 I am a social scientist and health systems researcher with the Chemriwelcom Trust Research Programme. My role in the health services that deliver for newborns has been in co-leading qualitative research aspects of the project for the last three years. Nurses are very important in the delivery of care for newborns. So our work was looking at the nursing culture in these hospitals, looking at what the barriers, the enablers are for actually being a nurse in a newborn unit and what that means in terms of service delivery. The methods that we used was initially inviting stakeholders and engaging them in understanding what the nursing issues are in the country. So these were mainly drawn from training institutions from the Ministry of Health and from the nursing council and we were also doing ethnographic work with frontline nurses to understand what the culture of nursing is in those public hospitals. The advantages of social science methods is that they provide a deep understanding of the phenomenon of interest. In our case, it provides a deep understanding of what it means to be a neonatal nurse. It provides a deep understanding of what the social context is within which the newborn nursing takes place. And particularly useful for this project is that it enabled us to understand whether some of the intangible things that you need to consider when you're coming up with a strategy to try and improve how care is provided, particularly in our case, task shifting strategy. The main methods that we used in this work was ethnographic methods. So we were embedded within these hospitals of an 18-month period and we were using long-form interviews with the nurses. So these are typically different from your usual question answer. We were really looking for narratives and stories from the nurses about what it means to work in those units. We spent a lot of time doing non-participant observations, more than 250 hours of observing night shifts, weekend shifts and day shifts. And because we were there for such a long time, we developed really close relationships with the nurses. That means we were able to talk with them informally and keep diaries of this. These were really innovative ways of trying to understand what it means to be a nurse in the newborn units. The newborn units themselves, I would say, they are small, very congested spaces in terms of they'll have anything from 40 to 80 babies. But what is more surprising is the ratio of nurses to babies. So you have one nurse to anything from 15 to 20 very sick babies, which makes it such quite a challenge for a nurse to work there. And most of the time, the nurses were actually unsupported to be able to provide that work. The mortality ratios were quite high, anything from 50% going upwards. And therefore, it means that they were quite emotional spaces, both for the researchers and for the nurses themselves. So some of the key findings that we saw unsurprisingly, nurses were completely overwhelmed. They had a very difficult job to do, but also interestingly, they came up with different ways of coping. I can think of three main ways that they came up with that really stood out from this work. So one of those things was a way of prioritizing tasks. So they had developed a hierarchy of doing those tasks that the more technical tasks were given more priority, sort of making sure the babies that making sure that the babies get their medicines, making sure that they get fluids. This was more prioritized more than the bedside care, which includes things like canceling mothers or took into a mother after they've lost a child that was given as much priority. Another thing that came from our work was that there was already informal task shifting that was happening in these words. So because the nurses are so stretched in terms of what to do, they were informally delegating to mothers, to students and to support staff. So some of the things they were delegating is like feeding the children, feeding the babies, cleaning of the babies and in some hospitals, mothers were actually tasked with weighing and keeping feeding charts in the various hospitals where we went to. And then lastly, the routines that nurses came up with included coming up with sort of a mental a lot of making sure that you get through some tasks so that at the end of the day, they're able to say, I was able to achieve this. So in each typical shift, they will make sure, for example, that medicines have been given, fluids have been given, ward runs have been done. And that was a way of them just getting through what is essentially a difficult job. I think the unique thing that this work has shown is that there is need to invest in the software strengthening of human resources. Because often what has happened is that a lot of focus has been on strengthening the hardware of human resources. So for example, thinking of how to increase the numbers of nurses within maybe a health system, how to increase training, but it's a little bit more about thinking about what does this training mean. So for example, if you're training more, if you're training nurses, are we preparing them for the practical and realistic conditions that they find on the ground where they don't have enough support and they don't have enough basic resources. Another potential solution is thinking about task shifting. So from our work, there was already informal and organic task shifting going on. So what lessons can we draw from that that can inform a more formal and strategized task shifting strategy where we can move some of the non-technical tasks away from nurses to enable them to actually do tasks that they have been trained for, and tasks that actually reinforce their professional identity, and then move the non-technical tasks to a lower harder, so more of the clerical jobs can go to a more informal harder with the nurses actually supervising and supporting that harder. I think from this work, there is potential to look at nurse resilience and how that can be maintained. So for example, from our work, despite all these challenges, nurses were showing up for work and they were still working with poor support and lack of enough drugs and basic equipment. So there was a passion, they had a passion for what they were doing. So how do we tap into that intrinsic motivation and maintain it so that there ought to be more research that looks into that. And then if we think about task shifting, we also have to think about, well, what are some of the regulatory and governance mechanisms that we need to think about when we introduce a new cadre? How do you start thinking about integrating it to the formal health systems? And understanding that those formal health systems are also complex as they are out with their own problems. So I see these two as ways of thinking ahead in terms of future research in this area.