In 2023, Kakamega’s county health department came to us with a challenge. Some hospitals had specialized newborn units (NBUs), but many nurses didn’t have the skills or confidence to use them fully. Partner facilities also reported high referral rates for newborns with complications that could have been managed on-site.

Historically, our MENTORS program has focused on upskilling nurses to appropriately manage and mitigate obstetric complications, with an additional module on neonatal resuscitation. But the county’s call for support prompted us to rethink the scope of our curriculum and build a more comprehensive newborn training package—grounded in our tested, cohort-based mentorship approach.

Building the training package

We worked closely with the Ministry of Health (MoH) and Kakamega County to align the training with national guidelines and ensure strong county ownership. Together, we built a newborn mentorship model that combined structured clinical training, real-time coaching, and leadership from county health teams to strengthen providers’ skills and confidence.

County leadership proved essential to the success of the program. Dr. Roseline Malangachi, the County Paediatrician, and Lead Trainer for the newborn package, championed the training and ensured the package aligned with county priorities. At the facility level, Dr. Faith Mutai, Paediatrician at Malava Sub-County Hospital, and Patricia Nafula, the hospital’s Nursing Services Manager, served as trainers and supported Dr. Malangachi. Their hands-on involvement grounded the program in the realities of daily clinical care and made the training practical.

As Allan Govoga Agala, Program Manager at the Ministry’s Division of Newborn and Child Health, noted:

“Jacaranda Health’s work offers valuable insights for partners looking to strengthen neonatal mentorship. Our goal is to develop a national mentorship package that ensures all healthcare providers have the same level of skills and knowledge.”

Understanding the challenges

In November 2023, Jacaranda initiated a CIFF-supported pilot study in Kakamega County to understand the experiences of mothers and nurses surrounding care for at-risk newborns, and how our programs could support them. Group discussions with mothers unearthed knowledge gaps around newborn danger signs, infection control, and feeding practices. Frontline maternity nurses voiced a lack of knowledge to confidently identify high risk newborn cases, and skills to apply the right preventative management during emergencies. All providers unanimously agreed on the need to routine refresher training on care.

“There is a big gap in skills and knowledge surrounding newborn care. And you can’t afford to miss a step when managing a baby.” – Kakamega Nurse, Study Participant

Launching a newborn care mentorship pilot

In March 2024, with the MoH’s Division of Maternal and Newborn Health alignment, we rolled out a six-month newborn care mentorship pilot in Kakamega to strengthen provider capacity in managing sick and small newborns. Providers built critical skills and practical experience through lectures, simulation drills, and hands-on coaching. The roll-out of the newborn package began with a training of trainers week, empowering a multidisciplinary team frontline nurse ‘champions’ and county pediatricians to cascade vital skills in emergency newborn care down to their peers in facilities. Participants were taken through a range of drills and exercises, covering best practices for safe newborn transfers, to appropriate management of respiratory distress, jaundice and birth asphyxia.

Key results

Between March and September 2024, the mentorship program trained 65 frontline providers (38 nurses and 5 clinical officers) across three high-volume Level 4 hospitals: Malava, Butere, and Lumakanda. By the end of the six-month period:

• 43 providers completed the full mentorship curriculum (66% completion rate).
• Knowledge on neonatal care increased from 56.8% to 94.2%.
• Competency in neonatal resuscitation rose from 64.5% to 94.0%.

In one year, neonatal deaths in the three pilot hospitals dropped by 34%—from 82 deaths in 2023 to 54 in 2024. This reduction reflects a shift in neonatal care. The training had supported day-to-day changes in how providers delivered care to newborns, responded to neonatal emergencies, and worked as a team inside newborn units.

Through the mentorship program, providers built hands-on skills in neonatal and newborn emergency care. As their confidence grew, they began managing more critical cases on-site and stabilizing newborns they once would have referred to county hospitals. Referral rates steadily dropped—especially in facilities with well-equipped, functional newborn units—driven not just by exposure, but by targeted training that shifted how providers delivered care.

Malava Hospital shows just how powerful that shift can be. Before the training, providers referred out all infants under 1500 grams. After the mentorship, they began caring for stable preterm babies themselves. In March, staff independently managed two very preterm newborns—each weighing just 800–900 grams at birth—and discharged both in stable condition at nearly twice their birth weight. One baby, now known affectionately as the ‘miracle baby,’ has even returned to visit the team who cared for her.

Beyond the numbers

Mentees expressed greater confidence in handling critical cases
Mentorship brought about changes in how providers approach newborn care. Providers shared they had improved confidence, particularly in managing preterm babies with respiratory distress. One clinician from Malava Hospital shared the new skills from the training, empowered them to swiftly initiate neonatal resuscitation, stabilizing the baby before referral to the neonatal unit.

“A preterm baby was born with poor muscle tone and weak respiratory effort. Before the training, we would hesitate. Now, we promptly initiate resuscitation and stabilize the baby before transfer.”

Mentees highlighted stronger teamwork within newborn care units
Providers shared improvements in teamwork and coordination within newborn care units. Structured case reviews, daily neonatal rounds, and clearer role allocations during emergencies streamlined care and enhanced communication among team members. One nurse from Butere Hospital described the impact:

“We now have structured debriefs after critical cases, which help us learn from each experience and ensure we provide the best care possible.”

Mastering neonatal resuscitation through simulation drills
Simulation drills allowed providers to practice under real-time feedback, enhanced preparedness and gave them the confidence to handle emergencies effectively. One participant noted:

“Real-time feedback during drills has greatly improved our ability to handle neonatal resuscitation. We are now more confident in emergencies.”

Looking ahead

Mentees praised the mentorship program and recommended increasing the frequency of hands-on drills and incorporating unexpected clinical complications into training scenarios. These enhancements will strengthen providers’ ability to manage a wider range of newborn emergencies with precision and confidence.

With promising results and strong engagement from healthcare providers, Jacaranda is now looking ahead to the next phase: scaling the initiative to reach even more facilities and frontline workers. Jacaranda and Kakamega County will launch a new training cycle in March 2025, expanding mentorship to five additional facilities. Building county-level ownership is crucial to sustaining these gains.

We are also collaborating with the Ministry of Health to ensure our newborn mentorship remains aligned with their national training package. To reach more providers remotely, we plan to expand the program to our WhatsApp-based DELTA platform, which trained 3,500 providers in other modules in 2024.

By the end of 2025, Jacaranda hopes to expand newborn mentorship to other high-priority counties, focusing on regions with high neonatal mortality rates. We plan to leverage our dashboards, PULSE, as a complement to the training – enabling us to better track and flag gaps in provider performance, broader quality of newborn care metrics, and additional factors that might influence comprehensive newborn care, such as the availability of commodities, equipment, and staffing. Scaling mentorship will require close collaboration with county and national health leaders, along with partners who can help sustain training efforts over time.