Examining the absorption of post-internship medical officers into the public sector at county-level in devolved Kenya: a qualitative case study

BMC Health Services Research

Research

Jacinta Nzinga¹  Daniel Mbuthia¹  Joshua Munywoki¹  David Gathara²  Yingxi Zhao³  Mike English⁴  Catia Nicodemo⁵ 

[1] KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya;KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya;MARCH Centre, London School of Hygiene and Tropical Medicine, London, UK;Nuffield Department of Medicine, NDM Centre for Global Health Research, University of Oxford, S Parks Rd, OX1 3SY, Oxford, UK;Nuffield Department of Medicine, NDM Centre for Global Health Research, University of Oxford, S Parks Rd, OX1 3SY, Oxford, UK;MARCH Centre, London School of Hygiene and Tropical Medicine, London, UK;Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK;Department of Economics, Verona University, Verona, Italy;

关键词: Human resources for health;    Labour market;    Recruitment;   

DOI  :  10.1186/s12913-023-09928-0

 received in 2023-05-20, accepted in 2023-08-16,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundAfter Kenya’s decentralization and constitutional changes in 2013, 47 devolved county governments are responsible for workforce planning and recruitment including for doctors/medical officers (MO). Data from the Ministry of Health suggested that less than half of these MOs are being absorbed by the public sector between 2015 and 2018. We aimed to examine how post-internship MOs are absorbed into the public sector at the county-level, as part of a broader project focusing on Kenya’s human resources for health.MethodsWe employed a qualitative case study design informed by a simplified health labour market framework. Data included interviews with 30 MOs who finished their internship after 2018, 10 consultants who have supervised MOs, and 51 county/sub-county-level managers who are involved in MOs’ planning and recruitment. A thematic analysis approach was used to examine recruitment processes, outcomes as well as perceived demand and supply.ResultsWe found that Kenya has a large mismatch between supply and demand for MOs. An increasing number of medical schools are offering training in medicine while the demand for MOs in the county-level public sector has not been increasing at the same pace due to fiscal resource constraints and preference for other workforce cadres. The local Department of Health put in requests and participate in interviews but do not lead the recruitment process and respondents suggested that it can be subject to political interference and corruption. The imbalance of supply and demand is leading to unemployment, underemployment and migration of post-internship MOs with further impacts on MOs’ wages and contract conditions, especially in the private sector.ConclusionThe mismatched supply and demand of MO accompanied by problematic recruitment processes led to many MOs not being absorbed by the public sector and subsequent unemployment and underemployment. Although Kenya has ambitious workforce norms, it may need to take a more pragmatic approach and initiate constructive policy dialogue with stakeholders spanning the education, public and private health sectors to better align MO training, recruitment and management.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

【 图 表 】

Fig. 1