Kenya

To promote the health and survival of mothers and babies, Kenya has adapted the WHO goal-oriented Antenatal Care (ANC) package, popularly known as focused ANC (FANC). The Ministry of Health (MOH) has designed new guidelines for ANC services, placing emphasis on refocusing antenatal care, birth planning and emergency preparedness, and the identification, prevention and management of life threatening complications during pregnancy and childbirth. ANC visits are now used as an entry point for a range of other services, thus promoting comprehensive integrated service delivery. A major challenge, however, is whether the Kenyan health care system can cope with the implementation of this package.

This case study describes how five Integrated Management of Childhood Illness (IMCI) trainers and supervisors conducted an assessment of provider knowledge and skill to carry out IMCI at 38 facilities in two districts in Kenya. [author’s description]

This assessment establishes the link between service quality and initial training by examining the skill retention of 2 cohorts of service providers who participated in a family planning (FP) training program in Kenya during 1994–1995. The following two questions were considered: 1) Do providers use the skills in which they were trained? 2) Is the length of time after the course concludes related to whether trained providers retain their new skills? [publisher’s description]

This presentation was part of the ECSA Workforce Observatory Meeting in Arusha. It argues that an established human resource information system is critical for proper human resource management. It discusses the process of implementing an HRIS system for nursing in Kenya and some of the lessons learned from this implementation.


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The emphasis of the COPHIA program is the provision of home-based care and support services by multi-purpose community-based health workers to vulnerable households in the geographic focus areas that are coping with the burden of caring for seriously ill family members or caring for orphans and vulnerable children. The COPHIA community-based health workers, with the support of clinical and non-clinical supervisors, provide the direct physical and emotional care and support services to PLWHA and orphans and vulnerable children in the project catchment area with the support of trained primary caregivers.

This report presents the results of a longitudinal, quasi-experimental study evaluating the introduction and use of COPE and the resulting changes in service quality in two countries, Kenya and Guinea. At the end of a 15-month period, providers’ attitudes, providers’ ability to solve problems, service quality, and client satisfaction were assessed at eight intervention sites and at eight matched control sites, using both qualitative and quantitative methods. [author’s description]

Presbyterian Church of East Africa (PCEA) Chogoria Hospital is a faith based non-governmental organization providing a wide range of healthcare services. The organization faces a number of challenges related to sustainability: declining donor support (especially for reproductive health services), low cost recovery levels, and increasing poverty levels among its clientele. In response to these concerns, a team from Chogoria Hospital attended a one-week workshop held in Ghana on financial sustainability and developed a small scale operations research project to determine the cost of providing a selected number of reproductive health (RH) services and to evaluate their cost recovery levels.

Past attempts to estimate the cost of migration were limited to education costs only and did not include the lost returns from investment. The objectives of this study were: (i) to estimate the financial cost of emigration of Kenyan doctors to the United Kingdom (UK) and the United States of America (USA); (ii) to estimate the financial cost of emigration of nurses to seven OECD countries (Canada, Denmark, Finland, Ireland, Portugal, UK, USA); and (iii) to describe other losses from brain drain. [author’s description]

The competency-based approach used in JHPIEGO-supported training improves performance by ensuring that trainees go back to their worksites with the knowledge and skills required to provide FP services. Once back at the workplace, however, participants often face constraints that limit their ability to provide quality services. Factors that can affect the performance of the healthcare provider include: job expectations, performance feedback, supplies and equipment, motivation, possessing the knowledge and skills to provide services, and supervision. For these participants—and their colleagues in clinical settings—to perform well, it is essential that they have regular and supportive personal contact from supervisors… JHPIEGO proposes to address training-related supervision problems through the development of a supervision learning package. Before embarking on the development of the supervision learning package, JHPIEGO carried out a performance analysis that focused on reproductive health (RH) supervisors. [publisher’s description]

