,139 (Kenya), $252,469 (Malawi), $214,019 (Nigeria), and $238,726 (Tanzania); Scenario B requires four specialist and 17 general nurses with costs from $195,125 (Malawi) to $211,630 (Nigeria); and, Scenario C requires four specialist and 8 general nurses with costs from $126,235 (Malawi) to $134,487 (Nigeria). Investment is critical, and cost estimates are useful for scale up and national investment case budgeting and resource allocation.

This study explores the critical role of human resources for health (HRH) in improving maternal and neonatal health (MNH) outcomes in Kenya. Despite standardized clinical guidelines, many low and middle income countries struggle with effective care delivery. Through a mixed methods assessment of four high performing facilities, the research highlights how behavioral norms and organizational structures influence frontline provider performance. Key findings indicate that successful HRH strategies vary across facilities; for instance, Kiambu utilized a structured system with daily mentorship, while Pumwani focused on real time triage and strong teamwork. Intrinsic motivators, such as professional pride and peer recognition, were essential for staff retention and responsiveness, leading to over 95% success rates in managing maternal emergencies. The study concludes that high quality MNH care requires supportive, behaviorally attuned HRH environments alongside competence