Dr. Janet Muriuki Technical Director HRH Capacity Bridge Project IntraHealth International Improving health system through strengthening management of the health workforce for effective health care delivery

About IntraHealth International Inc. We look after the health worker ….. as the health worker looks after the clients

Background and Legal Frameworks Goal : ‘attaining the highest possible standard of health in a manner responsive to the needs of the population’. Provides the underlying rationale and justification for recommending functions to devolve to County governments (Article 187 of the Constitution), and those to retain at national (MOH). Provides for the right to the highest attainable standard of health to every Kenyan.

Constitutional and Legal Provisions on HR 1.Article 10 on National values and Principles of Governance 2.Article 41 on Labor Relations 3.Article 47 on Fair Administrative Action 4.Article 56 on Minorities and Marginalized Groups. 5.Article 186 on Respective functions and powers of national and County governments (Fourth Schedule). 6.Article 232 on Values and Principles of Public Service 7.Article 234 on Functions and Powers of the Public Service Commission. 8.Article 235 on Staffing of County Governments 9.Article 236 on Protection of Public Officers 10.The Public Service Commission Act, The Transition to Devolved Government Act, The County Government Act, Employment Act, 2007 and other Labour Laws 14.Inter-Governmental Relations Act, Civil Servant Code of regulation 16.Trade Disputes Act (Cap 234)

“The general prevailing atmosphere for health workers in their work places” On average 55% - 65% of county workers are health workers 46,000 health workers were devolved and seconded to counties PROBLEM

CHALLENGES AT COUNTY LEVEL ON HEALTH WORKFORCE MANAGEMENT LACK OF POLICIES (including on sharing of specialists) INADEQUATE HRH BUDGETS RESISTANCE TO DEVOLUTION LACK OF CLEAR PROCESSES ON HRM & HRD (Promotion, Transfers, Training) POOR WORK ENVIRONMENT & RENUMERATION UNEQUAL DISTRIBUTION & SHORTAGES OF KEY CADRES LOW RETENTION FACTORS (ASAL)

HRH County Clusters 47 Counties with diverse HRH Challenges 9 HRH County Clusters

INTERVENTIONS 8

Concept note for establishing County HRH unit Competency framework for County Human Resource Management County Health Workforce recruitment and deployment guidelines Incentive framework for attraction and retention of health workers Advisory on HIV Testing and Counselling Service Providers Transition HR Service Assessment Supervision tool 10

County HRH Unit County Executive for Health Proposed Human Resource for Health

12 Work climate improvement OSH Tailor-made HR solutions Work tools and equipment Performance Appraisal System CPD HR Supportive Supervision Workplace wellness Gender mainstreaming

13 o Hiring of critical health workforce (316) at a higher job group. o Revision of the existing health workers terms and remuneration o Doctors are housed in paid up quarters and have four return air tickets to Nairobi per year o Absorption of contract workers into county payroll o Contracting other specialized health workforce on a need basis. i.e. consultants. o Renovation of old facilities o Equipping of health facilities and commodity procurement o Capacity building of the health managers for senior management and strategic management courses at the KSSG.

LAKE BASIN CLUSTER NYAMIRA BOMET KERICHO KISUMU SIAYA MIGORI HOMABAY KISII CONCEPT NOTE ON SHARING OF SPECIALISTS – PHYSICALLY & VIRTUALLY Cardiologist, nephrologists, urologist, intensivists, anaestiologists etc.

Health Workforce Contracting 837 SHW support HIV care and treatment in 43 Counties 232 SHW transitioned to County GOK payroll

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E-HRM course modules

HR Data System Strengthening 24 Counties on comprehensive HRHIS training & implementation TWGs at Counties and at national to implement the iHRIS system 47 Counties trained on Basic iHRIS Scanning of 46,000 personnel records and index to iHRIS HRHIS and DHIS integration to link HW info with service statistics at the county and national levels

CALL FOR ACTION KMA members should:- Take advantage of the free on-line eLearning course on HRM Participate at County/ inter-county level in the HRH Stakeholder forum & HRM TWGs Contribute in the development and operationalization of guidelines for contracting of medical specialists (Private practitioners can be contracted to provide services to county governments) Give input on key HRH documents such as Internship Policy amongst others 19

TAKE HOME LINKS ON HRH eLearning HRH Course – for all DOCTORS and Line managers:- MOH REPOSITORTY OF HRH DOCUMENTS:- HRH DATA SYSTEM FOR USE BY PUBLIC AND PRIVATE SECTOR :- or - or 20

Courses are accessible at: