The Kenya ethics protocol “Exploring the Future of Hospitals offering ‘first referral’ services in Africa: Research on Service Delivery, Workforce Dynamics and Technology Integration in Kenya linked to a multi-country collaboration including South Africa and Uganda” was approved by the Kenya Medical Research Institute Scientific and Ethics Review Unit (KEMRI SERU) on 12th May 2025. The next step is to obtain for a research license from the National Commission for Science, Technology and Innovation (NACOSTI) https://oris.nacosti.go.ke as well as local facility clearance.