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 exa...
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| Format: | Article |
| Language: | English |
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BMC
2022-08-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12913-022-08432-1 |
| _version_ | 1811340321626259456 |
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| author | Lizah Nyawira Benjamin Tsofa Anita Musiega Joshua Munywoki Rebecca G. Njuguna Kara Hanson Andrew Mulwa Sassy Molyneux Isabel Maina Charles Normand Julie Jemutai Edwine Barasa |
| author_facet | Lizah Nyawira Benjamin Tsofa Anita Musiega Joshua Munywoki Rebecca G. Njuguna Kara Hanson Andrew Mulwa Sassy Molyneux Isabel Maina Charles Normand Julie Jemutai Edwine Barasa |
| author_sort | Lizah Nyawira |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-13T18:39:15Z |
| format | Article |
| id | doaj.art-d2f7cb9648a74278b3e707a538bda1c3 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-04-13T18:39:15Z |
| publishDate | 2022-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-d2f7cb9648a74278b3e707a538bda1c32022-12-22T02:34:46ZengBMCBMC Health Services Research1472-69632022-08-0122111410.1186/s12913-022-08432-1Management of human resources for health: implications for health systems efficiency in KenyaLizah Nyawira0Benjamin Tsofa1Anita Musiega2Joshua Munywoki3Rebecca G. Njuguna4Kara Hanson5Andrew Mulwa6Sassy Molyneux7Isabel Maina8Charles Normand9Julie Jemutai10Edwine Barasa11Health Economics Research Unit, KEMRI-Wellcome Trust Research ProgrammeHealth Systems and Research Ethics Department, KEMRI-Wellcome Trust Research ProgrammeHealth Economics Research Unit, KEMRI-Wellcome Trust Research ProgrammeHealth Economics Research Unit, KEMRI-Wellcome Trust Research ProgrammeHealth Economics Research Unit, KEMRI-Wellcome Trust Research ProgrammeFaculty of Public Health and Policy, London School of Hygiene and Tropical MedicineDirectorate of Medical Services, preventive and promotive health, Ministry of HealthHealth Systems and Research Ethics Department, KEMRI-Wellcome Trust Research ProgrammeHealth Financing Department, Ministry of HealthCentre for Health Policy and Management, Trinity College, the University of DublinHealth Systems and Research Ethics Department, KEMRI-Wellcome Trust Research ProgrammeHealth Economics Research Unit, KEMRI-Wellcome Trust Research ProgrammeAbstract 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.https://doi.org/10.1186/s12913-022-08432-1Human resources for HealthEfficiencyPerformanceKenya |
| spellingShingle | Lizah Nyawira Benjamin Tsofa Anita Musiega Joshua Munywoki Rebecca G. Njuguna Kara Hanson Andrew Mulwa Sassy Molyneux Isabel Maina Charles Normand Julie Jemutai Edwine Barasa Management of human resources for health: implications for health systems efficiency in Kenya BMC Health Services Research Human resources for Health Efficiency Performance Kenya |
| title | Management of human resources for health: implications for health systems efficiency in Kenya |
| title_full | Management of human resources for health: implications for health systems efficiency in Kenya |
| title_fullStr | Management of human resources for health: implications for health systems efficiency in Kenya |
| title_full_unstemmed | Management of human resources for health: implications for health systems efficiency in Kenya |
| title_short | Management of human resources for health: implications for health systems efficiency in Kenya |
| title_sort | management of human resources for health implications for health systems efficiency in kenya |
| topic | Human resources for Health Efficiency Performance Kenya |
| url | https://doi.org/10.1186/s12913-022-08432-1 |
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