1
|
Nyawira L, Tsofa B, Musiega A, Munywoki J, Njuguna RG, Hanson K, Mulwa A, Molyneux S, Maina I, Normand C, Jemutai J, Barasa E. Management of human resources for health: implications for health systems efficiency in Kenya. BMC Health Serv Res 2022; 22:1046. [PMID: 35974324 PMCID: PMC9382760 DOI: 10.1186/s12913-022-08432-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/09/2022] [Indexed: 11/21/2022] Open
Abstract
Background Human resources for health consume a substantial share of healthcare resources and determine the efficiency and overall performance of health systems. Under Kenya’s devolved governance, human resources for health are managed by county governments. The aim of this study was to examine how the management of human resources for health influences the efficiency of county health systems in Kenya. Methods We conducted a case study using a mixed methods approach in two purposively selected counties in Kenya. We collected data through in-depth interviews (n = 46) with national and county level HRH stakeholders, and document and secondary data reviews. We analyzed qualitative data using a thematic approach, and quantitative data using descriptive analysis. Results Human resources for health in the selected counties was inadequately financed and there were an insufficient number of health workers, which compromised the input mix of the health system. The scarcity of medical specialists led to inappropriate task shifting where nonspecialized staff took on the roles of specialists with potential undesired impacts on quality of care and health outcomes. The maldistribution of staff in favor of higher-level facilities led to unnecessary referrals to higher level (referral) hospitals and compromised quality of primary healthcare. Delayed salaries, non-harmonized contractual terms and incentives reduced the motivation of health workers. All of these effects are likely to have negative effects on health system efficiency. Conclusions Human resources for health management in counties in Kenya could be reformed with likely positive implications for county health system efficiency by increasing the level of funding, resolving funding flow challenges to address the delay of salaries, addressing skill mix challenges, prioritizing the allocation of health workers to lower-level facilities, harmonizing the contractual terms and incentives of health workers, and strengthening monitoring and supervision.
Collapse
Affiliation(s)
- Lizah Nyawira
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Benjamin Tsofa
- Health Systems and Research Ethics Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Anita Musiega
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Joshua Munywoki
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Rebecca G Njuguna
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Kara Hanson
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Andrew Mulwa
- Directorate of Medical Services, preventive and promotive health, Ministry of Health, Nairobi, Kenya
| | - Sassy Molyneux
- Health Systems and Research Ethics Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Isabel Maina
- Health Financing Department, Ministry of Health, Nairobi, Kenya
| | - Charles Normand
- Centre for Health Policy and Management, Trinity College, the University of Dublin, Dublin, Ireland
| | - Julie Jemutai
- Health Systems and Research Ethics Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Edwine Barasa
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya. .,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK. .,Institute of Healthcare Management, Strathmore Business School, Strathmore University, Nairobi, Kenya.
| |
Collapse
|
2
|
Nimako K, Gage A, Benski C, Roder-DeWan S, Ali K, Kandie C, Mohamed A, Odeny H, Oloo M, Otieno JTB, Wanzala M, Okumu R, Kruk ME. Health System Redesign to Shift to Hospital Delivery for Maternal and Newborn Survival: Feasibility Assessment in Kakamega County, Kenya. GLOBAL HEALTH, SCIENCE AND PRACTICE 2021; 9:1000-1010. [PMID: 34933993 PMCID: PMC8691889 DOI: 10.9745/ghsp-d-20-00684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 09/22/2021] [Indexed: 11/29/2022]
Abstract
Maternal and newborn health (MNH) service delivery redesign aims to improve maternal and newborn survival by shifting deliveries from poorly equipped primary care facilities to adequately prepared designated delivery hospitals. We assess the feasibility of such a model in Kakamega County, Kenya, by determining the capacity of hospitals to provide services under the redesigned model and the acceptability of the concept to providers and users. We find many existing system assets to implement redesign, including political will to improve MNH outcomes, a strong base of support among providers and users, and a good geographic spread of facilities to support implementation. There are nonetheless health workforce gaps, infrastructure deficits, and transportation challenges that would need to be addressed ahead of policy rollout. Implementing MNH redesign would require careful planning to limit unintended consequences and rigorous evaluation to assess impact and inform scale-up.
