Dr. Nelson Muriu. Director, Nyeri County Department of Health. Presentation on the county Health Workforce in 2018 and teh task ahead for new county governments.

1. DEPARTMENT OF HEALTH SERVICES
HUMAN RESOURCEs FOR HEALTH
“A county Snapshot”
COUNTY GOVERNMENT OF NYERI

2. Our vision
An efficient and high quality health care system
that is accessible, equitable and affordable for all

3. Status of Select Health indicators
 Nyeri County has relatively good health indicators
Immunization(85%),
 FP Uptake (73%),
skilled delivery(88%),
 4th ANC(61%),
 MMR(110/100,000)
 HIV Prevalence(3.4%)
 The county is experiencing increased burden of non
communicable conditions
Recent Surveys shows HTN(13-28%) and Diabetes(6-19%)

4. Service delivery
One Level V hospital
10 level IV hospitals (4 CG, 3 FBO, 3 Private)
118 CG RHFs
251 Functional CHUs
Other private facilities/clinics
On avg, the pop can access a health facility within a
radius of at least 7 Km.
Doctor/Pop ratio: 16.7/100,000
Nurse/Pop ratio: 117/100,000

5. Health Financing
 The average allocation is 35-40% of total county budget averaging
2.3-2.7 B
 Approximately 70% of the health budget –Personal Emoluments
 Hospital generate revenues through user fee charges which amount to
approximately 300 million per year
 Reimbursement to Hospital has been challenging due to existing laws
and policies which delays transfer and flow of funds to hospital.
 Low coverage of health insurance amongst community member
hence waiver and exemption take approximately 7.5% of total
hospital revenue

6. Source of funding for health (CHA)

7. 2015/16 Budget Analysis
Personnel Salaries
72%
Development
13%
Operations &
Maintenance
15%

8. Health Workforce
 Health sector is heavily dependent on skilled workforce
 County total current Health workforce is 1711(55%)
 Excludes support services in solid waste management and contracted
service in hospitals & casuals in RHF’s
 Despite the apparent huge workforce health continues to experience
shortages in skilled labour because
 Hospitals and Health Centres provide a 24 hour service,
 Aging workforce & staff exit without replacement(>251)
 Withdraw of support from implementing partners(CHS& A+K)
 Expansion of specialized services & operationalization of new
facilities
 The Health Sector has experienced numerous industrial strikes has
significantly affected the indicators

9. Health Workforce cont’d
 Allowances given to HCWs in the recent past increased expenditure
on P/E from Kshs 1.5 B to approx. 1.9B
 Payment of monthly stipends for clinical officers and nurse interns
although training is a function of the National Government
 Doctors released for post graduate studies and other health workers
on training are retained on the payroll hence overstretching the
budget on personnel emolument
 Opening of new level IV hospital Othaya requires additional 400
health workers for full operationalization(this translates to approx.
Kshs. 500 million a year

10. Distribution of Consultants across the County
Specialty Nyeri CRH Karatina Mukurweini Othaya Mt.Kenya
General Surgeon 2 1 1 0 0
Orthopedic Surgeon 1 1 0 0 0
Plastic & Reconstructive 1 0 0 0 0
ENT surgeons 1 1 0 0 0
Physicians 2 1 1 0 0
Radiologists 1 0 0 0 0
Paeditricians 2 1 1 0 0
Obs/Gynaecologists 2 1 1 0 0
Pathologists 1 0 0 0 0
Urologists 1 1 0 0 0
Anesthesiologists 1 1 0 0 0
Ophthalmologists 1 0 0 0 0
Psychiatrists 1 0 0 0 0
Dental Specialists 2 0 0 0 0
Total 18 8 4 0 0

11. Distribution of Doctors in the County
Hospital Available No. needed for
optimal staffing
Gaps
MO’s
Pharmacists
Dentists
MO’s
Pharmacists
Dentists
MO’s
Pharmacists
Dentists
Nyeri CRH 13 8 7 30 9 5 17 0 2
Karatina 8 3 2 11 5 4 3 2 2
Mukurweini 4 1 0 8 3 4 4 2 4
Othaya 3 1 1 8 3 2 5 2 1
Mt. Kenya 1 1 0 4 2 1 3 1 1
FBO’s 2 0 0 0 0 0 0 0 0
Total 31 14 10 61 19 15 32 9 10

