When One Nurse Watches Twenty Babies: Why Counties Are Turning to Innovation to Strengthen Newborn Care in Kenya.

When you tour most newborn units (NBUs) across Kenyan hospitals, you stumble upon the realities of service delivery which are not defined by any lack of commitment from healthcare workers, but by the immense pressure placed on already stretched health systems. Kenya continues to face significant shortages in specialized maternal and newborn healthcare workers, particularly nurses supporting neonatal and high-dependency newborn care.

According to the World Health Organization, the global health workforce shortage is projected to exceed 10 million health workers by 2030, with sub-Saharan Africa carrying the greatest burden. Within Kenya’s public health system, these shortages are especially visible in County Referral Hospitals and busy Maternity Facilities where newborn admissions continue to rise while staffing growth remains constrained. In many facilities, one nurse may be responsible for monitoring more than 15 premature or critically ill babies during a single shift, despite global neonatal intensive care recommendations often ranging between one nurse for every one to four critically ill newborns depending on severity of illness and level of care.

In practice, healthcare workers constantly oscillate between incubators manually checking temperature, respiratory rate, oxygen saturation and pulse rate while simultaneously administering medication, documenting care, counselling mothers, coordinating referrals and responding to emergencies. For newborns whose conditions can deteriorate within minutes, delayed detection can quickly become life-threatening. This challenge contributes to the broader newborn survival burden in Kenya, where neonatal complications such as prematurity, birth asphyxia and infections remain among the leading causes of newborn mortality. According to the World Health Organization, nearly 2.3 million newborns die globally every year, many from preventable complications that can be mitigated through timely monitoring, early detection and quality inpatient care.

Figure 1.0: Simulation of an overwhelmed nurse in an NBU set-up

Against this backdrop, counties are increasingly beginning to see health innovation not as a luxury or pilot activity, but as a transformative policy lever and a practical tool for strengthening overstretched systems. One such innovation gaining traction within county health systems is NeoGuard by Neopenda, a neonatal monitoring solution designed to support continuous monitoring of vital signs including oxygen saturation, respiratory rate, pulse rate and temperature. Rather than replacing nurses, the technology is helping healthcare workers monitor multiple babies more effectively from centralized displays while receiving alerts whenever a baby’s condition moves outside normal ranges. This innovation saves lives by enabling effective risk-based management of neonates and timely intervention in case of any deviations in vital signs – in the context of constrained human resources.

Figure 2.0: A complete set of a Neoguard system

Recent county-led deployments in Kericho, Migori and Kakamega are beginning to illustrate what this shift could mean for the future of newborn care in Kenya. Earlier this month, Kericho County, led by the County Governor, officially launched the deployment of NeoGuard devices across eight health facilities simultaneously, making it one of the most advanced county-wide neonatal innovation deployments currently underway under the Public Sector Scaling (PSS) initiative. Following a benchmarking visit to Kisii County in 2025, the county developed a structured procurement plan and later acquired 100 NeoGuard devices distributed across Kericho County Referral Hospital, Kapkatet, Sigowet, Londiani, Roret, Sosiot, Fort Tenon and Kipkelion facilities, in respect to their newborn unit capacity.

What makes the Kericho experience particularly important is that the county moved beyond the common donor funded “single-site pilot” approach that often characterizes healthcare innovation deployment. Instead, the county invested its own budget resources and integrated neonatal monitoring capacity across multiple facilities at once, signaling a transition from demonstration projects into county-driven system-level scale. This approach is important because strengthening lower-level facilities reduces unnecessary patient referrals, lowers pressure on tertiary newborn units and allows more newborns to receive quality care closer to their communities. This approach echoes and aligns with the national level policy priority of strengthening primary healthcare (PHC) as a key driver of UHC.

The experiences emerging from Roret Sub-County Hospital help paint this reality more clearly. During training and installation sessions, healthcare workers expressed optimism that the devices would significantly reduce referrals once the newborn unit becomes fully operational. For many lower-level facilities, referrals are not only costly to counties and families, but also risky for unstable newborns who require continuous monitoring during transportation. Innovations that strengthen monitoring at peripheral facilities therefore have implications far beyond individual hospitals; they strengthen the entire referral ecosystem.

Figure 3.0: NeoGuard monitoring station set-up at Kericho County Referral Hospital: Looking is Dr. Erick Mutai, The County Governor

Kakamega County presents yet another compelling example of how counties are institutionalizing neonatal innovations within routine service delivery. After a similar benchmark visit to Kisii County, Kakamega moved from observation to procurement, acquiring 80 NeoGuard devices now deployed across Kakamega County General Hospital, Malava, Butere and Lumakanda facilities. What stands out in Kakamega’s rollout is not just procurement itself, but the level of integration into routine health systems. Training sessions involved Nurses, Pediatricians, Biomedical engineers, ICT teams and Clinical officers, reflecting a broader recognition that sustainable innovation scale depends on cross-functional, multidisciplinary and system-wide readiness and not simply device availability.

Figure 4.0: Ongoing multi-team NeoGuard training at the Kakamega General Referral Hospital

The rollout experiences in both counties have highlighted important operational realities that are often overlooked in innovation conversations. County teams are already dealing with practical issues and systemic uncertainties such as mounting monitors within crowded NBUs, reliable power access, charging infrastructure, workflow integration and continuity of effective use when trained staff are transferred or rotated. Tellingly, one of the biggest lessons emerging from county innovation scale readiness assessments is that innovation sustainability is often threatened not by technology failure, but by workforce turnover. In some counties, innovation use has significantly slowed following the transfer of trained personnel, leaving facilities without staff confident enough to continue using the systems. In other cases, loosing leaders and innovation champions through redeployment has the same effect.

This has prompted counties and partners to begin exploring Training-of-Trainers (ToT) models where selected frontline healthcare workers and facility managers receive deeper tutor-oriented training and become county-level champions responsible for onboarding new staff and sustaining institutional memory. This emerging shift recognizes an important truth about healthcare innovation scale: technologies alone do not transform health systems; people do.

Across Kericho, Kakamega and other counties, nurses remain the central drivers of adoption. They are the ones integrating innovations into already demanding workflows, troubleshooting operational challenges, mentoring colleagues and sustaining continuity of care despite staffing shortages and resource limitations. In many ways, the success or failure of innovation scale within public health systems may ultimately depend on how well counties support and empower these frontline healthcare workers.

The broader lessons emerging from these county experiences extend well beyond neonatal monitoring. Across Kenya, counties continue to grapple with workforce shortages, rising patient volumes, referral inefficiencies and constrained infrastructure and financing. What counties like Kericho and Kakamega are beginning to demonstrate is that innovation adoption works best when it is demand driven, Government-led, integrated into routine systems, financed through public resources and structures and actively owned by frontline healthcare workers themselves.

Figure 5.0: Nurse at Kericho County Referral Hospital using a NeoGuard device

The future of maternal and newborn healthcare innovation in Africa may therefore depend less on proving that technologies work and more on proving that Governments, with strategic engagement and support, can sustainably integrate them into everyday care delivery. Counties that move beyond isolated pilots and begin embedding innovations into county-wide systems are offering an important glimpse into what that future could look like. And at the center of that future remains that nurse in the newborn unit: still overstretched and navigating difficult realities, but now increasingly supported by innovations designed not to replace human care, but to augment and amplify it.