Attaining universal healthcare for Kenyans will largely depend on whether the coverage is wide enough and affordable to the majority of Kenyans and whether there is adequate healthcare personnel to provide the needed care.The health sector workforce determines the scope of service coverage, which in turn influences healthcare outcomes. With the devolved management of health workers, the number of health workers has expanded because of direct employment and deployment.
This has improved the ratio of health professionals to that of the population across the country, although the ratio still falls short of the World Health Organization (WHO) target of 30 medical officers per 100,000 people and 230 nurses per 100,000 people. In the devolved system, and through the county and national governments, the country has achieved 25 medical officers per 100,000 people and 77 nurses per 100,000 people.
That said, several supply challenges require urgent attention in improving health service delivery. For example, although most counties are investing to expand healthcare infrastructure, this is done without an equivalent increase in human resources.Further, due to inadequate deployment framework, unengaged trained health professionals coexist with under-resourced facilities. Shortages are also experienced across some categories of technical staff, including community health workers, health technologists, health engineers, doctors, dentists and surgical staff, among others.
Other supply challenges include reluctance of health workers to relocate to rural and/or hardship areas with limited amenities compared to urban areas. In addition, retaining health professionals is an emerging challenge due to the relatively high demand for health professionals across the globe, dynamics in health care, and attractive remuneration packages and better working conditions in other countries.In addressing these challenges, it is important to strengthen human resource planning and management practices, provide better working conditions, and promote integrated planning. A competent and well-motivated staff will go a long way in improving service delivery and support in achieving universal health care.
Attracting and retaining health workers in hardship areas will require implementing special incentives such as provision of housing (or better housing); adequate hardship allowance; and provision of in-service training and targeted career progression opportunities. Other solutions include the creation of a formal support structure that facilitates the design and implementation of recruitment and retention interventions owing to the dynamic nature of health service provision and the management of its human resources.
In improving the general working conditions, rechanneling healthcare resources to rehabilitating and upgrading existing health facilities would be more effective relative to constructing new facilities. Revamped and better equipped facilities will incentivize the working environment.To ensure health workers remain competitive, institutionalizing life-long training for medical staff is a priority, to keep them abreast of developments and trends in medical technology, procedures and patient care. In addition, counties need to embrace technology to overcome the physical barrier to specialized training and continuous skills development for specialized medical staff.
Improving management of the health workforce migration is paramount in maintaining a resourceful health sector. Some jurisdictions, for example, capture and share the number and profile of migrating health professionals as part of the workforce information system to guide decision making within government. Kenya is a signatory to the WHO Global Code of Practice on the International Recruitment of Health Personnel, and by regularly reporting on the status of health worker shortages can harness international support.
In addition, government to government agreements, and effectively enforcing training contracts requiring government trained medical students to be deployed immediately after training can strengthen management of health professionals. At local level, the effects of in-migration can be mitigated by, among other things, monitoring of health worker deployment, and institutionalization of sharing of the highly skilled health professionals across counties and health facilities.
Dr Onsomu and Munga are policy analysts at the Kenya Institute for Public Policy Research and Analysis (KIPPRA)