Kenya continues to lose many children and mothers from preventable and treatable conditions due to the acute shortage and skewed distribution of paediatric sub-specialists. The children mainly die of birth asphyxia, preterm births, neonatal sepsis, diarrhoea, and pneumonia while the mothers die of post-partum haemorrhage, puerperal sepsis, eclampsia, and obstructed labour. 

From the 2014 and 2022 KDHS, the rate of under-five mortality has declined by 11 (from 52-41), infant mortality by 7 (from 39-32), neonatal mortality by 1 (from 22-21) and maternal mortality by 7 (from 362-355). Given the slow rate of decline especially for neonatal mortality, achievement of Sustainable Development Goals (SDG) on reducing under five, neonatal, and maternal death rates to 25, 12 and 70 respectively by the year 2030 might remain aspirational unless accompanied by strategies involving transformational efforts on health workforce.

In this regard, the problem that the health workforce program seeks to address is the high paediatric mortality and morbidity due to the shortage of paediatric sub-specialists. Hence, the transformational goal is to reduce paediatric mortality and morbidity by training paediatric sub-specialists for the public sector where the burden of disease is higher, but none or few paediatric sub-specialists exist. The program already started and will continue to introduce new paediatric sub-specialty programs for cadres that will manage the common killer conditions. Indeed, as Kenya joins many countries in the implementation of Universal Health Coverage (UHC) as enshrined in the Global strategy on Human Resources for Health, there is a dire need for adequate paediatric sub-specialists to manage the growing numbers of paediatrics with complicated cases requiring specialized care.

The project has in the first phase (June 2019-July 2023) sponsored the training of 148 county-based staff to become neonatologists, paediatric emergency and critical care, infectious disease specialists, neurologists, haemato-oncologists, endocrinologists, midwives, paediatric nurses, and critical care nurses in their counties.

Out of the 148 beneficiaries enrolled, 91 (9 Paediatric subspecialists and 82 nurse specialists) have completed training and redeployed back to the county hospitals.

In the second phase starting in July 2023, the program will use the lessons learnt in phase 1 to broaden the scope and be more targeted on who to train. The focus and pathway to that will involve:

• Graduating the remaining 58 beneficiaries & intensification for post-training mentorship.
• Advocacy for the county to make investments in the requisite infrastructure, equipment, drugs & supplies to support post training practice.
• Continuous monitoring and evaluation of post-training impact for graduating fellows.
• Training needs assessment and subsequent fundraising for more scholarships from ELMA, GF, CIFF, J & J, MIHA, other donors & match funding from the government.
• Improving quality of training in select institutions and clinical rotation areas.
• Adoption of more innovative approaches such as team training to pair up the trained subspecialists with nurses and clinical officers with a matching specialisation.
• Embracing cost-effective models such as KMTC, College of Paediatrics, KNH & MTRH.
• Supporting health workforce interventions for all CHAI programs with HRH component.

Interventions across thematic areas

Service Delivery

• Support rational redeployment of the graduates to the right facilities and units where they can make an impact.
• Support post-training mentorship for all the graduates.
• Support the graduates to implement their Quality Improvement projects and knowledge sharing approaches such as CMEs & OJTs.
• Develop guidelines and standards for establishment of NICU and PICUs to enable the graduates to practice.
• Advocacy for county budgetary allocation on infrastructure, lab, equipment, supplies to support post-training practice.

Supply Chain

• Work with the county governments to allocate a budget for the procurement of Equipment, Drugs, Supplies, Diagnostics needed for post-training practice.
• Engage with NEST to avail key newborn equipment in 14 nest sites.
• Leverage on other CHAI programs supporting the supply chain in the facilities of redeployment

Data & Data use

• Monitor the selection, training, graduation, and post-training practice of the sponsored trainees.
• Update and implement the M & E tools & Indicators to track the quality of training and impact post training.
• Compile data on HRH gaps for all sub-specialists to inform on who to train
• Workforce planning: Create a national registry to track the availability, distribution, flows, demand, supply, capacity of the paediatric subspecialists

Health Financing

• Advocacy for national and county government match funding for training subspecialists
• Advocate for infrastructural investments on the infrastructure, equipment, supplies, lab tests and diagnostics through the CIDPs
• Fundraising for more grants from other potential donors; CIFF, J&J, GF
• Implement cost-effective models like training through KMTC & KNH to cut down on training costs and enable the training of more subspecs
•  Influence for HRH funding Policies