HRH Discussion at the National Nurses Association Of Kenya – NNAK conference.
Once again I take this opportunity to thank the nurses of Kenya in general and NNAK in particular for the invite to attend their conference. I thank Keprecon where we work with Collins Ajwang for facilitating this too. Being an advocate of Human Resources for Health I was particularly facinated by the excellent panel discussions about the nursing workforce in Kenya. I took furious notes from the various presenters and concluded that indeed Kenya has solutions to its own challenges.
I drafted a short policy brief from the discussions that I would want your inputs into to make it better. The policy brief is derived from the nurses’ discussion but I guess it could apply to other cadres in HRH.
Policy brief on nursing workforce
Goal: Strengthen Kenya’s nursing workforce to achieve adequate numbers, equitable distribution, decent work, and career progression, thereby supporting quality service delivery and UHC.
Priority objectives (short-, medium-, long-term)
● Short-term (0–12 months): Clear immediate hiring of backlog interns; launch career guidelines; county-level rapid recruitment drives where budget allows; implement retention ‘quick wins’ (flexible schedules, recognition, psychosocial support).
● Medium-term (1–3 years): Align training outputs and funded posts through MTEF; scale accredited internship centres; formalize managed migration agreements; expand specialty training and mentorship programs; implement housing/locum support pilots.
● Long-term (3–5 years): Institutionalize sustainable financing for nursing positions, workforce planning and data systems, nationwide mentorship and continuous professional development (CPD) networks, and equitable county-level staffing norms.
Recommended policy actions
1. Fund and clear the nursing internship backlog
○ MOH to coordinate with National Treasury and counties to fund the remaining internship positions and ensure posting of the 300+ unposted BSNs immediately.
○ Use a transparent placement portal (Nursing Council of Kenya + The Ministry of Health) that aligns approved internship centres with funded slots.
2. Align workforce planning with MTEF
○ Counties to include nurse hiring and internship slots in their MTEF submissions. MOH to provide technical templates for nurse workforce costing and PHC-targeted staffing norms.
3. Adopt managed migration and retention strategies
○ Negotiate agreements (bilateral or placement-linked training) with destination countries to support return-of-service clauses, skills exchange, or contributory funds that compensate domestic loss.
○ Introduce incentives for retention (housing near hospitals, study leave with guaranteed redeployment, scholarship bonds for specialty training tied to service obligations).
4. Improve employment terms and regulation of casual work
○ NCK, unions and associations to set minimum employment standards and a model contract for locum/temporary nurses to prevent exploitation.
○ Counties to monitor contractor and NGO hiring practices and enforce standardized terms.
5. Scale mentorship and career pathways
○ Launch a national Mentorship Initiative: designate and fund clinical instructor roles, OJT mentorship credits for promotion, and protected time for mentorship in job descriptions.
○ Fast-track East, Central and Southern Africa College of Nursing-aligned specialist training at accredited centres with clear job grades and redeployment policies.
6. Strengthen HR systems, data and monitoring
○ Implement a national nursing workforce dashboard (MOH + NCK + counties) tracking vacancy, attrition, migration destinations, internship placements, and specialty distribution.
○ Referral hospitals to harmonize HR instruments and adopt best-practice flexible scheduling and family-friendly policies.
7. Increase domestic financing and budgeting for nursing
○ National and county governments to ring-fence a percentage of health budgets for recruitment, internships, CPD, and housing support for nurses.
○ Explore public–private partnerships (PPP) for nurse housing, CPD delivery, and scholarship financing.
8. Quality assurance and accreditation expansion
○ NCK to fast-track accreditation of quality clinical sites and post-basic programs (e.g., palliative care, critical care) and ensure faculty capacity.
○ Scale up community/practice exposure in BSN internships to prepare nurses for PHC roles (PHC-aligned competencies).
9. Promote non-monetary motivation and wellbeing
○ Implement psychosocial support, burnout prevention programs, regular staff recognition, leadership training, and family-friendly scheduling across counties.
10. Stakeholder coordination and governance
● Establish an intergovernmental Nursing Workforce Taskforce (MOH, Council of Governors, NCK, Treasury, KEPSA, unions, NNAK) to oversee implementation, chaired on a rotating basis.
Implementation roadmap & responsibilities (high-level)
● Immediate (0–6 months): MOH & NCK to publish internship clearing plan and launch placement portal; counties to identify budgeted posts for immediate hires; Taskforce convened. (Lead: MOH)
● 6–18 months: Implement workforce dashboard; roll out national mentorship initiative; counties implement model locum contracts; fund housing pilot in 3 counties. (Lead: Counties + MOH)
● 18–36 months: MTEF adjustments completed; scale specialty training programmes; managed migration agreements negotiated; nationwide CPD network established. (Lead: MOH, Treasury, NCK)
● 3–5 years: Institutionalized funding lines, reduced vacancy rates to meet national staffing norms, improved retention metrics, and robust career progression pathways. (Lead: MOH, Counties)
Monitoring & Evaluation indicators
● Number of unposted BSN interns cleared and posted (target: 100% within 12 months)
● Nurse vacancy rate per county and national referral hospitals (target: 50% reduction in priority counties in 3 years)
● Annual nursing attrition rate and migration outflow (target: reduce attrition by 25% in 3 years)
● Number of accredited internship centres and specialty training seats (target: 30% increase in 2 years)
● Proportion of nurses with a formal mentorship assignment (target: 60% within 2 years)
● Uptake of model locum contracts across counties (target: adopted by 50% of counties in 18 months)
Estimated resource considerations (indicative)
● Clearing internship backlog & stipends: budget estimate to be costed per MTEF templates (MOH to provide unit costs).
● Mentorship initiative & faculty support: modest recurrent budget for protected time and stipends.
● Housing pilots: capital investment with potential PPP financing; explore social housing models near referral hospitals.
● Workforce dashboard: one-off ICT development cost and recurrent maintenance.
Conclusion
The NNAK conference discussion in October 2025 makes clear that Kenya’s nursing workforce is at a critical inflection point. With political will, coordinated financing, and targeted reforms (internship clearing, managed migration, mentorship, career pathways, and strengthened HR systems), Kenya can stabilise and grow a fit-for-purpose nursing workforce essential for UHC. Immediate action on internship placements, MTEF alignment, and a national taskforce will deliver visible gains within 12–24 months and provide the platform for sustainable long-term solutions.
Dr Simon Kigondu is the President of Kenya Medical Association