Health service delivery
- Incentives for health worker retention in Kenya: an assessment of current practice
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Kenya's health system faces a variety of human resource problems, primarily an overall lack of personnel in key areas, which is worsened by high numbers of trained personnel leaving the health sector to work overseas. This study provides a literature review and field research which obtains data on strategies for the retention of health workers in various institutions in Kenya.
The authors reviewed existing strategies for recruiting and retaining health workers over time in Kenya. The paper highlights how facilities in Kenya offered a number of financial incentives to their staff, such as paid leave and overtime pay, access to house or car loans at lower negotiated market rates and numerous allowances, such as transport, entertainment, hardship, responsibility, special duty and uniform allowances. Some staff worked in bonding agreements, whereby the institution paid for their studies but they had to work for a specific numbers of years in return.
Poor people - in both developed and developing countries - experience more ill health and shorter life spans than their richer fellow citizens. Although people's health is influenced by a wide range of socio-economic and lifestyle factors, access to high quality and affordable health care and public health services makes a critical contribution to health status.
Health services are failing poor people - with lower rates of child immunisation, skilled attendance at child birth, and TB and malaria treatment. It's also true that richer groups tend to benefit more from public sector subsidies to health care - hospitals in urban centres often receive disproportionate funds compared with primary care in poor rural areas. And in most poor countries which lack formal taxation and insurance systems, out-of-pocket payments are paid to both private and public providers, consume household income and assets, and contribute to impoverishment.
Improving service delivery to the poor involves all the major stakeholders in the health system - the policymakers in ministries of health, finance, and public administration, health service managers and workers, public and private providers and clients and communities themselves. Better access depends on a wide range of factors - on health policies, strategy and plans that prioritise health needs and set out revenue sources and resource requirements (including mechanisms to address inequalities), on motivated and properly trained and remunerated health workers, on infrastructure, drugs and equipment, on good referral links and communication, and – last but not least - on well-informed clients and their representative bodies.
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