During the 1990s in Kenya, nurse midwives, a new group of private-sector service providers, were licensed to operate private clinics close to communities. The private nurse midwives operate private clinics, nursing and maternity homes primarily in densely populated peri-urban areas, rural trading centers and towns. The networks described in this report emerged out of the need for a sustainable supervision system and a continuing education program for the private nurse midwives. [from introduction]

Under the USAID AIDS, Population and Health Integrated Assistance project, JHPIEGO has been working since 1995 with the Division of Primary Health Care (DPHC), the Nursing Council of Kenya (NCK) and the Division of Nursing (DON) to pioneer the development of an integrated clinical training system used for both preservice and inservice family planning (FP) training. JHPIEGO and its partners have strengthened both inservice training and preservice education systems cost-effectively by developing a core group of trainers, tutors and preceptors. In addition, training materials, for both student and participant use, have been supplied to a limited number of clinical facilities. [publisher’s description]

The objective [of this report is] to describe the development, initial findings, and implications of a national nursing workforce database system in Kenya. [from abstract]

As part of the East, Central and Southern African College of Nursing’s 7th Scientific Conference, this presentation describes a distance education project in Kenya that was designed to upgrade the compentencies of enrolled nurses to registered level. It outlines the rationale behind the upgrade, why distance education was selected, the implementation of the program, challenges, achievements and future plans.

This presentation was part of a International Conference on Global Health session, “Innovations in Human Resources: Strategies to Address the Health-Care Workers Shortage.” It discusses the context, the emergency hiring plan, strategies for finding local partners, design and implementation and lessons learned of Kenya’s emergency health workforce mobilization plan.

The Quality Assurance Project (QAP) has developed and twice tested a computer-based version of the Integrated Management of Childhood Illness (IMCI) training course. Earlier testing had shown that the computer-based training (CBT), which takes six days, was as effective as the 11-day training traditionally used to teach healthcare providers to use IMCI. This report describes more recent testing of the CBT, which is available on CD-ROM. The two training programs are equally effective in knowledge transfer, as demonstrated here through a knowledge test and observed performance with two simulated, standardized cases of childhood illness. Budgeted costs were $230 or 29% less per trainee for the computer-based training, largely because of the reduction in the number of days committed to training. [publisher’s description]

The popularity of female sterilization often falls behind other FP methods due in partly because the method is permanent, but mostly because there is a lack of trained service providers who are competent in performing this procedure. Government hospitals and clinics are the primary service delivery points for FP services and, in fact, provide services to more than two-thirds of Kenyan women who use modern methods of contraception. There is, therefore, a strong need for appropriately trained service providers at these sites who can support the service provision system. [publisher’s description]

This is the fourth of a series of policy briefs produced by the Community Health Department of the Aga Khan Health Service in Kenya. It focuses on a number of issues related to the management of health facilities: the rational for decentralisation of health services, the role of the community in the management of health facilities, the membership of local management committees, selection criteria and, finally, the involvement of local politicians.

These briefs are primarily intended for directors and managers of community-based health care programmes — whether working within ministries of health, international donor agencies or non-government organisations.

There is a serious human resource crisis in the health sector in developing countries, particularly in Africa. One of the challenges is the low motivation of health workers. Experience and the evidence suggest that any comprehensive strategy to maximize health worker motivation in a developing country context has to involve a mix of financial and non-financial incentives. This study assesses the role of non-financial incentives for motivation in two cases, in Benin and Kenya. [abstract]

Despite a pool of unemployed health staff available in Kenya, staffing levels at most facilities were only 50%, and maldistribution of staff left many people without access to antiretroviral therapy. Because in the current system it takes one to two years to fill vacant positions, even when funding is available, an emergency approach was needed to fast-track the hiring and deployment process. A stakeholder group was formed to bring together leaders from several sectors to design and implement a fast-track hiring and deployment model that would mobilize 830 additional health workers. [from abst

This report summarizes findings from Phase 2 of a two-phase case study to determine why certain reproductive healthcare facilities in low-resource settings perform better than others. The study examined the characteristics, behaviors, and coping strategies of high-performing reproductive healthcare facilities in Kenya, exploring elements of resilience and factors influencing performance. The study investigated the applicability of a performance improvement (PI) model that hypothesizes that both individual and organizational performance are influenced by seven performance factors: job expectations; motivation; knowledge and skills; performance feedback; infrastructure, equipment, and supplies; leadership and management systems; and client and community focus.

