Health workforce attrition in the public sector in Kenya: a look at the reasons

<p>Abstract</p> <p>Background</p> <p>Kenya, like many other countries in sub-Saharan Africa, has been affected by shortages of health workers in the public sector. Data on the rates and leading reasons for health workers attrition in the public sector are key in developing effective, evidence-based planning and policy on human resources for health.</p> <p>Methods</p> <p>This study analysed data from a human resources health facility survey conducted in 2005 in 52 health centres and 22 public hospitals (including all provincial hospitals) across all eight provinces in Kenya. The study looked into the status of attrition rates and the proportion of attrition due to retirement, resignation or death among doctors, clinical officers, nurses and laboratory and pharmacy specialists in surveyed facilities.</p> <p>Results</p> <p>Overall health workers attrition rates from 2004 to 2005 were similar across type of health facility: provincial hospitals lost on average 4% of their health workers, compared to 3% for district hospitals and 5% for health centres. However, there are differences in the patterns of attrition rates by cadre. Attrition among doctors and registered nurses was much higher at the provincial hospitals than at district hospitals or health centres, whereas the opposite pattern was observed for laboratory and pharmacy staff (lost at a higher rate in lower-level facilities). In provincial hospitals, doctors had higher attrition rates than clinical officers, and registered nurses had higher attrition rates than enrolled nurses. In contrast, attrition of enrolled and registered nurses in district hospitals and health centres was similar. The main reason for health worker attrition (all cadres combined) at each level of facility was retirement, followed by resignation and death. However, resignation drives attrition among doctors and clinical officers; retirement accounts for the main share of attrition among nurses and pharmacy staff; and death is the primary reason for attrition among laboratory staff, particularly in district hospitals. One limitation of the data is that sampling of health centres was non-random and the results may thus not be representative of all health centres.</p> <p>Conclusion</p> <p>Our findings indicate that appropriate policies to retain staff in the public health sector may need to be tailored for different cadres and level of health facility. Further studies, perhaps employing qualitative research, need to investigate the importance of different factors in the decision of health workers to resign.</p

Farmer organisations offer ICT solutions

Farmer organisations are an ideal medium for delivering ICT-based services to improve farmers' incomes, and expand their market

Adoption of innovative energy efficiency pots to enhance sustained use of clean cooking with gas in resource-poor households in Kenya: Perceptions from participants of a randomized controlled trial

Background: Scaling up clean cooking is a priority to address the substantial health burden from exposure to household air pollution resulting from burning of polluting fuels. The costs of cooking equipment and fuel, as well as cooking behaviors, may present barriers to adoption and sustained use of clean cooking. This paper reports novel qualitative findings from a Randomized Controlled Trial (RCT) evaluating the effects of innovative energy-efficient cooking pots on sustained use of LPG for the first time in a low and middle-income setting. Method: Semi-structured interviews (SSIs) were conducted with 22 of 200 cooks (LPG primary users) from an informal settlement in Nairobi, participating in the RCT. Data were analysed through thematic analysis. Results: Reported benefits of the enhanced pots (compared to standard pots), included perceived fuel and time savings and prestige. Findings also indicate participants' willingness to pay for the pots and ways to support their scale. Conclusion: This study highlights the potential for energy-efficient pots in facilitating sustained/exclusive clean cooking with LPG and their ability to meet all cooking needs. This is relevant to informing commercial scalability of energy-efficient cookware in the local Kenyan market

Health financing reform in Kenya- assessing the social health insurance proposal

Kenya has had a history of health financing policy changes since its   independence in 1963. Recently, significant preparatory work was done on a new Social Health Insurance Law that, if accepted, would lead to universal health coverage in Kenya after a tr&amp;nsition period. Questions of economic  feasibility and political acceptability continue to be discussed, with   stakeholders voicing concerns on design features of the new proposal   submitted to the  Kenyan parliament in 2004. For economic, social, political and organisational reasons a transition period will be  necessary, which is likely to last more than a decade. However, important objectives such as access to health care  and avoiding impoverishment due to direct health care payments should be recognised from the start so that  steady progress towards effective universal coverage can be planned and achieved

