Voices From The Capacity Project: Making An Impact—Transforming Service at a Remote Hospital in Kenya

"We had to queue too long for services, and at the end of the day most of us were referred to another hospital because Lopiding could no longer perform certain activities," recalls Nakalale Lesomoe, who lives in Kenya’s remote Turkana District. She is describing the difficult transition when the International Committee of the Red Cross handed over Lopiding Sub-District Hospital to the Kenya Ministry of Health in June 2006, after running it for 19 years primarily to treat war victims from Sudan.

The change-over left the hospital with good equipment but few resources and even fewer workers. The Ministry posted permanent staff but "only one reported," says David Simiyu Nalianya, a nursing officer in charge at Lopiding. "The others would not commit to work in this hard-to-reach area. Service delivery just went down and our clients responded by shunning the hospital."

But after a few months, community members found a remarkable improvement. "Around October, we started noticing a change in service delivery," reports community leader Phillip Ekwam. "Attitudes of the staff are now positive and patients are treated faster." The improvement came about due to the 14 health workers sent to Lopiding through the Emergency Hiring Plan (EHP) developed by the Capacity Project in collaboration with the Ministry of Health. Designed to increase the number of qualified profesionals working in Kenya’s public health facilities, the plan helped the Ministry expand access to treatment and care through the rapid hiring, training and deployment of 830 health workers at 198 sites.

At Lopiding, the EHP hires arrived to find a deteriorating facility. They quickly established order by insisting on cleanliness, updating inventories and producing regular documentation. Nalianya recounts that with the arrival of these motivated workers, the hospital embarked on community outreach. "We are now using the local chiefs to enlighten the communities through barazas [public meetings] about health issues and encourage them to come for services."

The Capacity Project partnered with the African Medical and Research Foundation (AMREF), Kenya Medical Training College and the Kenya Institute of Administration to provide the hires with a two-week training in integrated HIV prevention, care and treatment. "Before I came here, I was not even sure how to administer ARVs to children," admits Joseph Chebii Kiano. "With the knowledge I have gained, I feel equipped to manage a comprehensive care center." Cornelius Machage agrees. "In the medical college, we never covered anything on HIV. This training was such an eye opener!" The training also prepares the workers to improvise in hardship areas with limited electricity and resources.

One of the new hires, Peter Lomurukai, acknowledges the difficult conditions but asserts that "What I do is a calling to serve my people, and this requires dedication." Like Lomurukai, most of the EHP hires posted to Lopiding had personal ties with the community and requested the site. In the past, the Ministry of Health had deployed and transferred workers without considering such preferences, contributing to high attrition. The EHP interviews were held in sites across the country, helping to recruit workers with roots in rural areas who will be far more likely to thrive—and remain—in remote postings.

The Project assisted the Ministry to adopt more transparent hiring and deployment approaches. With the Ministry and Deloitte & Touche, the Project developed mechanisms ensuring that a process that normally took more than a year was completed in less than six months. "The recruitment, hiring and posting process was very fair, indeed the regional balancing was good," comments Christine Rotich, the Ministry’s senior HR officer. "Such a fair and open process earns the government credibility and improves its image."

The new hires received three-year contracts funded by the Capacity Project with the assurance that they will not be transferred to another facility. Afterward, the Project will assist the Ministry to create a transition plan for these workers to become regular government staff. The Project continues to help provide supportive supervision to the new hires.

[May 2007. Print a PDF version. To learn more about the EHP, read Kenya’s Health Care Crisis: Mobilizing the Workforce in a New Way.]

The Capacity Project, funded by the United States Agency for International Development (USAID) and implemented by IntraHealth International and partners, helps developing countries strengthen human resources for health to better respond to the challenges of implementing and sustaining quality health programs.

The Voices from the Capacity Project series is made possible by the support of the American people through USAID. The contents are the responsibility of IntraHealth International and do not necessarily reflect the views of USAID or the United States Government.