Background Nursing practice is a key driver of quality care and can influence newborn health outcomes where nurses are the primary care givers to this highly dependent group. However, in sub-Saharan Africa, nursing work environments are characterized by heavy workloads, insufficient staffing and regular medical emergencies, which compromise the ability of nurses to provide quality care. Task shifting has been promoted as one strategy for making efficient use of human resources and addressing these issues. Aims and objectives We aimed to understand the nature and practice of neonatal nursing in public hospitals in Nairobi so as to determine what prospect there might be for relieving pressure by shifting nurses’ work to others. Methods This paper is based on an 18-month qualitative study of three newborn units of three public hospitals—all located in Nairobi county—using an ethnographic approach. We draw upon a mix of 32 interviews, over 250 h’ observations, field notes and informal conversations. Data were collected from senior nursing experts in newborn nursing, neonatal nurse in-charges, neonatal nurses, nursing students and support staff. Results To cope with difficult work conditions characterized by resource challenges and competing priorities, nurses have developed a ritualized schedule and a form of ‘subconscious triage’. Informal, organic task shifting was already taking place whereby particular nursing tasks were delegated to students, mothers and support staff, often without any structured supervision. Despite this practice, nurses were agnostic about formal institutionalization of task shifting due to concerns around professional boundaries and the practicality of integrating a new cadre into an already stressed health system. Conclusion Our findings revealed a routine template of neonatal nursing work which nurses used to control unpredictability. We found that this model of nursing encouraged delegation of less technical tasks to subordinates, parents and other staff through the process of ‘subconscious triage’. The rich insights we gained from this organic form of task shifting can inform more formal task-shifting projects as they seek to identify tasks most easily delegated, and how best to support and work with busy nurses. Electronic supplementary material The online version of this article (10.1186/s12960-019-0352-x) contains supplementary material, which is available to authorized users.

No abstract

Aims and ObjectivesTo review systematically, qualitative literature covering the implementation of task shifting in sub‐Saharan Africa to address the growing interest in interventions of this kind. This review aims to distil the key practical findings to both guide a specific project aiming to improve the quality of neonatal care in Kenya and to contribute to the broader literature.BackgroundTask‐shifting programmes aim to improve access to healthcare by delegating specific tasks from higher to lower skilled health workers. Evidence suggests that task‐shifting programmes in sub‐Saharan Africa may improve patient outcomes, but they have also been criticised for providing fragmented, unsustainable services. This systematic review of qualitative literature summarises factors affecting implementation of task shifting and how such interventions in sub‐Saharan Africa may have affected health workers' feelings about their own positions and their ability to provide care.DesignFollowing literature search, a modified Critical Appraisal Skills Program (CASP) framework was used to assess quality. Thereafter, analysis adopted a thematic synthesis approach.MethodsA systematic literature search identified qualitative studies examining task ‐shifting interventions in sub‐Saharan Africa. Thematic synthesis was used to identify overarching themes arising from across the studies and infer how task‐shifting interventions may impact on the health workers from whom tasks are being shifted.ResultsFrom the 230 studies screened, 13 met the inclusion criteria. Overarching themes identified showed that task shifting has been associated with jurisdictional debates linked to new cadres working beyond their scope of practice, and tension around compensation and career development for those taking on tasks that were being delegated.ConclusionsBased on the qualitative data available, it appears that task shifting may negatively impact the sense of agency and the ability to perform of health workers' from whom tasks are shifted. The potential implications of task shifting on all health workers should be considered prior to implementing task‐shifting solutions.

Kenya's invasion of southern Somalia, which began in October 2011, has turned into an occupation of attritionwhile "blowback" from the invasion has consolidated in a series of deadly Al-Shabaab attacks within Kenya. This article reviews the background to the invasion, Operation Linda Nchi, and the prosecution of the war by Kenya's Defence Forces up to the capture of the city of Kismayo and the contest to control its lucrative port. The second section discusses Al-Shabaab's response, showing how the movement has reinvented itself to take the struggle into Kenya. We conclude that while the military defeat of Al-Shabaab in southern Somalia seems inevitable, such a victory may become irrelevant to Kenya's ability to make a political settlement with its Somali and wider Muslim communities at home. ON 16 OCTOBER 2011, KENYA'S armed forces invaded southern Somalia in the midst of a severe local famine and a regional drought. Their purpose was to capture the port city of Kismayo and to crush the Al-Shabaab Islamist militia. 1 The first aim was accomplished after more than a year of slow progress and sometimes hard fighting, but with the second aim seemingly as remote as ever after a third year of war, the capture of Kismayo looks increasingly like a hollow victory. Al-Shabaab has reacted with gun, bomb, and grenade attacks against targets in Nairobi, Garissa, and other Kenya towns, most notorious among them the assault upon Nairobi's

Highlights We report findings from a point prevalence survey across 14 Kenyan public hospitals. About half of the hospitalised patients received appropriate antibiotic therapy. Laboratory investigations supported less than 1% of the antibiotic prescriptions. Physical availability of treatment guidelines influenced treatment appropriateness. There is need for context-specific, up-to-date, and accessible treatment guidelines.