12. No. of HCWS in selected Cadres in the County
Cadre Nyeri CRH Karatina Mukurweini Othaya Mt.Kenya
Nurses 237 108 43 35 14
Clinical officers 28 11 8 7 3
Lab Techs 19 6 4 7 2
Physiotherapist 9 3 2 3 1
Pharm Techs 1 2 3 3 1
OT 6 3 2 2 1
Plaster Techs 3 1 2 0
HRIOs 5 3 2 2 1
Radiographers 5 3 1 2 0
Nutritionist 2 2 1 1
Social Workers 2 2 0 1 0

13. Post Graduate Training for Doctors(2013-2017)
S/No. Field Of Specialization Cumulative Trained/ in school
1. General Surgery 5
2. Neuro-surgery 1
3. Plastic &reconstructive surgery 1
4 Orthopedic surgery 3
5. Obstetrics /gynecology 6
6. Diagnostic Radio Imaging 3
7. Pathology 2
8. Clinical Pharmacy and Pharmacology 5
9. Pediatric dentistry & Dental Public Health 2
10. Anesthesia 2
11. Internal Medicine 7
12. Health Informatics 1
13. Ophthalmology 1
14. Urology 3
15. Public Health and Epidemiology 4
16. Paediatrics & child health 3
17. ENT 2
18. Psychiatry 1
19. Oncology(short courses) 2
Total 53

14. P/E Analysis-Nyeri County
Work Station No of Staff Budget Per Annum %Amount
County Health Office 57 71,852,352 3.2
Hospitals 924 1,252,925,460 56.1
Rural Health Facilities 645 738,361,644 33.1
Unskilled Casuals 736 83,906,722 3.8
Skilled Casuals 124 47,616,000 2.1
Defunct Municipal Council
Staffs 85 36,820,260 1.7
Total 1,711 2,231,482,438 100

15. Causes of staff shortage in the County
1. Progressive expansion of health services especially in hospitals
2. Opening up of specialized units (renal and dialysis, Intensive
Care Unit etc.)-MES
3. Operationalization of new health facilities (22 facilities opened
since devolution of health services.
4. Staff exits due to natural attrition (251 exits in the last 4 years
(FY 2013/14 - 2017/18) without replacement.

16. Staff exits by cadre (2013/14- 2017/18)
Cadre No. of exits
Clinical officers 7
Consultants 8
Dental Officer 2
HRIO 5
Laboratory Technologist 6
Nurses 131
Pharmacist 5
Public Health officers & Technicians 10
Radiographer 4
Rco Anaethetist 1
Medical Officers 21
Other Cadres 51
Grand Total 251

17. Financial savings from staff exitsFY 2013/14-
2017/18
Year 2013/14 2014/15 2015/16 2016/17 2017/18 Total
No.of Exits 32 70 36 61 52 251
Monthly
Savings 3,024,880.0 5,800,391.0 2,384,937.0 4,305,182.0 5,307,010.0 20,822,400.0
Annual
Savings(Kshs) 36,298,560.0 69,604,692.0 28,619,244.0 51,662,184.0 63,684,120.0 249,868,800.0

18. Key Achievements
 Promotion of health care workers
 600+ nurses promoted
 All Doctors were promoted
 356 HCWs in other cadres promoted
 The County has a departmental HR unit
 Has operationalized the IHRIS system
 Training HCWs every year- Currently 1 physician,nurse
in India for oncology.
 Managed to keep the County Referral Hospital open in
the last nurses strike
 Started a County internship program- 200 beneficiaries

19. Situation During Nurses Strike
Month No. of Nurses
NEVER WENT ON STRIKE 462(59%)
RESUMED ON JUNE 8
RESUMED ON JULY 26
RESUMED ON AUG 19
RESUMED ON SEPT 52
RESUMED ON OCT 24
RESUMED ON NOV 186

20. Proposed Recommendations
 Staff redistribution & deployment based on data.
 Consider other forms of staff engagement such as locums, short-
term contracts or volunteerism as part of addressing the staffing
gaps.
 Develop a clear succession management plan
 532 officers are >56 years of age
 88 Nurses retiring in the next 2 years
 To date > 251 staff have exit service without replacements and 244 are
projected to exit in the next 5 years
 Develop policies on inter-county sharing of consultants and
specialized skills.
 Encourage Centers of excellence in hospitals for effective equipping
 Use of technology to address some of the gaps-e.g. Tele-radiology

21. Proposed Recommendations…..
 Adopt more cost-effective and sustainable strategies for HCWs
training e.g. CME’s ,OJTs, mentorship

22. THANK YOU