Investing in the health workforce in Kenya: trends in size, composition and distribution from a descriptive health labour market analysis.

Investing in the health workforce to ensure universal access to qualified, skilled and motivated health workers is pertinent in achieving the Sustainable Development Goals (SDGs). The policy thrust in Kenya is to improve the quality of life of the population by investing to improve health service provision and achieving universal health coverage. To realise this, the Ministry of Health undertook a Health Labour Market Analysis with to generate evidence on the relationship between supply, demand and need of the health labour force. In the context of supply, Kenya has a total of 189 932 health workers in 2020 with 66% being in the public sector and 58%, 13% and 7% being nurses, clinical officers and doctors, respectively. The density of doctors, nurses and clinical officers per 10 000 in Kenya in 2020 was 30.14, which represents about 68% of the SDG index threshold of 44.5 doctors, nurses and midwives per 10 000 population. Findings indicates that Kenya needs to align future production in terms of cadre and quantity to the population health needs. Achieving this requires a multisectoral approach to ensure apposite quantity and mix of intakes into training institutions based on the health needs and ability to employ health workers produced.

Effects of selected socio-demographic characteristics of community health workers on performance of home visits during pregnancy: a cross-sectional study in Busia District, Kenya.

OBJECTIVE: Appropriate performance of home visits facilitates adoption of best practices at home and increased demand for facility based services. METHODS: It was a cross-sectional study in which community health workers were observed conducting home visits during pregnancy.  Data was collected using a structured questionnaire and the Consultant Quality Index (CQI-2 tool) on record keeping, use of job aids, counselling, client satisfaction and client enablement. Descriptive and inferential statistics were used. Relationships were determined using chi square and odds ratios. RESULTS: The study showed significant relationships of age with good record keeping (p = 0.0001), appropriate use of job aids (p=0.0001), client satisfaction (p = 0.018) and client enablement (p = 0.001). Male CHWs were 1.6 times more likely to keep better records than females (OR 1.64 CI (1.02-2.63), while females were more likely to counsel and enable their clients OR 0.42 CI (0.25-0.71) and OR 0.29 CI (012-070) respectively when compared to men. Moreover, higher levels of education were associated with good record keeping OR 0.30 CI (0.19-0.49), p=0.0001; appropriate use of job aids OR 0.30 CI (0.15-0.61) and to appropriately counsel their clients OR 0.34 CI (0.20-0.58) than their lower literacy level counterparts. Experience of CHWs was associated with appropriate use of job aids (p = 0.049); client satisfaction (p = 0.0001) and client enablement (p = 0.032). CONCLUSIONS: Socio-demographic characteristics of community health workers affect the performance of home visits in various ways. The study also confirmed that CHWs with lower literacy levels satisfy and enable their clients effectively.

Community case management of childhood diarrhea in a setting with declining use of oral rehydration therapy: findings from cross-sectional studies among primary household caregivers, Kenya, 2007.

We sought to determine factors associated with appropriate diarrhea case management in Kenya. We conducted a cross-sectional survey of caregivers of children < 5 years of age with diarrhea in rural Asembo and urban Kibera. In Asembo, 61% of respondents provided oral rehydration therapy (ORT), 45% oral rehydration solution (ORS), and 64% continued feeding. In Kibera, 75% provided ORT, 43% ORS, and 46% continued feeding. Seeking care at a health facility, risk perception regarding death from diarrhea, and treating a child with oral medications were associated with ORT and ORS use. Availability of oral medication was negatively associated. A minority of caregivers reported that ORS is available in nearby shops. In Kenya, household case management of diarrhea remains inadequate for a substantial proportion of children. Health workers have a critical role in empowering caregivers regarding early treatment with ORT and continued feeding. Increasing community ORS availability is essential to improving diarrhea management.

Health systems research in a low-income country: easier said than done.

Small hospitals sit at the apex of the pyramid of primary care in the health systems of many low-income countries. If the Millennium Development Goal for child survival is to be achieved, hospital care for referred severely ill children will need to be improved considerably in parallel with primary care in many countries. Yet little is known about how to achieve this. This article describes the evolution and final design of an intervention study that is attempting to improve hospital care for children in Kenyan district hospitals. It illustrates many of the difficulties involved in reconciling epidemiological rigour and feasibility in studies at a health system, rather than an individual, level and the importance of the depth and breadth of analysis when trying to provide a plausible answer to the question: does it work? Although there are increasing calls for more health systems research in low-income countries, the importance of strong, broadly based local partnerships and long-term commitment even to initiate projects is not always appreciated.

Assessment of inpatient paediatric care in first referral level hospitals in 13 districts in Kenya.

BACKGROUND: The district hospital is considered essential for delivering basic, cost-effective health care to children in resource poor countries. We aimed to investigate the performance of these facilities in Kenya. METHODS: Government hospitals providing first referral level care were prospectively sampled from 13 Kenyan districts. Workload statistics and data documenting the management and care of admitted children were obtained by specially trained health workers. FINDINGS: Data from 14 hospitals were surveyed with routine statistics showing considerable variation in inpatient paediatric mortality (range 4-15%) and specific case fatality rates (eg, anaemia 3-46%). The value of these routine data is seriously undermined by missing data, apparent avoidance of a diagnosis of HIV/AIDS, and absence of standard definitions. Case management practices are often not in line with national or international guidelines. For malaria, signs defining severity such as the level of consciousness and degree of respiratory distress are often not documented (range per hospital 0-100% and 9-77%, respectively), loading doses of quinine are rarely given (3% of cases) and dose errors are not uncommon. Resource constraints such as a lack of nutritional supplements for malnourished children also restrict the provision of basic, effective care. INTERPRETATION: Even crude performance measures suggest there is a great need to improve care and data quality, and to identify and tackle key health system constraints at the first referral level in Kenya. Appropriate intervention might lead to more effective use of health workers' efforts in such hospitals.