PRESENTED AT THE AMREF INTERNATIONAL CONFERENCE

25TH NOVEMBER 2014BY RICHARD GICHUKI, PROJECT OFFICER

RABD-AMREF KENYA

FACTORS AFFECTING MOTIVATION AND RETENTION OF PRIMARY HEALTH CARE WORKERS IN THREE DISPARATEREGIONS IN KENYA:

PRESENTER DISCLOSURES

Richard Gichuki

No relationships to disclose

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• Background

• Study objectives

• Methodology

• Results

• Discussion

• Conclusion and recommendations

OUTLINE

•Human resources for health (HRH) is one of the six building blocks of the health systems –WHO

•Report published in 2004 estimated 1m additional HWs in sub-Sahara Africa.

•Attracting and retaining HWs in Kenyan Health system has been a challenge.

•Baseline study conducted in 2011 and published in HRH journal (http://www.human-resources-health.com/content/12/1/33/abstract )

BACKGROUND

BACKGROUND_CONCEPTUAL FRAMEWORK

• “Push and pull factors” that determine movement of personnel (Padarath A, et all; 2003)

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Push Factors-leave Pull Factors-Attract

Low remuneration and salaries Levels of morale

Lack of Job satisfaction Rewards and Incentives

Work associated risks Social values

Lack of further education and career development opportunities

Barriers to migration

Lack of education opportunities for children

Low quality of life and high levels of crime

• Main objective–Investigate whether factors related to the motivation and retention of HWs differ across the three different settings in Kenya

• Specific objectives–To investigate whether socio-demographic characteristics of the respondents varies across the disparate setting.–To determine whether work environment factors differ across the three settings–To determine whether factors related to job satisfaction differ across the three settings.

STUDY OBJECTIVES

• Cross sectional mixed methods design utilizing quantitative and qualitative methods

• Sampling technique: – Cluster sampling used to select 81

facilities where 361 HWs were drawn– Purposive sampling: FGDs (7) and In-

depth interviews (30)

• Study Population and sites– HWs mainly from primary level fac’ – 3 counties visited -Turkana North,

Machakos County, Kibera in Nairobi County

METHODOLOGY

DATA COLLECTION AND ANALYSIS

•Data analyzed through:−Content analysis of qualitative information

−Descriptive statistics−Proportions

−Bi-variate analysis−Chi-square test−0.05 level of significance used.

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Ownership of Facilities by Region

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Type of Service ProviderNairobi Machakos Turkana Total(n=101) (n=143) (n=102) (n=346)

% % % %Administrator 2.0 3.0 1.0 2.0CHEW 1.0 2.1 3.9 2.3CHW 10.9 3.5 14.7 9.0Clinical Officer 9.9 7.7 9.8 9.0Lab Technician 11.9 11.2 4.9 9.5Lay Counsellor 3.0 1.4 5.9 3.2MO 2.0 4.9 1.0 2.9Nutritionist 7.9 2.8 5.9 5.2Parmacists 5.0 2.1 4.9 3.8Registered Nurse 33.7 44.8 32.4 37.9Support Staff 5.0 9.8 2.9 6.4Allied Professional 7.9 6.3 12.7 8.7Total 100.0 100.0 100.0 100.0

SERVICE PROVIDER BY REGION

Characteristic CategoryNairobi Machaks Turkana

P-value(n=101) (n=143) (n=102)Sex Male 38% 33% 55% 0.001 Female 62% 67% 45%Age <35 63% 52% 77% 0.004 >35 37% 48% 23%Post Sec Educ Yes 89% 79% 78% 0.001

No 11% 21% 22%Alternative Yes 38% 42% 35% 0.373Sources of Income No 62% 58% 65%

RESULTS: BACKGROUND CHARACTERISTICS OF RESPONDENTS

Characteristic CategoryNairobi Machaks Turkana(n=100) (n=136) (n=98) P-value

Attended Upgrading Course

Yes 45% 35% 34% 0.096

No 55% 65% 66%Highest level of upgrading course attended

Diploma 22% 40% 27% 0.01Masters 16% 2% 0%Other1 62% 57% 73%

RESULTS: TRAINING CHARACTERISTICS OF PROFESSIONAL HEALTH WORKERS

“The other thing apart from money for their own pockets there are also money for trainings like if you have a certificate in nursing the county health team should give you money to go and train in that way you will attract more people” FGD-Turkana

