Human resources are an essential component of the health system, especially in the provision of basic healthcare services.
The attainment of universal health coverage (UHC), especially primary healthcare, is underpinned by an adequate, fit-for-purpose, motivated and equitably distributed health workforce.
These human resources potentially influence the efficiency of counties to provide quality health services. For example, the 342 maternal deaths per 100,000 live births in Kenya (which is ranked position 30 globally, with the worst maternal mortality ratio) implies that 98 per cent and 82 per cent of women respectively seeking antenatal care and giving birth in health facilities are not accessing quality maternal healthcare.
With the 2010 Constitution, health service delivery became a fully devolved function. County governments are charged with undertaking all the routine human resources for health planning and management processes, including recruitment, deployment, in-service training and payments of salaries.
The Constitution expressly provides for the right to health under Article 43(1), which led to the enactment of the Health Act, 2017. Art. 43(1)(a) states: every person has the right to the highest attainable standard of health, which includes the right to health care services, including reproductive health care.
The human resources challenges bedevilling the sector cannot guarantee the citizens their constitutional right to health. A shortage of trained health professionals has denied most Kenyans access to acceptable and quality healthcare and services. More terrifyingly, the population is growing by more than 3,200 daily, which does not match the rate of new doctors and other cadres in the market.
Prevent peak performance
For instance, the WHO-recommended ratio is 44.5 nurses, physicians and doctors for 10,000 people but Kenya is at a distant 13.8. The distribution inequalities are far worse in some counties, leading to inequitable access to quality healthcare and services, especially in remote regions. Other factors that prevent health professionals from peak performance include exposure to poor working conditions; ill-equipped facilities; and poor remuneration or non-payment of salaries due to inadequate and delayed disbursement of funds to counties by the National Treasury.
In 2017, doctors went on the longest-ever strike by health professionals in Kenya—100 days—that created a health crisis for millions of people. At the core of their complaints were low pay and poor working conditions. Nurses had gone on a five-month strike over the same issues. A combination of understaffing, poor pay and inadequate facilities have an overall demoralising effect and burnout among health professionals.
The Health Act envisioned that the government shall ensure an enabling environment consisting of the minimum human resource for health as per the norms and standards. But gaps in human resources for health still exist, despite sustained pressure by stakeholders for the government to act on policies and recommendations to establish truly strong human resources for health.
The Act provides for the Kenya Health Human Resource Advisory Council (KHHRAC), mandated to review policy and establish uniform norms and standards for the posting of interns to national and county government facilities; inter-county transfer of healthcare professionals; transfer of healthcare professionals from one level of government to another; welfare and scheme of service for health professionals; management and rotation of specialists; and maintenance of a master register for health practitioners.
Almost five years later, the inaction of KHHRAC indicates a lack of political will to allocate the council funds to execute its mandate. The recent announcement by the President to resuscitate it is a good sign. Backed by adequate staffing and budget allocation, that will help to solve some of the pertinent issues in the health workforce. The meetings between the Health Principal Secretary (Public Health and Professional Standards) and KHHRAC to explore strategies to improve health workers’ welfare should be sustained.
Author: Gilbert Wangalwa, Deputy Country Director, Amref Health Africa in Kenya.
Article first published on https://nation.africa/kenya/blogs-opinion/blogs/political-will-needed-to-end-human-resources-for-health-challenges-4226760