Kenya Health Workforce Report

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Kenya Health Workforce Report:The Status of Healthcare Professionals in Kenya, 2015

Collaborating InstitutionsKenya Ministry of Health (MOH)Radiation Protection Board (RPB)Medical Practitioners and Dentist Board(MPDB)Society of Radiographers of Kenya (SORK)Nursing Council of Kenya (NCK)Public Health Officers and TechniciansCouncil (PHOTC)Clinical Officers Council (COC)Kenya Health Workforce Project (KHWP)Pharmacy and Poisons Board (PPB)Emory UniversityKenya Medical Laboratory Technicians andTechnologists Board (KMLTTB)U.S. Centers for Disease Control andPrevention (CDC)Kenya Nutritionists and DieticiansInstitute (KNDI)Donor SupportThis report was supported under a cooperative agreement from the Centers for DiseaseControl and Prevention (CDC) Coordinating Office of the Center for Global Health (CGH)Division of Global HIV and TB (DGHT) through the Association of Schools and Programsof Public Health (ASPPH) Grant Number U36OE000002 to Emory University, Nell HodgsonWoodruff School of Nursing. The contents of this article are solely the responsibility ofthe authors and do not necessarily represent the official views of CDC or ASPPH.Contact InformationMinistry of HealthAfya House, Cathedral RoadP.O. Box 30016, Tel. 2717077, Nairobihttp://www.health.go.keMedical Practitioners and Dentist Board (MPDB) www.medicalboard.co.keNursing Council of Kenya (NCK) www.nckenya.comClinical Officers Council (COC) www.clinicalofficerscouncil.orgPharmacy and Poisons Board (PPB) www.pharmacyboardkenya.orgKenya Medical Laboratory Technicians and Technologists Board (KMLTTB)www.kmlttb.orgKenya Nutritionists and Dieticians Institute (KNDI) www.kndi.instituteRadiation Protection Board (RPB) www.rpbkenya.orgSociety of Radiography in Kenya (SORK) www.radiography.or.kePublic Health Officers and Technicians Council (PHOTC) www.photc.orgEmory UniversityKENYA HEALTHWorkforce Project

AcknowledgementThe Kenya, health professional regulatory agencies play a significant role towardsensuring excellence in examining the health workforce based on four characteristics namelyAvailability, Accessibility, Acceptability and Quality. Data collected by health regulatoryagencies are crucial in measuring how a country is performing in these areas, determiningthe scope and nature of gaps, guiding how interventions can improve health workforceregulation, and measuring success of these interventions. Kenya, supported by the USPresident’s Emergency Plan for AIDS Relief (PEPFAR) and the US Centers for Disease Controland Prevention (CDC), developed electronic databases at these regulatory agencies that canprovide information to assist in moving towards universal healthcare for all.These databases, referred to as regulatory human resource information systems (rHRIS),serve as the basis of the data in this National Report on the Status of the Health Workforcein Kenya. The availability, distribution, and accessibility of the health workforce with therelevant skills at a particular period strongly influence the ability of health systems tomeet the constitutional requirement of providing quality health services to every citizen. Inaddition, the aspiration of universal health coverage in the Sustainable Development Goals(SDGs) is largely dependent on a health workforce that is responsive to the ever-evolvingneeds of health systems.Factors that influence the demand for health services have a role in shaping therequirements of a health workforce. Changes in population demographics, epidemiologicalprofiles of communities, morbidity and mortality dynamics, and policies, among otherfactors, influence the demand and supply of health workers. Therefore, strengtheningthe health workforce through policy, adequate financing, planning, recruitment, training,deployment, and retention is paramount to ensuring everyone has access to a qualifiedhealth worker, thus improving the ability of health systems to achieve global and nationalhealth goals as prioritized in the new SDG targets.In coming up with this report, the following institutions are acknowledged:Kenya Ministry of Health (MOH)Radiation Protection Board (RPB)Medical Practitioners and Dentist Board(MPDB)Society of Radiographers of Kenya (SORK)Nursing Council of Kenya (NCK)Public Health Officers and TechniciansCouncil (PHOTC)Clinical Officers Council (COC)Kenya Health Workforce Project (KHWP)Pharmacy and Poisons Board (PPB)Emory UniversityKenya Medical Laboratory Technicians andTechnologists Board (KMLTTB)U.S. Centers for Disease Control andPrevention (CDC)Kenya Nutritionists and DieticiansInstitute (KNDI)We would also like to thank the Centers for Disease Control and Prevention (CDC)Coordinating Office of the Center for Global Health (CGH) Division of Global HIV and TB(DGHT) through the Association of Schools and Programs of Public Health (ASPPH) GrantNumber U36OE000002 to Emory University, Nell Hodgson Woodruff School of Nursing foralso contributing to the development of this report.Dr Jackson K. Kioko, OGW, Director of Medical Services