% of respondents reporting Machakos Nairobi Turkana P-Value

Satisfied with their job 35.3 43.6 43.2 0.563Job good match for skills 63.0 78.2 68.2 0.334Recognition for doing work 52.1 55.4 65.9 0.246

Training have been provided to succeed in their work 61.3 74.3 53.4 0.034*

Morale level at depart’ is good 42.0 58.4 60.2 0.046*

Feels protected from comm’ diseases (HIV) 56.3 73.3 69.3 0.045*

RESULTS: JOB SATISFACTION

% of respondents Machakos Nairobi Turkana P-value

Workload is manageable 37.2 71.6 64.0 <0.001

Good access to drugs 37.2 71.6 64.0 <0.001

Equip’s to do their job 19.8 30.4 33.7 0.264

Efficient transp’ to work 33.1 54.0 31.4 0.001

Job allwd relx dur’ Lunch 43.0 77.5 77.9 <0.001

Good schooling for child’ 46.0 46.1 36.0 0.193Good access to water 47.1 70.6 62.8 <0.001

RESULTS: ASSESSMENT OF WORK ENVIRONMENT

RESULTS: ASSESSMENT OF WORK ENVIRONMENT

• “I think that one of the challenges that people experience is the means of transport whereby in case you have some emergency and you want to report to the work-station you cannot get there in good time so transport is a major challenge” FGD-Turkana  

• “Water is not available for 24 hours because we are using a bore hole that is using a generator, I mean source of power. So when there is mechanical problems the patients go without water” FGD-providers Machakos.

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RESULTS: RENUMERATION PACKAGE

• Enough promotion opport’= 40%

• Enough Training opport’= 32%

• While 18% felt that their salary is fair

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RESULTS: RENUMERATION PACKAGE

• “By increasing the hardship allowance and for example if you are working in Kenyatta and you are being paid 100,000 if you go to Kitui and the pay is made at 200,000 then they will come” FGD-Providers-Machakos

• “Enhanced allowances like house allowance a fellow on Kitale receives more than a person in Lodwar and when it comes to hardship when you are not married you get Kshs. 600. What does that mean? Is it standard? There are a lot of things that de-motivate one from working here especially when it comes to the issue of allowances” FGD-Providers –Turkana

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• Provider working in Nairobi county twice more likely to have undergone at least one training since post basic training compared to other counties OR: 2.1 (1.2, 4.22).

• Provider working in Turkana county 90% more likely to be younger(<35yrs) than other counties OR: 1.9 (1.1, 3.7).

• Turkana county had the highest proportion of male respondents (54%) compared to Machakos (32%) and Nairobi (35%).

DISCUSSION

• Retaining HWs at their places of work hinges on several issues: remuneration including allowances, as well as good infrastructure.

• County Governments though still new in their functions, have an unprecedented opportunity to offer incentives that could encourage HWs to remain in the rural and remote areas

• Attracting HWs to rural and remote areas will require creative approaches

• Workers already employed in the rural and remote regions face a number of constraints that curtail their ability to offer health care to patients

CONCLUSION

• Attracting HWs to rural areas– Engage county governments to improve infrastructure

in counties– Engage potential HWs to work in rural and remote areas

• Retaining HWs in rural areas– Address HWs remuneration package– Improve working environment in HFs– Make the HWs comfortable especially those in rural and

remote areas– Focus on health managers as an important variable in

health worker motivation

• Need for further analysis of the data for more results

RECOMMENDATIONS

• European Union for Funding

• World Vision Kenya as prime Partner

• County Health management Teams for facilitating the survey

• HCWs

• AMREF ESRC for ethical approval

• Research team

ACKNOWLEDMENT

Thank you