Understaffed and Overburdened: The Looming Healthcare Crisis in Kenya

By Patrick Alushula

Health facilities are fast coming closer to the households. Patients are flocking in. But there is a problem: many doctors, nurses, and other key health personnel are at home nursing the pains of unemployment. 

Employed medical specialists are shuttling from one health facility to another in the quest to meet the rising needs of patients. The difference between those who are graduating from medical schools and those actually practicing is the patients’ pain point. 

For Kevin Oduor, his pain point ended in the death of his wife, leaving him with many unanswered questions. 

“I may never get the answers. But l am convinced I lost my wife and child in the hands of a hospital that didn’t live up to its promise,” says Mr Oduor. 

When labour pains set in around 5 a.m., Mr Oduor, a resident of Huruma in Nairobi, opted to drop his wife at a faith-based health facility located about 500 metres from his home.

As an informal sector worker, he didn’t secure a day off work. He hoped to reunite with his wife and their bundle of joy in the evening. Instead, her wife bled to death, kicking off a series of accusations and counter-accusations that involved two hospitals and a mortuary. 

He is left with memories and a pathologist report showing “severe hemorrhage” as the cause of death of his wife.

Kevin is part of the many people carrying the pain that has nearly everything to do with the staffing levels in hospitals. While universities continue to admit and churn out more health practitioners, not many of them are ending up in active practice. 

Donald Ngalula who graduated in 2020 from Moi University with a degree in nursing has for instance had to start looking for research jobs after several failed attempts to secure employment.

“I have had to look for other sectors of the economy to put food on the table. I have had to go into research,” he opened up in a recent TV interview. 

Ministry of Health data shows that while the number of registered core health workers per 10,000 people had improved from about 15 in mid-2018 to 19 by mid-2021, those in active practice per the same number of people stood at about 8.  This means that of 100 core health workers that graduate and get licensed, just about half are actually practicing.

“For healthcare, you cannot lie so much because when services are not offered, people die. If you go to a hospital and there are no healthcare workers, you will have a bad outcome because an overwhelmed workforce ends up supervising deaths. One death is way too many,” says Dr Atellah.

For Nairobi City, Kenya’s capital, the number of doctors per 100,000 people had come down from 37 in 2012 to 14 in 2015, according to a Nairobi City County Health Reforms Task Force report. That of clinical officers had declined from 14 to 6 over the same period. 

The task force report made public in January 2023, showed that Nairobi has 816 health facilities — 135 public and 681 private, faith-based, and non-governmental organizations (NGO) owned — against a population of about 4.85 million. The report estimates that the city has 7.1 million people during any working day. 

With a public health workforce of about 4,756 that includes 454 clinical officers and 393 medical officers and specialists, the task force that was led by Dr Githinji Gitahi, the global chief executive officer of Amref Health Africa, concluded that the current workforce is “highly inadequate.” 

“The current health workforce establishment is highly inadequate and does not conform to the norms and standards across all the staff cadres with the most pressing gaps affecting public health officers, medical and nursing staff, and community health workforce,” says the task force.

“The task force notes with concern that staffing gaps occasioned by retirements, resignations, deaths, non-implementation of the approved establishment among other factors have resulted in poor service delivery and highly demotivated workforce.”

The staff shortage, coupled with poor pay and “chronic delays” in payment of salaries and remittance of statutory deductions was also cited as sucking morale out of public healthcare workers in Nairobi, leading to exits.

Across the country, the shortage of doctors, nurses, and other health practitioners persists.  While the number of health practitioners leaving colleges is still not matching the needs of a population that stood at over 47 million people in 2019 and is projected to hit 70 million by 2045, not having all those leaving training join Kenya’s health sector is making the situation even worse.

Amid the shortage of health practitioners, there have been many health facilities coming up across the country, an example being in the estates of Nairobi City. 

Many are promising key inpatient and outpatient services including diagnostic imaging, dialysis, emergency, laboratory tests, surgery and specialist clinics such as gynecology and pediatric services.

In addition, they say they have specialists for those services and that they run a 24-hour service. But in many of these facilities, specialized doctors such as genealogists, pediatricians and urologists are only found on specific days and hours.

Dr Atellah says government and private investors have been obsessed with setting up health facilities and making grand launches without caring about hiring enough healthcare personnel.

“Health service delivery cannot be synonymous to the construction of health facilities. The level of services branded outside many of these health facilities does not really manifest at the point of service delivery. Many of them have engaged doctors and other specialists on locum arrangement and so even commitment levels are low,” said Dr Atellah.

With public and private health facilities dragging their feet on employment, many doctors and nurses are opting to move outside Kenya in search of employment and better remuneration, further stretching the current health workforce. 

Ministry of Health statistics show that while Kenya had about 11,000 registered doctors by the end of June 2019, about 4,860 or 44 percent, were either unemployed, working in the informal sector, or moved out of the country in search of better pay.

