Kenya Health Workforce Project

The purpose of the Kenya Health Workforce Project is to develop an informatics system that provides data for planning, capacity building, and development of policy to ensure that adequate human resources are available for the increased healthcare demands due to the HIV/AIDS epidemic, as well as healthcare in general. This project began in 2002 with initial funding from the Office of Global Health of the Centers for Disease Control and Prevention (CDC) and was subsequently funded by the Kenya CDC Global AIDS Program (GAP).

Project Objectives

1. Build the capacity of Kenya’s healthcare managers to utilize human resource data for optimizing the supply, deployment, and capacity building of the workforce to meet the demands of the HIV/AIDS epidemic in Kenya.

2. Establish the capacity for an electronic database of staff returns from all Kenyan provincial nursing offices. This includes installing computer workstations, software, and training data entry personnel.

3. Disseminate information about the process of creating an electronic data system for managing human resources for healthcare, and findings from data analysis.

4. Establish electronic database for other healthcare cadres.

5. Continue support and maintenance for current operating systems.

6. Insure data quality and accuracy of existing data collections systems for nursing workforce.

More on objectives..

Find out more about the Project:

I.The global shortage of health care workers

Many countries around the world, especially developing countries, face a shortage of healthcare personnel at a time when the demand for these human resources is increasing, especially for care and treatment of persons with HIV/AIDS. This is a serious problem for many developing countries that are doubly hit with a high prevalence of HIV/AIDS and a severe shortage of healthcare personnel. In order for healthcare system managers to effectively and efficiently manage the existing workforce and place new workers in the places most needed, informatics systems are needed that can be used to adequately and accurately assess and monitor the supply and deployment of healthcare professionals. Human resources for healthcare are an essential component for addressing global health and preventing the spread of disease in our increasingly global society; yet the lack of reliable systems to monitor key workforce information greatly hinders the effective management of the limited human resources for healthcare.

The HIV epidemic has added stress to the shortage

The widespread epidemic caused by HIV/AIDS, especially in sub Saharan Africa, where prevalence of the disease ranges up to 40% in some areas, has placed enormous demands on the health workforce. The U.S. Government has developed an ambitious agenda for providing HIV/AIDS treatment and care to approximately 3 million people in sub-Saharan Africa, the region most affected by this disease. This initiative requires that an adequate healthcare infrastructure be in place, including personnel trained to provide the complex treatment and care needed for persons with HIV/AIDS, in an area where healthcare professionals face an increasing patient load and where professionals themselves are dying from AIDS. Out-migration of healthcare professionals to developed countries has further strained the health workforce. Shortages of healthcare professionals in developed countries such as the United States and the United Kingdom has led to aggressive recruitment of trained professionals from less developed countries.

What global health agencies are doing

Global health agencies are recognizing the importance of human resources for healthcare. The World Health Organization (WHO) dedicated the 2006 World Health Day and its accompanying World Health Report to the issues of human resources for health and workforce disparities confronting the global community. The United Nations Population Fund (UNFPA) has not only recognized the importance of human resources for health in their 5-year review of the Millennium Development Goals, but has also determined the health of the world’s population to be inextricably linked to the health and migration of its health workforce.

Informatics systems are critical for managing the health care workforce.

Critical to addressing human resource needs is the creation of effective workforce information systems that are capable of providing accurate information required for human resource planning and development. One of the major problems that developing countries face in assessing workforce capacity is the lack of electronic database systems that can be analyzed for monitoring and staffing needs. For example in Kenya, forms for nursing registration and training collected by the Nursing Council of Kenya (NCK) were previously kept in large hard copy files, one file for each nurse trained. Data on workforce deployment is submitted in hard copy by each province on a quarterly basis to the Ministry of Health Chief Nurse’s Office (MOH-CNO). These data are manually transcribed by MOH officials and stored in hard copy format which makes retrival and analysis difficult. The Kenyan MOH and NCK lacked computer equipment, software programs, and technical support for informatics systems. The Kenya Health Workforce Project has worked to address this issue and is seeking funding to continue to address this critical issue.

