Determinants of retention strategies for health care practitioners in public health facilities in Kenya: a case of County Hospitals in Nairobi Kenya

At the heart of each and every health care system, the workforce is central to advancing health. Healthcare is a labour- intensive industry and therefore retention and growth of is important. This study seeks to determine the retention strategies used by public health facilities where brain drain has become rampant in the facilities. The study sought to determine the retention strategies by looking at the following three aspects of the facilities. First the study looked at the relationship between the motivation strategies used and how they influenced staff retention in the public health facilities. Secondly, the study looked at the relationship between employee relations management strategies adopted to enhance the retention of healthcare practitioners in Kenya. Thirdly, the study focused on the professional growth strategies that are in place and how they influenced retention of healthcare practitioners in the public healthcare facilities. The study was based on various theories on employee behaviors such as the Expectancy theory and Maslow’s Theory. To achieve these objectives, the data was collected at the 3 County hospitals in Nairobi County (Mama Lucy Kibaki Hospital, Mbagathi County hospital and Pumwani Maternity Hospital) where a sample of 165 respondents was drawn using simple random sampling method. Primary data was collected using a semi structured questionnaire. Data was analyzed using SPSS (Version 20.0). Basic descriptive statistics were used as well. The data was then analyzed through percentages, frequencies, mean, standard deviation and inferential statistics. The findings were presented in tables, graphs and narratives for easy comparison. The study found out that all the variables had a positive and significant influence on employee retention. Motivation strategies had a significant influence on employee retention as shown by the coefficient (β = 0.365, t = 4.433, p> 0.000). Employee relations management strategies also showed a significant influence on employee retention with the coefficients (β = 0.168, t = 32.132, p> 0.005) indicating a positive effect employee retention. Professional growth strategies as well showed a significant influence with a coefficient of (β = 0.309, t = 3.781, p> 0.000) showing a positive and significant relationship. The study concluded that the hospital supervisors should usually discuss issues affecting employees with them and other employees and mentor and coach them. The study recommended that the hospitals should have a clear career development plan for their employees which improve their retention

Improving Access to Maternal Health Care through Devolution in Western Kenya

Devolution was greeted with great anticipation in Kenya as a means of bringing services closer to the people. However, since the implementation of the recent devolution reforms, criticism has mounted, with evidence of corruption, poor management, late payment of county staff and considerable disaffection among service providers, especially health professionals. In this study, we examine health-care users’ and providers’ perceptions of the effect of devolved health services on referral maternal health-care access in Kisumu and Uasin Gishu counties in Western Kenya. Our findings suggest that while health workers are dissatisfied, there is considerable satisfaction among users of referral maternal health services. Users largely associate their satisfaction with devolution. However, closer analysis suggests that improved access is not only linked to devolved health services but also to other developments both at the national level (health campaigns, increased mobile telephony) and county level (improved transportation, relocation of available funds)

Prioritising African perspectives in Psychiatric Genomics Research: issues of translation and informed consent

Psychiatric genomics research with African populations comes with a range of practical challenges around translation of psychiatric genomics research concepts, procedures, and nosology. These challenges raise deep ethical issues particularly around legitimacy of informed consent, a core foundation of research ethics. Through a consideration of the constitutive function of language, the paper problematises like-for-like, designative translations which often involve the ‘indigenization’ of English terms or use of metaphors which misrepresent the risks and benefits of research. This paper argues that effective translation of psychiatric genomics research terminology in African contexts demands substantive engagement with African conceptual schemas and values. In developing attenuated forms of translational thinking, researchers may recognise the deeper motivational reasons behind participation in research, highlighting the possibility that such reasons may depart from the original meaning implied within informed consent forms. These translational issues might be ameliorated with a critical re-examination of how researchers develop and present protocols to institutional ethics review boards

A qualitative study using traditional community assemblies to investigate community perspectives on informed consent and research participation in western Kenya

