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Advancing Human Resources for Health (HRH) issues in a challenging environment

In one of my earlier blogs I posted about attending a workshop on Peer Learning. The output of that workshop was that each health facility created a three month action plan whereby they could partner with other health facilities with the aim of making advances on some key HRH issues. Currently, we are at the half-way point on achieving goals set in these action plans. An approach taken by my colleague Patrick Kyalo, Human Resources Advisor in the Christian Health Association of Kenya (CHAK), has been to plan field trips to various facilities throughout Kenya to assess progress.

Recently I accompanied him on one such trip to a facility which is part of the CHAK network. We visited Mwangaza Ulio na Tumaini Clinic in one of the poorest slum areas called Korogocho, located 11 kilometers northeast of Nairobi.  To date, the majority of my field trips to date have been to larger hospitals. In many cases, due to their size and available resources, they have been able progress with some improvements. However, this trip was to a health center which was a good opportunity to experience how a smaller facility with limited resources can progress.  Korogocho is a slum area is outside the city, therefore cheaper to rent a room here as opposed to some slums in the city.  Houses mainly consist of one room and are typically made of mud and corrugated iron. It is also notorious as being insecure. Operating a health centre in such an environment presents challenges, the main ones being generating revenue and security. However, it is also vital to have such facilities in these locations.  When the founders of the facility were establishing this site they conducted a survey on maternity outcomes. Based on the high percentages of newborn deaths when mothers stayed in Korogocho as opposed to moving outside the need was apparent. The clinic provides a maternity unit and outpatient services. Costs are typically greater than income from user fees but to counter-act this, some very innovative projects have been put in place. One example is a program called ‘Catch a Baby’ whereby local people in the community and outside are asked to help raise funds towards the costs of an expectant mother attending the clinic.  The maternity cost for attending the clinic and follow up immunizations for one year is approximately US$60 / 5,000 Kenyan shillings. However most mothers can only afford a small portion of this given their income is extremely low (in many cases $1-2 per day) so this program can help reduce the deficit. While visiting to assess how much progress made on the action plan, we toured the facility with Ceri Njuguna, Executive Officer at the clinic. A key issue in the area HRH is workforce retention.  Multiple factors that contribute to worker retention include payment, benefits, job satisfaction and work setting and conditions. My colleague Patrick asked some of the workers how long they worked at the facility and if they planned to leave.  The really encouraging thing to hear was that most employees were there for over 2 years and seemed very happy. I was also extremely impressed with how clean, bright and well organized the clinic was and great to see such good working conditions. The clinic has three aims, Very Important Person VIP, Patient and Gospel Care. VIP care prides itself in treating all people attending with dignity and respect. Considering the harsh and underdeveloped area they live in this is such a great goal but additionally encourages people to attend and seek medical care. Advances such as implementing a formal employee appraisal program were also well underway and awaiting board approval. We both left the clinic feeling that good progress was being made and agreed that it was far easier gauge this progress first-hand rather than through emailed reports and phone calls. On such trips I do get frustrated at not being able to apply quick fixes to issues; at the same time appreciate the busy environment of health service delivery and how many small steps are required to bring about improvements.

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