By late 2024, routine practices at Kilifi County Hospital were no longer matching the scale of patient needs, and the maternity ward felt the weight of the disparity with every shift. The hospital leadership team noted an alarming trend while reviewing the PULSE dashboard, a real-time performance tool co-designed by Jacaranda Health and government partners to help leaders identify gaps in maternal care. 

The numbers showed a stark increase in neonatal deaths, rising from 67 in 2023 to 287 in 2024. Periodic Maternal and Perinatal Death Surveillance and Response reviews (MPDSR) added depth to the data by linking each death to clinical decisions, skill gaps, data quality and reporting gaps, as well as system failures observed on the ward in real time.

In response, the maternity nurse in charge convened with the Sub-County Reproductive Health Coordinator and the in-charges of the High Dependency Unit (HDU) and Newborn Unit (NBU). Using PULSE data, they agreed that saving newborn lives would require a deliberate shift in how the facility learned, reflected, and built clinical skills.

A Shift In The Ward

The data pushed the facility and county leaders to prioritize weekly MPDSR reviews over sporadic ones. The meetings provided the nurses with the opportunity to review cases and allowed the team to carry out targeted drills based on gaps identified during the meetings. 

“We realized that if we only looked at the deaths once in a while, we would always be late,” says Salim Ahmed, Maternity Unit In-Charge. “That is why we committed to weekly MPDSR reviews to catch gaps early and act immediately.”

Nurses during a weekly MPDSR review

PULSE data identified asphyxia as a leading cause of neonatal death. Through MENTORS, Jacaranda Health’s peer-training initiative for sustainable Emergency Obstetric and Newborn Care (EmONC) skills, the team prioritized neonatal resuscitation training. Drills were expanded to include all nurses and students, ensuring a coordinated and confident response to newborn distress.

Nurses at Kilifi Sub-County Facility participating in a Mentorship Drill

To accelerate progress through stronger clinical leadership, the County Reproductive, Maternal, Newborn, Child, and Adolescent Health Coordinator (RMNCAH), Kenneth Miriti, encouraged consultant gynaecologists to take a more active role in leading drills alongside frontline teams, introducing a multi-cadre approach to their in-facility mentorship training.

“At first, these drills were led by nurses and midwives, not consultants,” he explains. “But when we compared performance across facilities, it became clear that sites with mentorship from senior, high-level clinicians consistently achieved better results.”

As part of the facility’s mitigation plan to ensure all staff are well-equipped during emergencies, they also organized their emergency drugs in a way that ensures access and muscle-memory familiarity in a high-pressure situation. 

“We came up with emergency boxes that have all you need for each obstetric emergency that we use during the training drills and in real situations so that the team can familiarize themselves with the contents.” Dr. Busra A Ahmed, Obstetrics and Gynaecology Consultant and Mentor. 

Dr. Busra A. Ahmed, the facility’s Obstetrics and Gynecology Consultant taking the team through a MENTORS drill

A Drop  Neonatal Mortality

An increase in quality data capture and skills confidence in staff, led to a drop in neonatal deaths from 287 in 2024 to 231 by end of 2025, which serves as the ultimate proof of the facility’s turnaround. This data point signaled the end of overwhelmed shifts and the gradual beginning of a new culture defined by capable, supported staff handling emergencies with confidence.

Graph Source: Jacaranda Health PULSE Dashboard

“Before, we were not confident in setting up even a CPAP, especially for very small babies,” says Zacharia M. Nyambu, a medical officer who has worked at the facility for two years and became a mentee eight months ago. “Now, we can stabilize them better, and we are seeing higher survival rates.”

According to the nurse in charge, Josephine Kazungu, the team is now confident in taking on the night shift. “Planning the monthly rota is not a headache because the team is capable of handling the situations that come up within the facility,” she mentioned. 

Nurses reported greater confidence during night shifts, improved teamwork during emergencies, and stronger clinical judgment across units. The hospital sustained weekly case audits, reinforced accountability, and built a culture where data directly guided learning and clinical action, translating into more babies surviving and going home with their families.