A similar case was observed with nurses and clinical officers, with 38.2 percent and 37.2 percent of them not being in active practice in Kenya’s health sector, upsetting the country’s quest for increased access to quality healthcare.

In Nairobi County alone, the Dr Githinji-led task force said 300 nurses exited public service in 2022 for various reasons including lack of promotion prospects and search for green pastures, especially in the UK, USA, Canada, and Australia.

The government has also been facilitating the exit of doctors and nurses. Kenya is, for instance, expected to send at least 20,000 nurses to the UK in 3 years in an agreement inked between the two countries when the then President Uhuru Kenyatta visited the UK in July 2021.

A 2006 study by Joses Muthuri Kirigia and others, titled ‘The cost of health professionals' brain drain in Kenya,’ put the total cost of educating one medical doctor from primary school to university at (US) $65,997 (Kshs 9.4 million) and that for every doctor who emigrates, the country loses about $517,931 (Kshs 73.7 million) worth of returns from investment. 

The loss incurred by Kenya through emigration was obtained by compounding the cost of educating a medical doctor and a nurse over the period between the average age of emigration (30 years) and the age of retirement (62 years) in recipient countries.

The study put the total cost of educating one nurse from primary school to the College of Health Sciences at $43,180 (Kshs 6.1 million), and estimated the total loss for Kenya due to emigration at $338,868 (Kshs 48.2 million).

“We suspect that the magnitude of the socioeconomic loss due to brain drain is likely to be even larger than our estimates. Therefore, there is a need for more precision in the measurement of the magnitude of the socioeconomic loss due to brain drain, for use in advocacy and policy,” said the study.

Health Cabinet Secretary Susan Nakhumicha on August 21 flagged off 76 nurses from Kenya to work in the United Kingdom, pointing to the government-supported policy that is upsetting local healthcare delivery more. 

“I reckon that questions abound on the impact of this agreement regarding the drain on our domestic healthcare resources. Let me allay these fears today by stating that this agreement bears testament to a common spirit of mutual respect and shared responsibility,” Ms Nakhumicha said on the deal. 

While statistics reveal inadequate staffing, the country has no known documentation of deaths that are directly linked to the shortage of healthcare workers. 

The exits are happening in a country where Kenya National Bureau of Statistics (KNBS) data shows that the number of registered medical officers has dropped to 9,638 or 19 per 100,000 people in 2022 from 8,682 or 21 per 100,000 people some 10 years earlier. 

The worsened number of registered medical officers per 100,000 people over the past decade means the population growth is faster than the rise in the number of doctors being churned from colleges. 

Having nearly half of registered doctors out of practice makes a bad situation worse, according to Dr Atellah, who says that there are over 4,000 jobless doctors in the country despite a clear shortage of staff in public and private hospitals.

“It is sad that Kenya seems to have adopted a policy of train and dump yet there is a rising need for healthcare as the country’s population grows. Kenya should be the one importing healthcare workers, not exporting,” said Dr Atellah.

Against the World Health Organisation (WHO) recommended ratio of one doctor per 1,000 patients, Kenya is at one per 17,000, according to the Kenya Medical Practitioners and Dentists Union (KMPDU), leaving the country in breach.

About 1,330 doctors were registered in 2022 alone, the highest in a single year since KNBS started disclosing the data. There were 1,321 in 2020.

However, out of about 5,553 doctors that have been registered in the past five years to 2022, just about 1,000 secured jobs, with Nairobi and Kiambu absorbing the highest number at 134.

KMPDU estimates that, at the same level of patients, the country would require over 50 years to fulfill the WHO ratio, assuming 1,000 doctors are employed per year. 

The shortage of key health personnel in hospitals could be a blow to the country’s push for a universal healthcare program that seeks to deliver affordable and quality healthcare for all citizens.  

While statistics reveal inadequate staffing, the country has no known documentation of deaths that are directly linked to the shortage of healthcare workers. 

It is a gap that KMPDU wants to fill by starting to track circumstances surrounding every death that occurs in public facilities so as to help policymakers to quantify the price the country is paying for having an inadequate health workforce. 

“We need to get down and look at statistics of preventable deaths that happen in health facilities across the country. We want to track cases of deaths that would have been prevented if the government did not neglect service delivery,” says Dr Atellah. 

“We want to speak with figures. We have all these mortality meetings that usually happen in nearly every public hospital on Wednesdays. We cannot normalize death.”

The Ministry of Health has also launched a nationwide health facility census to determine the gaps that exist in the health sector.

The exercise, which targets 15,000 health facilities both private and public, seeks to find out the infrastructure in the facilities, the equipment and machines, and the human resources available to run the facilities.

"We don't want when people are referred by the Community Health Promoters they find the facilities they have been referred to are not ready to offer the services they are looking for," said Ms Nakhumicha.


Patrick Alushula is a senior business journalist at Nation Media Group’s Business Daily. He has a keen interest in insurance, banking, the stock market, health, and sustainability.

This story was developed as part of the Baraza-Fringe Data Storytelling Fellowship.

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