Ke ny a H e al th Work f orce R e p o r t : T h e St a t u s o f He a l t h c a r e Pr o f e s s i o n a l s i n K e n y a , 2 0 1 5Table of ContentsList of Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4List of Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4List of Appendices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Abbreviations and acronyms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Executive summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131.1 Importance of the health workforce . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131.2 Significance of a national health workforce report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141.3 Relevance and utilization of a national health workforce report . . . . . . . . . . . . . . . . . . . . . . 152. Kenyan context . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162.1 Geography and demography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162.2 Governance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172.3 Economic context . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172.4 Health status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193. Kenya’s health system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213.1 Policy and governance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213.2 Service provision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223.3 Health care financing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223.4 Health service professional organizations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 244. Background information on the regulatory agencies . . . . . . . . . . . . . . . . . . . . . . . . . . 264.1 Regulatory agencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 264.2 Regulatory functions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 264.2.1 Nursing Council of Kenya (NCK) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 294.2.2 Medical Practitioners and Dentist Board (MPDB) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 304.2.3 Clinical Officers Council (COC) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 314.2.4 Pharmacy and Poisons Board (PPB) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 324.2.5 Kenya Medical Laboratory Technicians and Technologists Board (KMLTTB) . . . . . . . . . . 334.2.6 Public Health Officers and Technicians Council (PHOTC) . . . . . . . . . . . . . . . . . . . . . . . . . 344.2.7 Society of Radiography in Kenya (SORK) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 354.2.7 Radiation Protection Board (RPB) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 364.2.8 Kenya Nutrition and Dieticians Institute (KNDI) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 382

5. Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 406. Tracking health professionals’ supply, regulation, and redeployment . . . . . . . . . . . . . . 446.1 Pre-service education for health professionals in Kenya . . . . . . . . . . . . . . . . . . . . . . . . . . . 446.1.1 Health Professionals’ Training Institutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 446.1.2 Health professionals’ training capacity (annual output) in Kenya . . . . . . . . . . . . . . 476.2 Internship and licensing examinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 526.2.1 Internship . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 526.2.2 Licensing examinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 576.3 Registration of health professionals in Kenya . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 606.3.1 New registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 606.3.2 Ever-registered . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 646.3.3 Retention/renewal of health professionals in Kenya . . . . . . . . . . . . . . . . . . . . . . . . 696.3.4 Retention/renewal (specialization) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 746.4 Deployment and attrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 766.4.1 Deployment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 766.4.2 Healthcare workers distribution and HIV prevalence . . . . . . . . . . . . . . . . . . . . . . . . 786.4.3 Attrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 796.4.4 Attrition by death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 817. Conclusion and discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 828. References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 849. Appendices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 873

Ke ny a H e al th Work f orce R e p o r t : T h e St a t u s o f He a l t h c a r e Pr o f e s s i o n a l s i n K e n y a , 2 0 1 5List of Tables2.1Top ten causes of morbidity and mortality in Kenya2.2Selected mortality rate indicators3.1Health professional regulatory agencies in Kenya3.2Health service professional associations in Kenya4.1CPD points required to renew licenses in various regulatory agencies5.1Renewal of licenses periods reported per profession6.1 Distribution of retained medical doctors and dentists engagingin private practice6.2Ratio of health professionals to population in KenyaList of Figures2.1Kenya’s population trajectory 1960–20142.2Map of Kenya showing the 47 county governments2.3Kenya’s budget for the FY 2016/2017 allocations (billions)2.4Distribution of health budget in the fiscal year 2016/20172.5Top ten causes of morbidity and mortality in Kenya2.6Injuries, communicable and noncommunicable diseases projections3.1NHIF membership from June 2010 up to June 20154.1Role of regulatory agencies in regulating training of health professionals in Kenya6.1Health training institutions by county and sponsoring agent6.2 A map showing the distribution of the health training institutions in Kenya bycounty and sponsoring agent6.3Health training institutions by county and cadre6.4Indexing of new nursing students by cadre, 2006–2015 in Kenya (N 30993)6.5Age distribution during enrolment to nursing programs in 2015 (N 4828)6.6Number of doctors and dentists’ graduates per year6.7Indexing trend for Clinical medicine students by program, 2006–20156.8Medical laboratory students indexing by training level (2010–2015)6.9 Annual training capacity for pharmacists and pharm technologists – locallytrained (2013–2015)6.10Distribution of internship centers by cadre and county (2015)6.11No. internship applications for BScN graduates by year6.12No. internship applications for clinical medicine graduates by year6.13No. of internship applications for medical and dental graduates by year6.14 Number of medical doctors and dentists trained outside of country applying forinternship by year4

