Major reforms needed for a dedicated health workforce

Health CS Susan Nakhumicha. [Elvis Ogina, Standard]

Kenya has witnessed major reforms in the healthcare service delivery in the last decade. The Constitution recognizes the rights of every citizen to good health.

Furthermore, the devolution of healthcare services to counties provides an opportunity for entrusting communities with greater responsibilities of governing their health and wellness.

Vision 2030, the blue print for social-economic transition to a middle-income county, envisages that the county will be opened up for medical tourism. Additionally, the Kenya Health Sector Strategic and Investment Plan, Universal Health Coverage and the Bottom-up Economic Transformation Agenda are some of the key drivers of a healthy and prosperous citizenry.

The World Health Organization recognizes six pillars of a functional health system: Leadership management and governance, health financing, health information systems, medical products, vaccines and technologies, and most importantly human resources for health.

The 2010 Constitution brought key reforms that changed health workforce management. These included transfers of health workforce management to 47 county governments. The sector wage bill rose by nearly three-fold from about Sh38 billion in 2013 to Sh108 billion in 2018.

Over 60 per cent of the Ministry of Health budget goes to salaries and other human resources support services. In the counties, the bulk of the personnel are healthcare workers. This underscores the need to invest in training, recruitment, deployment, management and welfare of the workers. To ensure availability of adequate workers with the right skills who are motivated, several reforms are required.

Lessons from Covid-19 pandemic show that health workforce must be equipped with skills for a world with an ever changing demography as well as variations in disease patterns and burden. Furthermore, workers must be prepared to address climate change mitigation measures that are directly associated health challenges.

The recognition of the role of the community health promoters as frontline service providers is critical in the drive to preventive and promotive health care.

Their mandate includes provision of health education and counselling, assessment, first aid, household health data collection, and linkages and referrals. The reform will entail ensuring the training is informed by a national training needs assessment, and that all medical training colleges and universities align their curriculum accordingly. The Kenya Health Human Resources Advisory Council is keeping track of the workforce's training, recruitment, outmigration and attrition numbers. Private sector workforce data should be included in the national account.

The traditional basis for recruitment has been on staff establishment aimed at meeting staffing norms and standards. There has been a rapid expansion of facilities without a concrete plan to address gaps in equipment and workforce.

The Public Service Boards play a critical role of recruiting and managing county workers, while the national government is charged with policy and regulation, standardization and quality assurance. Major reforms in this area aim at improving quantification of staffing needs, gaps and rationalized deployment of staff at all levels countrywide.

This calls for developing of new staff establishments based on workload. Secondly, there is need to strengthen the recruitment processes and structures, rationalize deployment of prioritized cadres and development of schemes of services for emerging cadres like community health promoters. Third, attention should also be given to improving staff retention and welfare, including creating an enabling working environment, to ensure they are motivated. Fourth, it is important to regularly conduct market analysis to take stock of qualified staff with no employment who can benefit from structured employment abroad.

Then there is a need for effective in-service training linked to skills proficiency, specialization, professionalism and quality of care. Unfortunately, most counties do not have a mechanism to ensure the staff return once they acquire the specialized skills.

Reforms in this area should emphasise creating a pool of a competent workforce capable of offering high-quality services, including specialized care. Professional development should be linked to renewal of practicing licences, and should entail adoption of innovative teaching and learning methodologies, telemedicine, artificial intelligence, and e-learning and mobile learning to improve access.

While the training is regulated under the Ministry of Education’s Commission for University Education and Technical and Vocational Training Authority, the Health Ministry regulatory bodies, and for profit and faith-based employers have a mandate to govern the practice of health professionals. There is need for real-time, accurate data for decision making at supply (training) and demand side (employment).

The county needs to invest a lot more in health workforce development and management. In line with the Abuja Declaration, not less than 15 per cent of the GDP should go to the sector. This calls for advocacy with the Planning Ministry and Parliament, while workers need to dedicate their knowledge, skills and time. 

Dr Kimachi is the director, Institute for Capacity Development - Amref Health Africa, while Maingi is a workforce specialist with Amref Health Africa