Voices from the Capacity Project

Kenya needs more health workers to care for its 32 million citizens, and it needs them fast. “Some health facilities are staffed by a single nurse,” says Anne Rono, Director of Human Resources of the country’s Ministry of Health (MOH). She attributes this “human resource crisis” to the combined effects of a long freeze on civil service employment and a high rate of attrition due to the impact of HIV/AIDS, poor working conditions and low salaries.

Kenya’s rural districts are marked by especially high HIV/AIDS prevalence, yet these areas bear the largest burden of the health worker shortage. At Nyando District Hospital, HIV/AIDS-related conditions afflict 99% of the adult patients. Each day over 100 new patients flock to the hospital, yet just one doctor, 15 nurses and four clinical officers are on hand to cover all shifts. The lean staff means that patients often wait for long periods to get attention, and the quality of care can suffer. Staff burnout is a problem at Nyando and across the country; an estimated 1,200 skilled workers leave Kenya’s health workforce every year.

“The country did not have a natural process of replenishing the workforce,” says Kimani Mungai, the Capacity Project’s Kenya Country Coordinator. In response, the Project worked with health sector leaders to develop the Emergency Hiring Plan (EHP), an innovative rapid-response staffing and training model. Designed to increase the number of qualified health professionals available to work in public health facilities, the EHP is helping the MOH to expand access to treatment and care through the rapid hiring, training and deployment of 830 health workers.

Jacqueline, Rachel and Sylvia, three nurses who have been posted to Kajiado District Hospital by the EHP, had endured several years of frustrating attempts to find employment. According to Jacqueline, the MOH’s previous hiring system lacked transparency “since the candidates were never told why they failed.”

The EHP recruitment was refreshingly efficient and open, the nurses agreed. Expecting a long wait after she applied, Sylvia was surprised to have an interview in July. “In September I reported for employment,” she recounts. “That was a fast and transparent process!” Mungai explains, “We put in place mechanisms to ensure that a process that normally takes more than a year took three and a half months.” The new hires are given three-year contracts; afterward the MOH will absorb them into the regular workforce.

EHP hires go through a two-week training to update their skills in treatment and patient relations. The training also helps the workers understand the ins and outs of government service and the laws pertaining to nursing. Recalling how she once worked for six months without a day off or compensation as she covered for a staff shortage, Rachel was delighted to learn about her rights. “When you know your rights, you know what to expect,” she asserts. “That motivates you as you set out to work.”

Jane Kibisu, Capacity Project HR Functions Manager in Kenya, says that the EHP works because it is an integral part of the MOH. “We ensured that MOH staff took the lead,” she says. The EHP is a public/private partnership that also includes the African Medical and Research Foundation (AMREF), Deloitte & Touche, Kenya Institute of Administration and Kenya Medical Training Colleges.

While the EHP has already made a difference – for example, a large hospital near the border with Sudan was scheduled to be closed down, but 15 nurses hired by the EHP are keeping it open and providing services for this remote region – Kibisu emphasizes that the EHP is a pilot that will be carefully evaluated. Above all, she says, “We want to see the impact on the community.”

At the graduation ceremony for the first group of new hires, Mungai felt a powerful sense of hope for his country’s future. Looking at the crowd of proud, eager recruits, poised to take their places in over 130 facilities to help the neediest of their fellow citizens, Mungai reflected, “They represented the face of Kenya, drawn from every corner of our country.”

[November 2006. Print a PDF version.]

The Capacity Project, funded by the United States Agency for International Development (USAID) and implemented by IntraHealth International and partners, helps developing countries strengthen human resources for health to better respond to the challenges of implementing and sustaining quality health programs.

The Voices from the Capacity Project series is made possible by the support of the American people through USAID. The contents are the responsibility of IntraHealth International and do not necessarily reflect the views of USAID or the United States Government.

Learn more about the Emergency Hiring Plan:

• Making an Impact: Transforming Service at a Remote Hospital in Kenya
• Susan’s Story: Keeping Secrets and Promoting Family Planning in Rural Kenya
• Reflections from the Capacity Project’s Ummuro Adano
• Mid-Term Evaluation of the Kenya Emergency Hiring Plan
• More Photographs