Management of human resources for health: implications for health systems efficiency in Kenya

Abstract

Background Human resources for health consume a substantial share of healthcare resources and determine the efficiency and overall performance of health systems. Under Kenya’s devolved governance, human resources for health are managed by county governments. The aim of this study was to examine how the management of human resources for health influences the efficiency of county health systems in Kenya. Methods We conducted a case study using a mixed methods approach in two purposively selected counties in Kenya. We collected data through in-depth interviews (n = 46) with national and county level HRH stakeholders, and document and secondary data reviews. We analyzed qualitative data using a thematic approach, and quantitative data using descriptive analysis. Results Human resources for health in the selected counties was inadequately financed and there were an insufficient number of health workers, which compromised the input mix of the health system. The scarcity of medical specialists led to inappropriate task shifting where nonspecialized staff took on the roles of specialists with potential undesired impacts on quality of care and health outcomes. The maldistribution of staff in favor of higher-level facilities led to unnecessary referrals to higher level (referral) hospitals and compromised quality of primary healthcare. Delayed salaries, non-harmonized contractual terms and incentives reduced the motivation of health workers. All of these effects are likely to have negative effects on health system efficiency. Conclusions Human resources for health management in counties in Kenya could be reformed with likely positive implications for county health system efficiency by increasing the level of funding, resolving funding flow challenges to address the delay of salaries, addressing skill mix challenges, prioritizing the allocation of health workers to lower-level facilities, harmonizing the contractual terms and incentives of health workers, and strengthening monitoring and supervision.

Closing the gap towards a successful referral system. A case study of a tertiary teaching and referral hospital, Kenya: pre-posttest study design

“…Inadequate human resource does also comprise the quality of care provided at the health facilities. This is in tandem with a study finding in Kenya that revealed Human resources for health was inadequately financed with insufficient number of health workers and there was maldistribution of staff in favor of higher-level facilities and in urban cities and this resulted in unnecessary referrals to higher level consequently compromised quality of primary healthcare (28–30). A number of studies in Brazil, Japan, United States of America and in Low- and Middle-income countries have also demonstrated inadequate human resource capacity and availability as the main reasons for patient referrals (31–35).…”

The autonomy of public health facilities in decentralised contexts: insights from applying a complexity lens in Kenya

“…County leaders are keen to consolidate their power and retaining control over resources and decision making is one way to achieve this. This control could also be used inappropriately, and county level political interests have been shown to influence decisions with negative implications for health system performance 13 27. It is likely that such political interest in control over resources manifests in overt resistance by some counties to give public health facilities autonomy, or covert resistance, camouflaged in strategic misinterpretation of PFM laws.…”