II. About the Project

In 2002, the Lillian Carter Center for International Nursing (LCCIN), Emory University Nell Hodgson Woodruff School of Nursing (NHWSN) began collaborating with CDC, the Nursing Council of Kenya (NCK) and the Kenya Ministry of Health (MOH). Findings from a joint CDC-LCCIN consultative Kenya site visit recognized that the lack of a reliable nursing workforce database impaired the country’s ability to develop effective workforce policy decisions and allocate resources appropriately. CDC’s Office of Global Health subsequently funded Emory’s proposal to establish a networked computerized database for Kenya’s nursing workforce. Recognizing the need to assure an adequate health workforce to carry out the enormous increase in healthcare programs addressing the HIV/AIDS epidemic, CDC’s Global AIDS Program with resources provided by the President’s Emergency Program for AIDS Relief (PEPFAR) began providing funding to the project in September 2005. To date, the Kenyan Health Workforce Project has focused on nursing professionals because nurses constitute the largest healthcare workforce in Kenya and provide the majority of healthcare in Kenya. However, work is already underway to include other health cadres.

III. How the Project works

Adequate management of human resources for healthcare requires data on both the supply of healthcare professionals and the demand for their services. In Kenya, the Nursing Council of Kenya (NCK) is responsible for regulating the practice of nursing. Data collected by the NCK includes nurses in training, professional registration, licensure, nurses trained outside Kenya that are applying to work in Kenya, and requests for information related to out-migration to work in other countries. These data represent the supply side. The demand side is represented by both the government and private employers of professionals that constitute the Kenyan healthcare system. The Chief Nursing Officer (CNO) in the MOH provides oversight for nurses employed by the MOH. Each quarter, the nursing officers in charge of each government health facility submit staff return reports to the Chief Nursing Officer that provide information on each nurse employed by that facility. These reports are compiled at the district and provincial levels and forwarded to MOH headquarters in Nairobi.

During 2002-2005 (the first 3 years of the project), a database was created for the supply side, that is, data collected by the NCK. Computer and satellite equipment were installed at NCK and data entry personnel were trained. Over a three-year period (10/2002-9/2005), Kenya’s hard copy nursing registration was transformed into a computerized system that includes every nurse ever-licensed from 1960 to the present, representing over 44,000 nurses.

Since 2006, the project has begun linking the information about the supply of nurses with worksite information about the deployment and demand for nurses at the provincial and district level. A software program for entering worksite data has been developed and implemented in Nyanza province. Nyanza province was chosen as the pilot site because it has the highest prevalence of HIV in Kenya. Computer equipment has been installed and data entry personnel have been trained. Satellite equipment was installed to allow for an electronic link with the database system at the NCK. Satellite equipment has also been installed at the MOH headquarters (CNO’s office) in Nairobi, allowing the CNO to access supply and demand information. Computer and satellite equipment was also installed in one district, Homa Bay, in Nyanza province, as a pilot activity. Data from this district is being entered into the database at the district level. Data from other districts in the province are entered at the provincial level.

The need to track training

Health care professionals must be trained to provide the complex care required for control and management of the HIV/AIDS epidemic. Building the technical capacity of the health workforce to address the prevention and treatment of HIV/AIDS requires a large training component on many different content areas and skills. Tracking of the number and location of personnel who have been trained and placed in jobs that take advantage of this training is critical to assuring that the health workforce has the capacity to carry out HIV/AIDS prevention and treatment objectives. Prior to this project, CDC and the MOH had limited ability to track the training and capacity building activities. Collecting data on specific HIV/AIDS training of all nurses is a critical activity of the project that began in FY2006.

To address the need to track the training of healthcare personnel related to the control and management of the HIV/AIDS epidemic, the project has been working collaboratively with CDC and MOH officials over the past year to develop a list of types of trainings to be tracked, data collection systems, and revision of the current software to include data on training.

