Kenya

This survey is the first attempt to examine the preparedness of the health
system to implement guidelines for HIV testing in clinical settings, and to provide comprehensive AIDS management. This includes availing HIV testing in clinical settings to both adult and pediatric patients, and providing treatment for HIV disease. The survey also examines the working environment in health care facilities, with an emphasis on HIV infection control and access to post-exposure prophylaxis for health workers themselves. [from foreword]

This study focused on the positive traits and strategies exhibited by high-performing facilities to determine how to improve performance at average and low-performing sites. [from author]

Faith-based organizations are a key link in the sustainability of accessible health services. In many African countries, they have been providing health care for over 60 years and in some, such as Kenya, for a century or more.

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.

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]

This article discusses the cost-effectiveness of a recent programme that involved training shopkeepers and community mobilisation for treating childhood fevers in the rural Kilifi District in Kenya. The programme offered workshops for shopkeepers on appropriate treatment for malaria in young children and also ran community information activities, with impact maintained through refresher training and monitoring. [author’s description]

The aim of the study was to estimate the use of skilled attendants’ delivery services among users of antenatal care and the coverage of skilled attendants’ delivery services in the general population in Kikoneni location, Kenya. Antenatal care attendance, deliveries by skilled attendants, and the percentage of antenatal care attendees who delivered in a healthcare facility were assessed. Targeted programmatic efforts are necessary to increase skilled attendant-assisted births, with the ultimate goal of reducing maternal mortality. [from abstract]

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.

The Capacity Project worked with health sector leaders to develop the Emergency Hiring Plan (EHP), an innovative rapid response staffing and training model. Designed to increase the number of qualified health professionals available to work in public health facilities, the EHP is helping the MOH to expand access to treatment and care through the rapid hiring, training and deployment of 830 health workers. [from author]

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]

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 research described in this report investigated whether facility-based teams that had been trained and coached to develop and implement improvements in performance of the Integrated Management of Childhood Illness (IMCI) algorithm through problem-solving teams would improve case management. The study compared 21 facilities with teams and 14 without, all in rural facilities in Kenya.

Accurate, detailed and up-to-date manpower data is a prerequisite for human resource management. This technical brief describes how the Ministry of Health 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. [adapted from author]

This Kenya assessment is part of a multicountry initiative to provide data and options to policymakers and donors amidst for building the capacity of health care systems in low resource countries through recruitment, training, and deployment of public and private health workers. The assessments look at how human resource (HR) policy and workload planning can address personnel shortages, specifically, gross imbalances across urban and rural areas and among personnel categories, including doctors, nurses, pharmacists, and lab technicians. [adapted from author]

The Health Management Information System (HMIS) in Kwale District, Coast Province is Kenya’s first computerised district-level HMIS. A joint effort of the Ministry of Health and the Community Health Department of the Aga Khan Health Service, Kenya, the system uses simple, user-friendly software developed by Data Dynamics Limited to collect and analyse data from local health facilities.

This presentation is from a Capacity Project sponsored interactive workshop to consider fresh perspectives on supportive supervision, exploring alternative approaches to the standard visiting-supervisor model from within and outside the international health care sector.

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.

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.

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.

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]

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]

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.

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]

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 report presents a comprehensive analysis of the human resources for health (HRH) currently available and required to reach the targets set by the President’s Emergency Plan for AIDS Relief and the Millennium Development Goals (MDGs) in both the public sector and the faith-based organizations (FBOs) in Kenya. A stratified convenience sample of health facilities at all levels of care (primary, secondary, tertiary) in each of the eight provinces was selected for the assessment. Detailed information on human resources and provision of services related to HIV/AIDS, tuberculosis (TB), malaria, maternal health, and child health was collected.

This review examines the systemic and individual causes of multiple job holding (MJH) and evidence on its prevalence. MJH should be seen as resulting initially from underlying system-related causes. These include overly ambitious efforts by governments to develop and staff extensive delivery systems with insufficient resources. Governments have tried to use a combination of low wages, incentives, exhortations to public service, and regulation to develop these systems.

This study investigated the uses of demographic census data for monitoring geographical imbalance in the health workforce for three developing countries, as a basis for formulation of evidence-based health policy options. [from abstract]

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.

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 organizations. This brief takes up a number of likely questions about the management functions of the nurses in charge of small, local health facilities:

• How prepared are “nurses in charge” for carrying out administrative and management functions?
• How should they relate to the new management committees?
• What additional training do they need?
• What are the lessons from the Kwale project—lessons about the training of nurses—that can be applied elsewhere?