Human Resources for Health Strengthening in Kenya
Human resources form the basis of any organization. Without people things simply wouldn’t happen. Applying this concept to the health sector, without human resources, there would be no one to provide health care to the sick and vulnerable members of society.
Put simply, the goal of strengthening Human Resources for Health (HRH) is “To get the right workers, with the right skills, in the right place, doing the right things” .
In reality it’s not so simple; hence the need to break the goal down into manageable components. The initial key parts of the goal are getting the right workers with the right skills. Kenya is among 57 countries in the world with a critical shortage of health workers. One measure used to assess levels is density of health workers per 1,000 people. The lowest acceptable ratio is 2.3 providers per 1,000 people. Africa is at this lowest level but has 24% of the global disease burden. In comparison Europe and the United States have ratios of 18.9 and 24.8 respectively . In 2005 a number of partners including IntraHealth, USAID, and the Ministry of Health (MoH) collaborated on an Emergency Hiring plan. Over 800 skilled workers were hired--a positive contribution to the goal.
Moving to the next part of the puzzle, assuming workers are in the right place doing the right things, you may be presented with additional challenges including staff retention issues. Migration of workers internationally is a contributing factor, but within a country, there is also movement from rural to urban areas. Many people want work in urban areas as opposed to rural areas for reasons including better pay and more perceived opportunities. Evidence to support this can be found in a statistic looking at ratio of doctors to population, 1:500 in Nairobi and 1:160,000 in the remote Turkana district . Non-financial factors such as for improved facilities, better work climate as well as better access to supplies, equipment, electricity, safe water, lack of career progression and excessive workloads also contribute to migration. Again numerous initiatives are underway to combat some of these factors to maintain a well-distributed workforce.
So, you may ask, how does my fellowship link to HRH? The answer is in the area of systems strengthening. Successfully tackling some of the issues outlined above requires data on the health workforce. I will be analyzing needs and proposing systems be put in place to help support IntraHealth’s goal of improving evidence-based decision making in the health sector. One objective in the Kenyan National HRH Strategic Plan is to strengthening human resource information systems (HRIS). Used effectively, such systems allow health institutions to track detailed information about health workers throughout their employment, including where they are deployed, salary history, promotions, transfers, qualifications, and training.
In the public sector the Kenyan MoH has already implemented the iHRIS system and is using this to track its workforce to identify areas in need of support. In addition to the public sector, faith-based organizations (FBO’s) are key providers of health care, providing more than 40% of the country’s health services in Kenya and serving many of the poorest communities. I am currently based in one such FBO, the Christian Health Association of Kenya (CHAK), which has a total of 546 health facilities, including 22 hospitals. FBOs have such a large presence in the health sector; it is vital that data on their health workers are also available for decision-making around strengthening HRH.
I am currently working on a pilot implementation plan to roll out a HRIS at two CHAK hospitals. At present no databases are in place to track employees across member units. Gathering reports on the workforce is extremely time consuming and does not utilize resources effectively. Current systems in place are either manual or fragmented. Additionally records in many cases are not up to date. Sometimes this is hard to comprehend when many western organizations have moved to an employee self-service model where data is readily available.
A large organizational change such as this is typically not embraced by those directly impacted as it presents uncertainty. However, in our kick-off meeting with HR representatives from two hospitals, both parties were extremely keen to get moving on the development of HRIS. They have been actively involved with this idea, proving to me that the appetite is there. This is a really encouraging sign and the hope is that others will replicate the effort when they see the success of this pilot project.