INTRODUCTION The Kenyan health sector is made up of 3 components The first component is the public sector which comprises the government owned health facilities Secondly is the non commercial private sector which comprises of Faith Based Organizations FBOs Non Governmental Organizations NGOs and the mission hospitals Third is the private sector which is entirely for commercial purposes The government is said to own a greater percentage of these facilities followed by the private sector as shown below in Figure 1 Even so the private sector is known to be the largest employer of healthcare professionals in Kenya Barnes et al 2010 Figure 1 Distribution of health facilities by ownership and level of care Source Kenya Ministry of Health 2012 In the past decade the government health expenditure has remained below the recommended This is at 6 below the 15 agreed upon in the Abuja Declaration and among one of the lowest shares in the East Africa Community World Bank 2014 Due to this the health sector is dependent on external donor funding Kenya's health sector has been labelled as labour intensive with spending 80 of its health budget to personnel compensation leaving about 20 to cater for infrastructure Even so health workforce still remains a challenge Ill equipped health facilities unsafe working environments poor remuneration unequal distribution of staff limited training opportunities and career progression and low morale are among the challenges faced by the global health workforce
This negatively impacts the health service delivery of the countries In the following sections I will elaborate on some challenges faced by the Kenyan health system and pose some strategies that could be used by the government to address them HEALTH WORKFORCE IN KENYA According to World Health Organization WHO 2006 health workforce consists of all people engaged in actions whose primary intent is to enhance health Evidence has directly correlated the size of a country's health workforce to its health outcomes The health workforce is one of the most important building blocks of the health system because in its absence healthcare ceases to exist Reduced health workforce numbers could be a contributory factor to the unattained Millennium Development Goals in most countries WHO 2006 projected a deficit of about 4 3million trained health workers globally with the heaviest burden felt by African countries In addition it grouped Kenya among the 57 countries globally that face health workforce crisis with only 13 doctors nurses and midwives among 10 000 people It recommended at least 23 doctors nurses and midwives 23 health workers doctors nurses midwives per 10 000 people the minimum required to achieve an 80 coverage rate for deliveries by skilled birth attendants In 2013 the Government of Kenya was devolved to the 47 counties thereby forming 4 levels of health care services in the health sector community health services primary care services county referral care services and national referral services as illustrated below
This was meant to address the unequal distribution of health resources and discrimination experienced in poorly developed rural areas of the country However since this development the unequal distribution of health workers between the urban and rural areas has persisted if not increased This can be attributed to inconsistent salary payments mass resignations and industrial actions at the county levels and national level Tsofa et al 2017 These mass resignations have been experienced mostly in the rural health facilities with health workers opting to work in the private sector More recently there have been reports of shortages of doctors in Embu County with only one medical officer catering to one of the hospitals Gachanja 2017 Most of the medical officers are reported to have gone to work in the urban counties and some in the private sector Health workers in the private sector are remunerated better than those in the public sector Figure 2 Figure 2 Salaries of health workers in United States Dollars USD Source Human Resource for Health Strategic Plan Review Report 2010 2011
Another major challenge experienced by the health sector is the migration of health workers to developed countries This has been attributed to better training opportunities better working conditions and remuneration in these foreign countries Political unrest in some parts of the country could have contributed to this particularly in the general election periods Research has shown that brain drain in Kenya results to financial losses estimated at US 517 931 per doctor and US 338 868 per nurse Kirigia et al 2006 Besides the economic loss Kirigia goes on to explain that brain drain exacerbates the existing health crisis in Kenya by worsening the shortage of health workers This eventually weakens the health facilities capacity due to the absence of supervisors hence lowers the quality of health services offered The weakening of the referral health system is inevitable at this stage as the patients will bypass the primary health care facilities due to lack of doctors and head straight to the tertiary facilities
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