Background: International collaborators face challenges in the design and implementation of ethical biomedical research. Evaluating community understanding of research and processes like informed consent may enable researchers to better protect research participants in a particular setting; however, there exist few studies examining community perspectives in health research, particularly in resource-limited settings, or strategies for engaging the community in research processes. Our goal was to inform ethical research practice in a biomedical research setting in western Kenya and similar resource-limited settings. Methods: We sought to use mabaraza, traditional East African community assemblies, in a qualitative study to understand community perspectives on biomedical research and informed consent within a collaborative, multinational research network in western Kenya. Analyses included manual, progressive coding of transcripts from Mabaraza to identify emerging central concepts. Results: Our findings from two mabaraza with 108 community members revealed that, while participants understood some principles of biomedical research, they emphasized perceived benefits from participation in research over potential risks. Many community members equated health research with HIV testing or care, which may be explained in part by the setting of this particular study. In addition to valuing informed consent as understanding and accepting a role in research activities, participants endorsed an increased role for the community in making decisions about research participation, especially in the case of children, through a process of community consent. Conclusions: Our study suggests that international biomedical research must account for community understanding of research and informed consent, particularly when involving children. Moreover, traditional community forums, such as mabaraza in East Africa, can be used effectively to gather these data and may serve as a forum to further engage communities in community consent and other aspects of research

Community Perspectives on Research Consent Involving Vulnerable Children in Western Kenya

Involving vulnerable pediatric populations in international research requires culturally appropriate ethical protections. We sought to use mabaraza, traditional East African community assemblies, to understand how a community in western Kenya viewed participation of children in health research and informed consent and assent processes. Results from 108 participants revealed generally positive attitudes towards involving vulnerable children in research, largely because they assumed children would directly benefit. Consent from parents or guardians was understood as necessary for participation while gaining child assent was not. They felt other caregivers,community leaders, and even community assemblies could participate in the consent process. Community members believed research involving orphans and street children could benefit these vulnerable populations, but would require special processes for consent

Serving East African Bioethics information and education needs

Objective: To identify the challenges of supporting the information needs of students and researchers participating in an international research ethics education practicum and exchange between universities in Kenya and the United States. Methods: One component of a grant-funded international research ethics training partnership supports a six-week intensive practicum exchange program. Master's level students from Moi University, Eldoret, Kenya, travel to the Indiana University (IU) School of Medicine-Indianapolis. While at the IU School of Medicine, the Kenyan students use library services to prepare for a mentored research project. As an outcome of the project, students are expected to conduct an extensive literature search that will be used as a foundational component for a thesis that is completed in Kenya. An informationist is embedded in this program to support the information needs of faculty mentors and practicum students. This paper uses narrative reports and program evaluation data to identify the challenges of (1) providing information literacy education, (2) confronting resource inequities, and (3) supporting information needs across cultures and universities in two countries. Results: Two cohorts of Kenyan students completed this practicum. The program leaders and librarians continue to adapt the information skills sessions to meet student interests and needs. Teaching has been a challenge because students demonstrate a wide range of technical sophistication. Some have extensive computing experience, but others struggle with Internet navigation, account authentication, and common technology skills. In the second cohort, the students worked well in pairs to find relevant research ethics materials while using the university's information portals and subscription resources. In both cohorts, students expressed a desire for a slower instruction pace and for additional sessions. Students were frequent customers for reference support. Librarians observed a preference for print monographs. While confirming a need for both print and electronic resources, practicum students have initiated a small and growing library of print materials for bioethics research at Moi University. Conclusion: Teaching information skills to a small group of adult students with a wide range of educational experiences is a challenge when students are working in a new (information rich) environment. Student evaluations have expressed an appreciation for instruction customized to their interests and needs, a slow delivery style, and opportunities for one-to-one instruction

Research ethics governance in times of Ebola.

CAPRISA, 2017.Abstract available in pdf