Health Services that Deliver: Improving Care for Sick Newborns (HSD-N) In 2009, there were 42,000 newborn deaths and they accounted for 40% of all deaths among children under 5 Kenya. This high neonatal mortality is a major reason why Kenya is not succeeding in its battle to reduce child deaths in line with stated targets. Recognising this, the Ministry of Health has started to focus on improving newborn (and maternal) health with strategies aimed at communities and small clinics. However, sick or vulnerable newborns will often require inpatient care in referral facilities from skilled workers with access to basic technologies. Interventions typically delivered at this level include, for example, fluids or feeds for those unable to suck or oxygen for respiratory support. Such interventions require carers to perform the same, time-consuming tasks multiple times per day for many days. Shortage of skilled health workers often means these services are inadequately delivered, potentially delaying or preventing recovery. We are planning research that will establish: the potential burden of severe neonatal illness; what existing infrastructure and human resource capacity is available supporting access for this population; utilisation of these services; and the quality of existing nursing care services. We will do this focusing on Nairobi's population of 5 million, many of whom are very poor. With a focus on universal coverage and neonatal care meeting agreed standards, this work will provide the basis for estimating the gap between available and needed services (Gap 1) and the quality gap between existing and desired services (Gap 2). In partnership with important stakeholders, we will explore how a low-income country might best tackle health workforce challenges to close these gaps and improve provision of essential nursing care to all sick newborn babies in an affordable and efficient way. This ultimate aim of research is driven by the fact that salary costs are a major proportion of total health care costs. One option will therefore be to explore alternatives to employing professional nurses if necessary interventions can be effectively provided by other groups under the supervision of professionals - an approach known as task-shifting. Although task-shifting sounds a simple solution, it may not always be. Failure to consider national regulations, the opinions of important professionals, managers or parents may lead to the approach being rejected or failing. Taking account of the local situation may be particularly important when those being cared for are sick, newborn babies and when day to day care has traditionally been given by professional, even specialist nurses.  First, therefore, we will define with the major groups what forms of care should be available to all, learn what regulations exist on providing care, and consider the concerns of major groups with respect to task-shifting. We will examine carefully all the things that nurses have to do in a range of different facilities, explore with experts which tasks may be simple enough for others to do, and examine whether there is time to do all the essential care tasks. We will estimate how much need there is for neonatal nursing care in Nairobi and the gap between what is available and what is needed. Using all these data we will explore how many new staff might be needed to improve the delivery of essential care for all newborns in need. We will also undertake preliminary work to explore the costs of meeting this need using extra professional nurses or if tasks were shifted to other, lower cost staff. Possible roles for lower cost staff will be informed by work examining what tasks to shift and how they might fit within existing patterns of providing care.  All this work will be conducted with the major decision makers in health, health professionals and parents to develop options sensitive to local conditions. Based on this body of work we aim to develop a task-shifting approach that can be tested in Kenya in the future. The Global Challenges Research Fund (GCRF) supports cutting-edge research to address challenges faced by developing countries. The fund addresses the UN sustainable development goals. It aims to maximise the impact of research and innovation to improve lives and opportunity in the developing world.