Source Country Perspectives on the Migration of Health Professionals from Kenya: A Systems Thinking Approach

Title: Source Country Perspectives on the Migration of Health Professionals from Kenya: A Systems Thinking Approach
Authors: Dogbey, Brenda Adhiambo
Date: 2016
Embargo: 2018-07-13
Abstract: Overview: A global shortage of over 7.2 million health workers poses a threat to service delivery particularly in sub-Saharan Africa. Sub-Saharan Africa bears a quarter of the global burden of disease; yet, it only has three percent of all health workers. Maldistribution and migration both to urban and international destinations pose persistent challenges to service delivery particularly to rural and remote populations. In Kenya, the health human resources are mostly concentrated in urban areas, and in some cases as high 70% of the health workers are serving only 20% of the population. Literature to date, particularly in the context of Kenya, has focused on doctors and more recently nurses. There has been a gap in analysis in exploring mid-level cadres such as clinical officers, a cadre of non-physician clinicians. Research objectives: The objectives of the research were to: 1) conduct a contextual analysis of human resources for health in Kenya; 2) understand the migration perspectives of Kenyan health professionals including doctors, nurses and clinical officers through an online survey; 3) explore the role of mid-level health worker cadre of clinical officers as a promising practice for Kenya. The thesis is presented in three papers congruent with the three research objectives. I interrogated these areas at a macro, meso and macro level using systems thinking theory. Findings: The first paper found significant developments in the policy context of managing health professionals in Kenya all of which have improved the working conditions for health professionals. International migration was found to have decreased over the past decade and was not deemed be a policy priority by government and development partner stakeholders. Health professional representatives, on the other hand, asserted that they continue to be disgruntled with the current situation and would not hesitate to migrate given the opportunity. The second paper found that the factors that discourage health professionals from staying in Kenya are similar to those available in the literature and include: dissatisfaction with remuneration, governance, working conditions and living conditions. Among health professionals considering migration, few had made short-term plans to leave. Family ties and fear of the unknown were found to be strong factors for continuing to work as health professionals in Kenya. Job security was found to be high in the government while recruitment agencies were not found to play a significant role in migration decisions of health professionals. The third paper found that there was general support for the scale of up clinical officers to enhance the Kenyan health workforce. Barriers to scale-up included resistance from medical doctors, who felt that clinical officers were not competent enough to handle complicated cases, and a lack of employment opportunities given a surplus of about 3,000 unemployed clinical officers in Kenya, who could potentially fill in the health workforce gaps. Conclusion: Overall policy developments have been implemented since 2007 presenting a promising future to the management of human resources for health (HRH) in Kenya. Although few health professionals are making concrete steps to migrate out of Kenya they continue to be dissatisfied with the current living and working conditions. Maldistribution and overall shortages of health professionals continue to hamper service delivery to vulnerable rural populations. Mitigating factors include the potential of scaling up the clinical officer cadre particularly through the surplus of 3000 unemployed clinical officers, a process that requires sufficient political and professional will. A holistic multi-level approach to health system planning is crucial to ensure that any new investments are well coordinated and involve an overall scale-up of health professionals.
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