Health Systems Collaborative research highlights
Newborn technology use in low-resource settings: the role of health professionals’ communication in implementation
Posted 16/10/2025. How does the hospital environment in low-resource settings influence the use of newborn care technologies? Gloria Ngaiza and colleagues examined Continuous Positive Airway Pressure (CPAP) and phototherapy. They highlight how the physical setting, socio-organizational factors, technological features, and the broader context impact how health professionals in Kenya communicate, and, ultimately, make decisions to use or not use technologies.
Sustainable by Design: Digital Health Business Models for Equitable Global Health Impact in Low-Income and Low-Middle-Income Countries
Posted 13/10/2025. Drawing on the business model challenges faced by digital health entrepreneurs in LMICs and lessons from market-shaping approaches that have expanded access to essential medicines in global health, Elvin Irihamye and colleagues provide a framework that shows how business strategy and market-shaping practices can be adapted to align digital health business models with the delivery of tangible global health impact.
Applying a multi-layered, mixed methods approach to evaluate technology and workforce interventions in Kenyan neonatal units
Posted 07/10/2025. How do we design and ethically implement complex health interventions and evaluations in settings that are under resourced without compromising patient care or research data? Michuki Maina and colleagues used layered mixed methodologies and sustained stakeholder engagement to design and conduct implementation research of a complex intervention in Kenyan neonatal hospitals.
Communication among health professionals using newborn technology for care: an exploratory scoping review
Posted 30/09/2025. Effective communication supports the adoption of health interventions. Gloria Ngaiza and colleagues reviewed communication among health professionals using newborn technology for care. The findings showed limited information, centred on a few technologies and disciplines of health professionals. The context of technology use was also crucial in communication, and further research is necessary to explore these areas.
Delivery of care in high mortality hospital settings: a direct observational study examining 1848 h of neonatal nursing in Kenya
Posted 20/08/2025. In resource-constrained countries, deploying better technologies is expected to improve neonatal care, but little attention has been paid to nurse staffing. Abdulazeez Imam and colleagues demonstrate high levels of missed nursing care and ‘off-loading’ of care to largely unsupervised nursing students and mothers, resulting from severe newborn unit nursing shortages in Kenya.
Creating different global health futures: mapping the health research ecosystem and taking decolonial action
Posted 29/04/2025. Decolonisation in global health emphasises the need to challenge and change entrenched power asymmetries and unfair health research practices. Nadia Tagoe, Sassy Molyneux, Caesar Atuire and colleagues have proposed practical decolonial action using a four-step framework and a reflexive tool that can help transform key domains of the global health knowledge ecosystem.
Longitudinal tracking of healthcare professionals: a methodological scoping review
Posted 09/04/2025. How do health workers move through their careers - and how do we know? A new scoping review led by Yingxi Zhao and colleagues examined 263 studies tracking healthcare professionals over time, exploring how career choices, working conditions and wellbeing are measured. The review highlights the need for stronger, standardised tracking methods to inform workforce planning and better support health worker wellbeing across contexts.
Situational analysis of antibiotic prescriptions in Kenyan neonatal units for antimicrobial stewardship: a retrospective longitudinal study
Posted 08/04/2025. High antibiotic use in Kenyan neonatal units may contribute to antimicrobial resistance. A study of 88,000 neonatal admissions in 22 hospitals found 62.6% received antibiotics at admission, mostly first-line drugs. However, non-first-line use was higher in outborn neonates. Monitoring antibiotic patterns at scale feasible and crucial for assessing antimicrobial stewardship and reducing resistance. With Jalemba Aluvaala and Mike English
Effects of health system limitations on the use of blood culture and sensitivity testing in Kenyan county hospitals: an interview-based qualitative study using causal loop diagrams
Posted 02/04/2025. Antibiotic resistance is rising in Africa, but blood culture and sensitivity (BCS) testing faces challenges in Kenyan hospitals. A study using a complex systems approach across eight hospitals found that interconnected issues in both demand and supply, including cost, turnaround time, and logistical barriers undermine the use and sustainability of BCS testing at scale; targeted antimicrobial stewardship may offer a viable alternative. By Jacob McKnight & Mike English with KWTRP colleagues.
Reducing global inequities in medical oxygen access: the Lancet Global Health Commission on medical oxygen security
Posted 01/04/2025. Medical oxygen is a critical treatment in severe illness, yet global access remains inequitable, especially in low-income countries. The COVID-19 pandemic highlighted these disparities. The Lancet Global Health Commission emphasizes systemic improvements, investments in infrastructure, workforce training, and affordability. Addressing these gaps can save millions of lives and strengthen global health resilience. With Jacquie Oliwa and Mike English as members of this Lancet Commission.