Collapse
Affiliation(s)
- Kojo Nimako
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Anna Gage
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Caroline Benski
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Khatra Ali
- Kenya Council of Governors, Nairobi, Kenya
| | | | | | - Hellen Odeny
- Kakamega County Department of Health, Kakamega County, Kenya
| | - Micky Oloo
- Department of Public Health, Masinde Muliro University of Science and Technology, Kakamega County, Kenya
| | | | - Maximilla Wanzala
- Department of Public Health, Masinde Muliro University of Science and Technology, Kakamega County, Kenya
| | - Rachel Okumu
- Kakamega County Department of Health, Kakamega County, Kenya
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
3
|
Nzinga J, Jones C, Gathara D, English M. Value of stakeholder engagement in improving newborn care in Kenya: a qualitative description of perspectives and lessons learned. BMJ Open 2021; 11:e045123. [PMID: 34193487 PMCID: PMC8246352 DOI: 10.1136/bmjopen-2020-045123] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Embedding researchers within health systems results in more socially relevant research and more effective uptake of evidence into policy and practice. However, the practice of embedded health service research remains poorly understood. We explored and assessed the development of embedded participatory approaches to health service research by a health research team in Kenya highlighting the different ways multiple stakeholders were engaged in a neonatal research study. METHODS We conducted semistructured qualitative interviews with key stakeholders. Data were analysed thematically using both inductive and deductive approaches. SETTING Over recent years, the Health Services Unit within the Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme in Nairobi Kenya, has been working closely with organisations and technical stakeholders including, but not limited to, medical and nursing schools, frontline health workers, senior paediatricians, policymakers and county officials, in developing and conducting embedded health research. This involves researchers embedding themselves in the contexts in which they carry out their research (mainly in county hospitals, local universities and other training institutions), creating and sustaining social networks. Researchers collaboratively worked with stakeholders to identify clinical, operational and behavioural issues related to routine service delivery, formulating and exploring research questions to bring change in practice PARTICIPANTS: We purposively selected 14 relevant stakeholders spanning policy, training institutions, healthcare workers, regulatory councils and professional associations. RESULTS The value of embeddedness is highlighted through the description of a recently completed project, Health Services that Deliver for Newborns (HSD-N). We describe how the HSD-N research process contributed to and further strengthened a collaborative research platform and illustrating this project's role in identifying and generating ideas about how to tackle health service delivery problems CONCLUSIONS: We conclude with a discussion about the experiences, challenges and lessons learned regarding engaging stakeholders in the coproduction of research.
Collapse
Affiliation(s)
- Jacinta Nzinga
- Health Services Unit, KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Kenya
| | - Caroline Jones
- Health Systems Research and Ethics, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Nuffield Department of Medicine, Oxford University, Oxford, UK
| | - David Gathara
- Health Systems Research and Ethics, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Mike English
- Health Systems Research and Ethics, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Nuffield Department of Medicine, Oxford University, Oxford, UK
| |
Collapse
|
4
|
English M, Strachan B, Esamai F, Ngwiri T, Warfa O, Mburugu P, Nalwa G, Gitaka J, Ngugi J, Zhao Y, Ouma P, Were F. The paediatrician workforce and its role in addressing neonatal, child and adolescent healthcare in Kenya. Arch Dis Child 2020; 105:927-931. [PMID: 32554508 PMCID: PMC7513261 DOI: 10.1136/archdischild-2019-318434] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To examine the availability of paediatricians in Kenya and plans for their development. DESIGN Review of policies and data from multiple sources combined with local expert insight. SETTING Kenya with a focus on the public, non-tertiary care sector as an example of a low-income and middle-income country aiming to improve the survival and long-term health of newborns, children and adolescents. RESULTS There are 305 practising paediatricians, 1.33 per 100 000 individuals of the population aged <19 years which in total numbers approximately 25 million. Only 94 are in public sector, non-tertiary county hospitals. There is either no paediatrician at all or only one paediatrician in 21/47 Kenyan counties that are home to over a quarter of a million under 19 years of age. Government policy is to achieve employment of 1416 paediatricians in the public sector by 2030, however this remains aspirational as there is no comprehensive training or financing plan to reach this target and health workforce recruitment, financing and management is now devolved to 47 counties. The vast majority of paediatric care is therefore provided by non-specialist healthcare workers. DISCUSSION The scale of the paediatric workforce challenge seriously undermines the ability of the Kenyan health system to deliver on the emerging survive, thrive and transform agenda that encompasses more complex health needs. Addressing this challenge may require innovative workforce solutions such as task-sharing, these may in turn require the role of paediatricians to be redefined. Professional paediatric communities in countries like Kenya could play a leadership role in developing such solutions.