Many countries have experimented with alternative ways of paying providers of health care services. This paper illustrates different methods, suggests some of the theoretic advantages and limitations of each, and provides a general theoretical framework for evaluating alternatives. Over the last two decades, new and more sophisticated payment systems have evolved, with a broadening of units of payment and setting of payments prospectively. The authors discuss the international experience of a number of payment systems, both traditional and more recently developed, including line-item budgeting, salary, fee-for-service, per diem, case-mix adjusted per episode, global budgets and capitation.

This presentation was given as part of the Christian Health Association’s Conference: CHAs at a Crossroad Towards Achieving Health Millennium Development Goals. It outlines FBO health services in Kenya and sources of and financial support for them. It also discusses the exodus of health workers from church health facilities, the reasons behind this migration and how this problem is being addressed.

Accurate, detailed and up-to-date manpower data is a prerequisite for human resource (HR) management. This Technical Brief describes how the Ministry of Health (MoH), with support from HLSP, conducted a human resource mapping exercise of all public health staff in Kenya, and discusses the implications of the findings. The aim is to demonstrate the many practical uses of human resource data – data which is not too complex to collect. [abstract]

This presentation was part of the ECSA Regional Health Ministers’ Conference. It describes an HIV/AIDS impact assessment done in Kenya and gives the detailed findings of the study.


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Through its work with the Zimbabwe National Family Planning Council and the Kenya Ministry of Health/Division of Primary Health Care, JHPIEGO facilitated the adaptation of materials to improve the performance of IUD service providers through structured on-the-job training (OJT). In Zimbabwe, providers at 14 sites learned IUD/genital tract infection skills by means of structured OJT. At the same time, in August 1996, JHPIEGO began pilot testing this structured OJT in Kenya at six provincial hospitals. Although the pilot test was intended to train about 40 service providers in both countries (two per site), it actually produced 50 providers who achieved competency during 4 to 6 weeks of self-paced learning. [publisher’s description]

This presentation was part of the ECSA 38th Regional Health Ministers’ Conference. It discusses the health sector vision, the role of the Department of Standards and Regulatory Services, the Nursing Council of Kenya, strategies to improve quality, the Kenya Quality Model, lessons learned and challenges.

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Jhpiego has been focused on improving the quality and availability of reproductive health and family planning services for slum residents, both by targeting the facility-based health care providers and the community members who access these services. This document outlines several lessons that have been learned from this experience. [adapted from author]

This case study evaluates a project in Kenya that concentrates on HIV and AIDS care and prevention through support and training of community volunteers to provide PLHA with HBC, widespread and diverse efforts to promote behavior change and raise awareness about HIV and AIDS, improving access to VCT, as well as capacity building efforts and direct material assistance for OVC and PLHA. [adapted from introduction]

Providing contraceptive services at VCT centers is an opportunity to prevent unintended pregnancies among clients whose needs may not be met through traditional family planning services. Operations research in Kenya suggests that integrating family planning into VCT services is feasible and acceptable. An integration intervention improved providers’ discussions about fertility desires and contraceptive methods with clients, without compromising the length of client-provider interaction or client waiting time. Although many VCT clients were considered at risk of unintended pregnancy, the i

This paper describes the experiences of three types of programs (government, reproductive health NGO, and women’s health NGO) in Kenya, India, and Guatemala that integrate gender in their work and examines how they integrate gender into programs that improve quality of care and access to care. It should be emphasized that this report does not document whether gender integration results in higher quality and access, but rather documents how gender integration can take place. [author’s description]