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.

Africa is rapidly urbanising and with this growth has come a proliferation of informal settlements. Residents of informal settlements often have limited access to services, insecure tenure and high exposure to shocks and stresses such as flooding and disease. Several global and national frameworks have indicated that a key tenet of sustainable urban growth is building 'resilience'. Yet, resilience can mean different things to different decision makers - an engineer might measure it as the number of alternative cables in the electricity network if one breaks; a psychologist might describe resilience as a person's ability to adapt to adversity. Indeed, resilience often does not have a direct translation in many languages. Those involved in making cities more resilient to natural hazards (e.g., floods) such as engineers and planners tend to have highly technical training. Within these groups, traditionally there is a tendency to quantify resilience in terms of what can easily be placed on the map - such as housing, infrastructure and critical facilities. This can result in some tunnel vision about what types of projects should be taken forward when local experience and perceptions are not taken into account. In spite of these challenges there is a genuine desire in our study city of Nairobi (Kenya) to include the voices of residents in decision making. However, it is not always clear how this more qualitative, experiential information on resilience (e.g., narratives) can be incorporated to existing ways of working by city actors, nor is there necessarily the capacity to undertake major new ways of working. The Expressive Mapping of Resilience (E-MoRF) project aims to mainstream innovative, low-cost ways of representing these community voices on the map, coupled with simple ways for decision makers to incorporate this data into their existing systems to result in more inclusive planning for resilience. The work here builds upon a previous NERC funded project 'Why we Disagree about Resilience' (WhyDAR) that was delivered with Kounkuey Design Initiative (KDI) in Nairobi (who we work with in E-MoRF). In WhyDAR, artists and residents of informal settlements worked together in a collaborative environment to define a broad range of ways that people cope with flooding, and the threats to their resilience. Using themes that came out of the workshop, coupled with data collected in the settlement using smartphones, we generated immersive maps combining 360 deg photos, audio and text to communicate a broader perspective of what resilience meant to the community. These prototype maps were made publicly available online using free software. We showed these prototype maps to decision makers such as urban planners, consultants and NGOs who stated that these maps are an engaging way to better understand what planning interventions might support the community, and commented that the data layers could be incorporated into their existing mapping software. At present these maps are static and there is no method in place to continually update them to make them regularly useable. In the E-MoRF project, we will move from prototype to operational maps through: A. Creating and distributing training resources for community groups to identify key components of resilience specific to them and then generate expressive map data to visualise this B. Creating an open, online platform where this map data can be uploaded, viewed and distributed to a range of decision makers C. Creating and distributing training resources for decision makers to help understand these new types of map and how they can be incorporated in their daily work D. Throughout the project, having a continuous cycle of feedback from community groups and decision makers to ensure the maps are useful, useable and used E. Exploring how the process affects decision making with regards to resilience F. Disseminating resources to encourage uptake of the approach in additional cities