Factors influencing attraction and retention of primary health workers in three disparate regions in Kenya in the context of devolution

Background

Though a number of interventions have been implemented to increase the number and length of stay of health workers in hard-to-reach areas, Kenya faces difficulties in attracting and retaining health workers there. An opportunity to address this situation at local level has been created by adoption of a new constitution that passes the management of health workers to 47 newly created Counties. This study sought to explore implications of the devolved system of governance on motivation and retention of different cadres of primary-level health workers in three regions in Kenya.

Methods

Data were obtained through semi-structured qualitative interviews with staff from public and private health facilities in marginalized and hardship zones in Northern Kenya-Turkana County (18 interviews), more accessible regions of Eastern region-Machakos County (9 interviews) and the densely populated but socio-economically disadvantaged urban slums-Kibera Nairobi County (17 interviews).The interviews were coded using  NVIVO10 software.

Results and discussion

The study shows that factors influencing motivation and retention were similar across the three regions and mainly revolved around health workers being supported to do their work in terms of medical supplies, hospital management support, and numerical adequacy. However, remote regions such as Turkana presented more challenges (poor opportunities for training, poor living conditions and inaccessibility) than Machakos or Kibera. Further, older health workers were more likely to stay in remote areas than younger ones. The new governance system, though its roles were still unclear, was seen to present a good opportunity to address health worker motivation and retention.

Conclusion

The findings show that factors that de-motivate or push health workers from hard to reach areas were similar and addressing these can greatly motivate health workers and retain them where they are needed. The new County governments can provide incentives that address specific issues in their regions which in turn can attract and retain health workers in difficult settings.