The World Health Organisation has broken down health system functions into six essential building blocks, including service delivery; health workforce; health information; medical products, vaccines and technologies; health financing; and leadership and governance.
Health systems strengthening addresses issues that influence sufficient numbers of well-skilled, well distributed and well-managed health workers, without whom high quality and accessible health services cannot be delivered.
Kenya is plagued by a health workforce crisis characterized by insufficient numbers of competent, well distributed and well managed health workers. Shortage of health workers is particularly acute in remote and hard-to-reach areas evidenced by relatively poorer health-related indicators, making it difficult for the country to achieve the health-related MDGs. According to the Kenya Demographic and Health Survey (KDHS) 2008-2009, immunization coverage (12-23 months) in Isiolo district was 45.2% compared to a national average of 77%. Skilled attendance at birth was 14% compared to a national average of 43%. The Ministry of Health's Norms and Standards (2006), stipulate that dispensaries and health centres should be staffed with a minimum of 4 and 16 nurses respectively.
This is not the case in Isiolo County where dispensaries have only 1 nurse while health centres have 2 at most. The study explored factors that influence nurses to leave or continue working in Isiolo, and proposed county- specific strategies to improve retention. Four FGDs were conducted and findings analyzed using thematic analysis, to identify key nurse retention factors. Subsequently, a tightly fOcused self- administered questionnaire was developed using the FGD findings and administered to all 139 nurses in the county. SPSS V20 was used to analyze closed ended responses in the questionnaire.
Insecurity, harsh weather, low salary, inadequate staff housing and poor facility infrastructure were identified as major push factors while motivational factors such as recognition and appreciation, influenced nurses to stay. An unexpected finding revealed that local/native nurses were iv rejected by their own communities. As a result, no local nurses worked in 39 (95%) of the health facilities. Age (p=0.02) and Health Facility Tier (p=0.00) predict nurse retention. The study found that older nurses were more likely to be retained for longer compared to younger nurses. Similarly, nurses who worked in higher tier facilities stood a better chance of being retained as compare to those working in lower facility tiers.
The County Director of Health should make deliberate efforts to implement recommendations made herein to improve nurse retention in Isiolo County.
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