TUAB025 - Amref Health Africa International Conference

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

PRESENTED AT THE AMREF INTERNATIONAL CONFERENCE 25TH NOVEMBER 2014 BY RICHARD GICHUKI, PROJECT OFFICER RABD-AMREF KENYA

PRESENTER DISCLOSURES

Richard Gichuki No relationships to disclose

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OUTLINE • Background

• Study objectives • Methodology

• Results • Discussion • Conclusion and recommendations

BACKGROUND •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-resourceshealth.com/content/12/1/33/abstract )

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

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STUDY OBJECTIVES • 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.

METHODOLOGY • 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

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. 8

Ownership of Facilities by Region

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SERVICE PROVIDER BY REGION Type of Service Provider Administrator CHEW CHW Clinical Officer Lab Technician Lay Counsellor MO Nutritionist Parmacists Registered Nurse Support Staff Allied Professional Total

Nairobi (n=101) % 2.0 1.0 10.9 9.9 11.9 3.0 2.0 7.9 5.0 33.7 5.0 7.9 100.0

Machakos (n=143) % 3.0 2.1 3.5 7.7 11.2 1.4 4.9 2.8 2.1 44.8 9.8 6.3 100.0

Turkana (n=102) % 1.0 3.9 14.7 9.8 4.9 5.9 1.0 5.9 4.9 32.4 2.9 12.7 100.0

Total (n=346) % 2.0 2.3 9.0 9.0 9.5 3.2 2.9 5.2 3.8 37.9 6.4 8.7 100.0

RESULTS: BACKGROUND CHARACTERISTICS OF RESPONDENTS Characteristic

Sex Age

Post Sec Educ

Nairobi Machaks Turkana Category (n=101) (n=143) (n=102) P-value

Male Female 35

38% 62% 63% 37%

33% 67% 52% 48%

55% 0.001 45% 77% 0.004 23%

Yes

89%

79%

78% 0.001

No

11%

21%

22%

38% 62%

42% 58%

35% 0.373 65%

Alternative Yes Sources of IncomeNo

RESULTS: TRAINING CHARACTERISTICS OF PROFESSIONAL HEALTH WORKERS

Characteristic

Category

Yes Attended Upgrading Course No Highest level of Diploma upgrading course Masters attended Other1

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

45%

35%

34%

0.096

55% 22% 16%

65% 40% 2%

66% 27% 0%

0.01

62%

57%

73%

“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

RESULTS: JOB SATISFACTION % of respondents reporting Machakos Nairobi Turkana P-Value Satisfied with their job 35.3 43.6 43.2 0.563 Job good match for skills 63.0 78.2 68.2 0.334 Recognition 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: ASSESSMENT OF WORK ENVIRONMENT

% of respondents

Machakos Nairobi Turkana P-value

Workload is manageable

37.2

71.6

64.0