Migration of health care workers such as: (i) rural to urban or vice versa; (ii) private to public or vice versa; (iii) exit from the health sector to other sectors can reduce the number of health workers available to serve a certain population. Between 2005 and 2009, majority of those who left the service were enrolled nurses, followed by medical doctors (Ministry of Health, 2014c). It is clear that migration both within the country and out of the country play a role in the availability of health workers.

Migration to other countries

The rate of migration is higher than the rate of absorption after training. In 2006, Kenya indicated that 51% of doctors and 8.3% of nurses emigrated, most of them to the UK (Clemens & Pettersson Gelander, 2006). For every 4.5 nurses Kenya adds to the nursing workforce through training, one nurse in the workforce applies to out-migrate, with 70% of them aged between 21 – 40 years. This pattern poses a threat to Kenya’s ability to increase the number of nurses in the workforce through training by 22% (Gross et al., 2011).

Rural-Urban Migration

The national census held in 2009 indicated that Kenya had a population of 38.6 million with 26.1 million and 12.1 million living in rural and urban areas, respectively (Kenya National Bureau of Statistics, 2010). However, this marks different in terms of the health professionals distribution, as more than half of health workers and 80% of doctors were based in urban regions (Gondi, Otieno, & James, 2006). Rural dispensaries report only 20% staffing rates in their nursing establishments, while district/urban hospitals report staffing rates of 120% (Luoma et al., 2010). The migration to urban areas is influenced by the housing allowances, which are much higher for those living in urban regions compared to those living in remote rural settings (Luoma et al., 2010). Further intensifying the misdistribution of healthcare workers by cadre is the employment of 42% of Kenya’s doctors and 13% of all nurses in the two national referral hospitals (Luoma et al., 2010).

Migration from public to private sector

A number of Kenyans seek health services in the public sector because of the subsidized medical fees and free services such as maternity care and HIV and AIDS treatment. However, a study conducted in Kenya revealed that 50.9% of health workers preferred working in Non-Governmental Organizations (NGO’S), 26.9% in government institutions, 11.7% out of the country, 6.3% in Faith Based Organizations (FBO) and 4.2% in private institutions (Ojakaa, Olango, & Jarvis, 2014). One of the strengths of the public health facilities is the stability of employment. However, a recent study conducted in public hospitals in three counties revealed that nearly 90% of health care workers were employed on permanent terms but about three quarters experienced low levels of job satisfaction (Tengah & Otieno, 2019). The poor remuneration, understaffing, inadequate medical supplies and poor working conditions  in the public sector has contributed to health care workers migrating to private clinics/hospitals (Ndetei, Khasakhala, & Omolo, 2008).

There is limited data on the salaries of health care workers in Sub-Saharan Africa. However, it is important to note that increased salary is not the only issue contributing to retention of workers. The following non-financial incentives have been considered a priority by health care workers in Kenya and Sub-Saharan Africa (McCoy et al., 2008; Ndetei et al., 2008):

• Enhanced working conditions such as medical supplies and upgrading of facilities
• Training e.g., Continuous Medical Education and improving the quality of supervision
• Good living conditions and opportunities for health workers to further their education and their children.
• Addressing job safety and security concerns

References:

Clemens, M., & Pettersson Gelander, G. (2006). A New Database of Health Professional Emigration from Africa. Human Resources for Health (Vol. 6). http://doi.org/10.2139/ssrn.924546

Gondi, O., Otieno, A., & James, J. (2006). Report on Human Resources Mapping and Verification Exercise. Nairobi, Kenya.

Gross, J. M., Rogers, M. F., Teplinskiy, I., Oywer, E., Wambua, D., Kamenju, A., … Waudo, A. (2011). The impact of out-migration on the nursing workforce in Kenya. Health Services Research, 46(4), 1300–1318. https://doi.org/10.1111/j.1475-6773.2011.01251.x

Kenya National Bureau of Statistics. (2010). The 2009 Kenya Population and Housing Census. Home Healthcare Nurse. 371–372. https://s3-eu-west-1.amazonaws.com/s3.sourceafrica.net/documents/21195/Census-2009.pdf

Luoma, M., Doherty, J., Muchiri, S., Barasa, T., Hofler, K., Maniscalco, L., … Maundu, J. (2010). Kenya Health System Assessment 2010. Health Systems 20/20 Project, 20(August), 1–133. https://www.hfgproject.org/wp-content/uploads/2015/02/Kenya-Health-Systems-Assessment-2010.pdf

Ministry of Health. (2014c). Health Sector: Human Resources Strategy: 2014-2018. Nairobi, Kenya. https://www.health.go.ke/wp-content/uploads/2016/04/Kenya-HRH-Strategy-2014-2018.pdf

Ndetei, D. M., Khasakhala, L., & Omolo, J. O. (2008). Incentives for health worker retention in Kenya: An assessment of current practice. EQUINET, 62, 29. https://www.equinetafrica.org/sites/default/files/uploads/documents/DIS62HRndetei.pdf

Ojakaa, D., Olango, S., & Jarvis, J. (2014). Factors affecting motivation and retention of primary health care workers in three disparate regions in Kenya. Human Resources for Health, 12(1), 33. http://doi.org/10.1186/1478-4491-12-33

Tengah, S. A., & Otieno, O. J. (2019). Factors Influencing Job Satisfaction among Nurses in Public Health Facilities in Mombasa, Kwale and Kilifi Counties, Kenya. Advances in Social Sciences Research Journal, 6(5). https://doi://doi.org/10.14738/assrj.65.6389