Collapse
Affiliation(s)
- Mike English
- KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Kenya .,Oxford Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, Oxfordshire, UK
| | | | - Fabian Esamai
- Department of Paediatrics and Child Health, College of Health Sciences, Moi University, Kenya, Eldoret, Kenya
| | | | | | - Patrick Mburugu
- Department of Paediatrics and Child Health, School of Medicine, Jomo Kenyatta University of Africulture and Technology, Nairobi, Kenya
| | - Grace Nalwa
- Department of Paediatrics and Child Health, Maseno University, Maseno, Nyanza, Kenya
| | - Jesse Gitaka
- Directorate of Research and Innovation, School of Medicine, Mount Kenya University, Thika, Kenya
| | - John Ngugi
- Department of Paediatrics and Child Health, Kenyatta University, Nairobi, Kenya
| | - Yingxi Zhao
- Oxford Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, Oxfordshire, UK
| | - Paul Ouma
- KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Kenya
| | - Fred Were
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| |
Collapse
|
5
|
English M, Gathara D, Nzinga J, Kumar P, Were F, Warfa O, Tallam-Kimaiyo E, Nandili M, Obengo A, Abuya N, Jackson D, Brownie S, Molyneux S, Jones COH, Murphy GAV, McKnight J. Lessons from a Health Policy and Systems Research programme exploring the quality and coverage of newborn care in Kenya. BMJ Glob Health 2020; 5:e001937. [PMID: 32133169 PMCID: PMC7042598 DOI: 10.1136/bmjgh-2019-001937] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 12/13/2019] [Accepted: 12/22/2019] [Indexed: 11/02/2022] Open
Abstract
There are global calls for research to support health system strengthening in low-income and middle-income countries (LMICs). To examine the nature and magnitude of gaps in access and quality of inpatient neonatal care provided to a largely poor urban population, we combined multiple epidemiological and health services methodologies. Conducting this work and generating findings was made possible through extensive formal and informal stakeholder engagement linked to flexibility in the research approach while keeping overall goals in mind. We learnt that 45% of sick newborns requiring hospital care in Nairobi probably do not access a suitable facility and that public hospitals provide 70% of care accessed with private sector care either poor quality or very expensive. Direct observations of care and ethnographic work show that critical nursing workforce shortages prevent delivery of high-quality care in high volume, low-cost facilities and likely threaten patient safety and nurses' well-being. In these challenging settings, routines and norms have evolved as collective coping strategies so health professionals maintain some sense of achievement in the face of impossible demands. Thus, the health system sustains a functional veneer that belies the stresses undermining quality, compassionate care. No one intervention will dramatically reduce neonatal mortality in this urban setting. In the short term, a substantial increase in the number of health workers, especially nurses, is required. This must be combined with longer term investment to address coverage gaps through redesign of services around functional tiers with improved information systems that support effective governance of public, private and not-for-profit sectors.
Collapse
Affiliation(s)
- Mike English
- Health Services Unit, KEMRI – Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine & Global Health, Nuffield Department of Clinical Medicine, Oxford, Oxfordshire, UK
| | - David Gathara
- Health Services Unit, KEMRI – Wellcome Trust Research Programme, Nairobi, Kenya
| | - Jacinta Nzinga
- Health Services Unit, KEMRI – Wellcome Trust Research Programme, Nairobi, Kenya
| | - Pratap Kumar
- Institute of Healthcare Management, Strathmore University Strathmore Business School, Nairobi, Nairobi Area, Kenya
- Health-E-Net Limited, Nairobi, Kenya
| | - Fred Were
- Department of Paediatrics, University of Nairobi, Nairobi, Nairobi, Kenya
| | - Osman Warfa
- Neonatal, Child and Adolescent Health Unit, Kenya Ministry of Health, Nairobi, Kenya
| | | | - Mary Nandili
- Neonatal, Child and Adolescent Health Unit, Kenya Ministry of Health, Nairobi, Kenya
| | - Alfred Obengo
- National Nurses Association of Kenya, Nairobi, Kenya
| | | | - Debra Jackson
- University of Technology Sydney, Sydney, New South Wales, Australia
| | - Sharon Brownie
- Griffith University Menzies Health Institute Queensland, Nathan, Queensland, Australia
| | - Sassy Molyneux
- Health Systems and Research Ethics, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, Oxford, UK
| | - Caroline Olivia Holmes Jones
- Center for Tropical Medicine and Global Health, University of Oxford Centre for Tropical Medicine, Oxford, UK
- Department of Health System and Research Ethics, KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Jacob McKnight
- Center for Tropical Medicine and Global Health, University of Oxford Centre for Tropical Medicine, Oxford, UK
| |
Collapse
|