 I'm Mike English, I'm Professor of International Child Health with the Centre for Tropical Medicine and Global Health in Oxford but I have lived and worked in Kenya at the Ken Murray Welcome Trust Research Programme. So the health services that deliver for Newborn's project was a set of multidisciplinary work that we wrote a proposal for way back in 2013 and we've been working on this area for four years and the idea of the health services that deliver for Newborn's project was to take Nairobi County as an example and really try and understand how care for sick Newborn babies, those that require to be admitted to hospital, how it's organised, what the capacity is, what are the challenges of delivering it and what are some of the key quality issues. Delivering high quality care is obviously a process that involves a huge number of different people from policymakers through to senior practitioners who lead in directorings through to those that actually provide the care even the families themselves and so we wanted to try and understand all of these elements and we were particularly concerned about in some parts of trying to understand actually physically what's the capacity of the system in Nairobi which serves a population of four and a half million people of whom a very large number of very from very low income settings. We were particularly interested in what the capacity was to provide the right amounts of care since we know that in Nairobi neonatal mortality that's the number of babies who die in the first month of life is extremely high. One of the major parts of this project was to try and understand the capacity to provide care for this Nairobi population and a lot of this work was led by a colleague of mine called Dr Gina Murphy but working with a large set of Kenyan researchers and one of the things we had to do first was establish how much care is actually needed and we had to do that by using epidemiological approaches by using lots of research findings that have estimated how many babies might get sick from particular conditions and so we pulled together lots of this epidemiological research and made an estimate based on the number of births we know happen in Nairobi County to suggest how many babies would need to access hospital services so that was one key piece of work. Then what Gina and the team with David and others in the team what they did was actually identify all the facilities that were expected to provide inpatient care for sick babies that's those babies that needed to spend one or two or three or even sometimes many more nights actually in hospital receiving care. That was quite a bit of work to identify all of those to reach out to them to ask if they would be happy for us to engage them in the research and then actually using tools to go out and try and characterize fully what they're capable of doing and the resources they have and some of their practices so that was about actually trying to assess if you like the readiness of the system to offer care to the sick newborns that we know will be likely to be needing it and the final thing we do is actually if you like check whether the medical care that was being provided was of a good standard and we used as a standard there the national recommendations for how neonatal care should be provided so we had several sets of work all building up to help us understand if you were a sick newborn in Nairobi you're maybe within six or 12 hours of birth that baby needs to be admitted to hospital we have we were able to estimate how much care is available to them and our estimates suggest that probably 40 to 45 percent of babies who should get to a good hospital for care probably never make it at all of the ones that do make it to the hospital we estimate that only half of those actually are admitted to a hospital which is ready to provide good quality care so what that means in reality is that of all the babies that perhaps should get into a good hospital for care only about one quarter actually make it to a place which can provide good quality care that was a whole set of work which is what we call effective coverage so we think the that's our key one of our key results is that effective coverage is only available for 25 percent of babies who need in hospital care in Nairobi County further work and I think my colleagues are talking about this went on to then investigate nursing care which wasn't captured in this initial set of estimates and we now know from the nursing care work and evaluating that that even that what I said was 25 percent might access a place ready to provide good care even if they reach those places the challenges with nursing care are so profound that most babies probably don't get high quality care now some of the key priorities we've identified in one sense may not be revolutionary but we've really been able to provide information to underline their importance absolutely critical is we need more nurses the number of nurses available to provide care to these sick newborns is just too few so that's an absolutely critical need however what we've also found is that the system of care for this population needs to be much better organized and we probably need to think about different levels of care what we've seen is that the majority of people and obviously particularly the poor people tend to use the government provided services and they're a completely overstretched and so what we need to do is strengthen the existing facilities but probably also think of ways in which we can add new facilities based care maybe in smaller places better distributed around the county and so that they can provide some basic forms of hospital care for newborns and if they're unable to provide more advanced care then we need systems where the babies and the mothers can be moved to a hospital where that care can be better provided so they're actually quite major long-term strategic issues for the health care system in Nairobi and we think probably for the rest of the country in how we're going to provide these services so there's issues of the infrastructure we need systems we need to move people from one place to another should they need more advanced care and then critically the human resources that we have able to offer those care this project has brought together epidemiologists clinicians clinicians like myself as a pediatrician it's brought together social scientists including anthropologists it's brought together statisticians and we've been working with policymakers with senior professionals with regulators and I think what it's shown us is that you need to make very special efforts to bring these groups together to help them understand each other each piece of work has its own methodology or approach but it's important that other parts of the team understand the value of those methods and it's also helped us to understand that these are long-term processes and we're learning as we go and it's been very important we feel to bring our stakeholders those organizations I've mentioned together on this journey because I think we're in a better place now to continue doing further multidisciplinary work going forwards to tackle many of the issues that we've now uncovered