Catastrophic expenditure associated with childhood hospitalisation for acute illness in Kenya and Uganda: a cross-sectional study
Posted 04/02/2025. In Kenya and Uganda, hospital care for under-fives is intended to be free. James Berkley and colleagues studied families’ healthcare, travel, other costs, and loss of earnings due to child admissions at six hospitals. 74% to 92% of households experienced ‘catastrophic’ expenditure (depending on the definition used) in relation to monthly income.
After neonatal care, what next? A qualitative study of mothers’ post-discharge experiences after premature birth in Kenya
Posted 28/01/2025. Each year, 15 million babies are born prematurely, with Sub-Saharan Africa and Asia accounting for over half. Weak healthcare systems and poverty in SSA worsen outcomes for mothers and babies. This study by Justinah Maluni and Dorothy Oluoch explores the challenges mothers face post-discharge and suggests strategies to improve care and reduce mortality and readmission rates.
Public service motivation, public sector preference and employment of Kenyan medical doctor interns: a cross-sectional and prospective study
Posted 11/09/2024. Daniel Mbuthia and colleagues surveyed 356 Kenyan medical doctors, to understand what influences their career choices at labour market entry, specifically understanding the role of public service motivation. They highlighted that nearly all surveyed doctors are public service oriented, many doctors stated intention to work in the public sector but were unable due to lack of job opportunities. Unfortunately, 13% of the doctors were unemployed one year after completing their internship.
Examining liminality in professional practice, relational identities, and career prospects in resource-constrained health systems: Findings from an empirical study of medical and nurse interns in Kenya
Posted 03/09/2024. Yingxi Zhao, Stephanie Nzekwu and colleagues examined new Kenyan doctors' and nurses' experiences of transitioning from training to practising as health professionals, drawing on the concept of liminality. The research highlighted three dimensions of liminal experiences in professional practice, relational inter- and intra-professional identity and status, and professional careers.
Factors influencing the development, recruitment, integration, retention and career development of advanced practice providers in hospital health care teams: a scoping review
Posted 10/07/2024. Physician associate and nurse practitioner roles have been developed largely to meet changing healthcare demand and increasing workforce shortages. Yingxi Zhao and colleagues summarise the factors influencing their development and integration in hospital teams, advocating for organisation context-specific workforce solutions, long-term investment, substantial resources, and transparent processes to meet evolving healthcare challenges.
Strategies for Deploying Pediatric Death Audit to Improve Quality of Care
Posted 26/04/2024. Pediatric death audits can be used to improve health care quality and outcomes for children. In this report, MOMENTUM Country and Global Leadership examined the use of death audits in Kenya, Nigeria, Sierra Leone, South Africa, and Zambia. These experiences suggested both challenges in the use of death audits for improving pediatric quality care as well as options to begin developing effective systems that incorporate audits, even in low-resource settings. Three HSC researchers are members of the Momentum team.
Effectiveness of a multi-country implementation-focused network on quality of care: Delivery of interventions and processes for improved maternal, newborn and child health outcomes
Posted 12/03/2024. The Network for Improving Quality of Care for Maternal, Newborn and Child Health (QCN) works with healthcare professionals to improve quality of care at global, national and local levels. In this evaluation Mike English and colleagues explore QCN’s effectiveness in Bangladesh, Ethiopia, Malawi and Uganda and provide useful knowledge for future multi-country global health networks.
Breaking the silence on first referral hospitals and universal health coverage
Posted 01/03/2024. First referral hospitals (FRHs) are neglected in the current discourse on universal health coverage (UHC) in low-income and middle-income countries. Mike English and colleagues propose a comprehensive approach that increases the focus on FRHs in the UHC discourse and shows that they are integral to enhancing primary health care (PHC) in low-income and middle-income countries.
First referral hospitals in low- and middle-income countries: the need for a renewed focus
Posted 28/02/2024. First referral hospitals (FRHs) fulfil important functions in health systems in low- and middle-income countries. Through three reviews Rosanna Mazhar and colleagues found confusion around the definition and function of FRHs and called for renewed interest and investment in FRHs from the global health academic and policy-making community.
Scoping review of interventions to improve continuity of postdischarge care for newborns in LMICs
Posted 19/01/2024. Newborn mortality rates post-hospital discharge in low-and-middle-income countries are a growing concern, with most deaths occurring within 30 days of discharge. Gulraj Grewal and colleagues highlight the interventions used to support care continuity post-discharge, assumptions underpinning these interventions, opportunities and challenges, and whether participatory methods were used in intervention development.