Dissemination

Although data has only recently been available for analysis, usage and dissemination of information has already begun. Project data have been presented at national, regional, and international meetings. In June, 2007 Developing a nursing database system in Kenya was published in Health Services Research [cite]. In addition, the NCK is using the software capabilities to carry out their various functions such as issuing photo-identified licenses. Data on the qualifications of nurses being hired through funding provided by the Clinton Foundation, Capacity Project and other HIV/AIDS initiatives can now be provided in a timely manner. The Kenyan MOH has established an internal working group, the Human Resources Information Systems workgroup that aims to facilitate coordination of human resources. Data from this project is being provided to this important work group. The project has also been presented to key stakeholders for two other healthcare cadres, physicians and laboratory technicians, for their buy-in in establishing a database for their constituents.

IV. More on objectives and progress

The overall goal of the project is to develop an informatics system that provides and ensures the use of data for planning, capacity building, and development of policy related to human resources to meet the demands of the HIV/AIDS epidemic. The specific objectives for the future are described briefly here.

1. Build the capacity of Kenya’s healthcare managers to utilize human resource data for optimizing the supply, deployment, and capacity building of the workforce to meet the demands of the HIV/AIDS epidemic in Kenya.

2. Establish the capacity for an electronic database of staff returns from all Kenyan provincial nursing offices. This includes installing computer workstations, software, and training data entry personnel

3. Disseminate information about the process of creating an electronic data system for managing human resources for healthcare, and findings from data analysis.

4. Establish electronic database for other healthcare cadres.

5. Continue support and maintenance for current operating systems.

6. Ensure data quality and accuracy of existing data collections systems for nursing workforce.

Objective 1: Build the capacity of Kenya’s healthcare managers to utilize human resource data for optimizing the supply, deployment, and capacity building of the workforce to meet the demands of the HIV/AIDS epidemic in Kenya. Kenyan healthcare managers, having never had computerized data, have limited knowledge and skills related to data collection, data protection, data quality, and use of data for monitoring, planning, and evaluation. Thus, several workshops will be held on these themes with national, provincial, and district level managers.

Objective 2: Establish the capacity for an electronic database of staff returns from all Kenyan provincial nursing offices. As of 2007, the project has implemented the database system in 2 (Nyanza and Rift Valley) of Kenya’s 8 provincial nursing offices that now have the capacity to electronically enter data from nursing staff returns. Nyanza Province was chosen because of its high prevalence of HIV/AIDS. Rift Valley was chosen because it is the largest province and also has a high prevalence of HIV/AIDS and already has satellite equipment for linkage with MOH headquarters in Nairobi through another CDC project. The project expects to bring on another 3 provinces in 2008. Other provinces will be brought on board as funding permits.

Objective 3: Disseminate information about the process of creating an electronic data system for managing human resources for healthcare, and findings from data analysis.

Project information will be disseminated to PEPFAR’s US government partners, the Kenya MOH AIDS offices and organizations, and the larger community in several ways. A glossy report describing the process and giving data on the state of nursing in Kenya will be developed and widely distributed. The project’s in-country director is a member of the MOH Human Resources Information Systems technical working group and provides information from the project to this cross cutting working group. The project will continue to be presented at national, regional, and international meetings. Manuscripts will continue to be published in the scientific literature and presented at scientific meetings.

Objective 4: Establish electronic database for other healthcare cadres.

CDC is interested in having the project pursue the development of informatics systems for other health cadres. The project has already hosted an informational meeting for stake holders from the physician and laboratory technologist cadres. The project expects to develop an informatics system for physicians and laboratory technicians similar to what has been created for the nursing cadre.

Objective 5: Continue support and maintenance for current operating systems.

Although the MOH is gradually becoming “computerized”, currently there is limited centralized technology support available for this project. The project contracts with local Kenyan companies that provide these services to the workstations and data users in the project. The project also must also cover fees for satellite connections. For the project to be sustainable, these functions and costs must eventually be absorbed by the MOH. Therefore, the project’s support during these next three years will enable MOH to begin to gradually absorb these costs items as routine expenses for maintaining their system.

Objective 6: Ensure data quality and accuracy of existing data collections systems for nursing workforce.

Ensuring data quality and accuracy involves a process at several levels, including at the point of data collection, edit and logic checks that can be built into the software data entry program, and cleaning of data during the analysis phase.

V. Collaboration and Partners

VI. Staffing

Nell Hodgson Woodruff School of Nursing, Emory University

Kenya Project Team

VII. Other Useful Links