AfriMTE and AfriCOMET : Empowering COMET to Embrace Under-resourced African Languages

Despite the progress we have recorded in scaling multilingual machine translation (MT) models and evaluation data to several under-resourced African languages, it is difficult to measure accurately the progress we have made on these languages because evaluation is often performed on n-gram matching metrics like BLEU that often have worse correlation with human judgments. Embedding-based metrics such as COMET correlate better; however, lack of evaluation data with human ratings for under-resourced languages, complexity of annotation guidelines like Multidimensional Quality Metrics (MQM), and limited language coverage of multilingual encoders have hampered their applicability to African languages. In this paper, we address these challenges by creating high-quality human evaluation data with a simplified MQM guideline for error-span annotation and direct assessment (DA) scoring for 13 typologically diverse African languages. Furthermore, we develop AfriCOMET, a COMET evaluation metric for African languages by leveraging DA training data from high-resource languages and African-centric multilingual encoder (AfroXLM-Roberta) to create the state-of-the-art evaluation metric for African languages MT with respect to Spearman-rank correlation with human judgments (+0.406)

Decomposing Kenyan socio-economic inequalities in skilled birth attendance and measles immunization

INTRODUCTION: Skilled birth attendance (SBA) and measles immunization reflect two aspects of a health system. In Kenya, their national coverage gaps are substantial but could be largely improved if the total population had the same coverage as the wealthiest quintile. A decomposition analysis allows identifying the factors that influence these wealth-related inequalities in order to develop appropriate policy responses. The main objective of the study was to decompose wealth-related inequalities in SBA and measles immunization into their contributing factors. METHODS: Data from the Kenyan Demographic and Health Survey 2008/09 were used. The study investigated the effects of socio-economic determinants on [1] coverage and [2] wealth-related inequalities of SBA utilization and measles immunization. Techniques used were multivariate logistic regression and decomposition of the concentration index (C). RESULTS: SBA utilization and measles immunization coverage differed according to household wealth, parent’s education, skilled antenatal care visits, birth order and father’s occupation. SBA utilization further differed across provinces and ethnic groups. The overall C for SBA was 0.14 and was mostly explained by wealth (40%), parent’s education (28%), antenatal care (9%), and province (6%). The overall C for measles immunization was 0.08 and was mostly explained by wealth (60%), birth order (33%), and parent’s education (28%). Rural residence (−19%) reduced this inequality. CONCLUSION: Both health care indicators require a broad strengthening of health systems with a special focus on disadvantaged sub-groups

Decomposing Kenyan socio-economic inequalities in skilled birth attendance and measles immunization

Abstract Introduction Skilled birth attendance (SBA) and measles immunization reflect two aspects of a health system. In Kenya, their national coverage gaps are substantial but could be largely improved if the total population had the same coverage as the wealthiest quintile. A decomposition analysis allows identifying the factors that influence these wealth-related inequalities in order to develop appropriate policy responses. The main objective of the study was to decompose wealth-related inequalities in SBA and measles immunization into their contributing factors. Methods Data from the Kenyan Demographic and Health Survey 2008/09 were used. The study investigated the effects of socio-economic determinants on [1] coverage and [2] wealth-related inequalities of SBA utilization and measles immunization. Techniques used were multivariate logistic regression and decomposition of the concentration index (C). Results SBA utilization and measles immunization coverage differed according to household wealth, parent’s education, skilled antenatal care visits, birth order and father’s occupation. SBA utilization further differed across provinces and ethnic groups. The overall C for SBA was 0.14 and was mostly explained by wealth (40%), parent’s education (28%), antenatal care (9%), and province (6%). The overall C for measles immunization was 0.08 and was mostly explained by wealth (60%), birth order (33%), and parent’s education (28%). Rural residence (−19%) reduced this inequality. Conclusion Both health care indicators require a broad strengthening of health systems with a special focus on disadvantaged sub-groups.</p

Field manual for tree volume and biomass modelling

Improving capacity in forest resources assessment in Kenya (IC-FRA)201