6.15Country of training of medical doctors and dentists6.16Nurse licensing examination candidates by year6.17CO Pre-internship exam pass rate by number of candidates per year6.18 Pharmacists and pharmaceutical technicians pre-registration /pre-enrolmentexam candidates by year6.19 Medical laboratory science registration exam pass rate by number of candidatesper year6.20Newly registered nurses by year and level 2006–20156.21Registration of medical and dental practitioners by year (2006–2015)6.22Number of newly registered dlinical officers by year and training level6.23No. of clinical officers trained outside Kenya6.24Registration of pharmacy/pharm tech practitioners by year (2011–2015)6.25Newly registered medical laboratory technicians and technologists, 2006–20156.26 Number of nurses aged less than 60 years and midwives ever-registered by yearof registration6.27Age profile of the registered nurses and midwives, 60 years by cadre6.28 Registration trend for all clinical officers that have ever been registered,1989–20156.29Age distribution of registered COs aged 60 years and below by level of training6.30Age distribution for ever registered medical and dental practitioners in Kenya6.31 Ever-registered pharmacists and pharm technologists’ registration trend(2004–2015)6.32 Ever-registered medical laboratory technicians and technologists’ registrationtrend (2004–2015) by qualification level6.33Number of ever-registered med. lab. practitioners by cadre and age (N 10, 833)6.34 Retention/renewal of license for nurses and midwives by year and level oftraining, 2009-2014 (N 31878)6.35 Retention/renewal of license for nurses and midwives by age and level oftraining, 2009-2015 (N 30495)6.36 Retention/renewal of license for clinical officers by age and level of training(2009–-2015)6.37 Retention/renewal of license for medical practitioners and dentists by year(2009–2015)6.38 Retention/renewal of license for pharmacists and pharm techs by year(2011–2015)6.39 Retention/renewal of license for lab technologists and technicians by year(2006–2015)6.40 Retention/renewal of license for lab professionals by age and level of training(2009–2015)6.41No. and type of specialized nurses captured in the system6.42No. and type of specialized clinical officers captured in the system N 10166.43Specialization for dental practitioners5

Ke ny a H e al th Work f orce R e p o r t : T h e St a t u s o f He a l t h c a r e Pr o f e s s i o n a l s i n K e n y a , 2 0 1 56.44Specialization for medical practitioners (N 2090)6.45Number of nurses to clinicians by county, Kenya in 20156.46 Number of applications for certificate of good conduct intention to out migrateby cadre and reason (N 469)6.47 Number of applications for pharmacy practitioners by Country intended to outmigrate (N 107)9.1 Number of attrition cases through death by cadre and year (Data sourced fromAfya Sacco and harmonized with data base records) – 2009–2015List of Appendices1 Kenya counties map showing healthcare workers distribution andHIV prevalence rates62Approved nursing programs in Kenya3Approved clinical officers’ training programs in Kenya4Approved pharmacy training programs in Kenya5Entry requirements for training medical professions in Kenya6A map of training institutions by profession7Key stakeholders from the Kenya’s health sector who provided technical advice

Abbreviations and acronymsAIDSAcquired Immunodeficiency SyndromeAMRAdult Male Mortality RateBSCBachelor in ScienceCDCUS Centers for Disease Control and PreventionCDRCrude Death RateCOCClinical Officers CouncilCPDContinuing Professional DevelopmentCTMRComputed Tomography and Magnetic ResonanceGDPGross Domestic ProductGOKGovernment of KenyaHIVHuman Immunodeficiency VirusHSSFHealth Sector Services FundIMFInternational Monetary FundIMRLive Infant Mortality RateIPPDJKUATIntegrated Personnel and Payroll DatabaseJomo Kenyatta University of Agriculture and TechnologyKEMRIKenya Medical Research InstituteKEMSAKenya Medical Supplies AgencyKESKHHEUSKHPFKMLTTBKNDIKenya shillingKenya Household Health Expenditure Utilization SurveyKenya Health Policy FrameworkKenya Medical Laboratory Technicians and Technologists BoardKenya Nutritionists and Dieticians InstituteKTBKenya Tourism BoardMERMonitoring, Evaluation, and ReportingMMRMPDBMaternal Mortality RatioMedical Practitioners and Dentist BoardNCKNursing Council of KenyaNHAKenya National Health AccountsNHIFNational Health Insurance FundNMRNeonatal Mortality RatePACORIPDERCPan African Congress of Radiology and ImagingProfessional Development, Education and Research CommitteePEPFARU.S. President’s Emergency Plan for AIDS ReliefPHOTCPublic Health Officers and Technicians CouncilPPBPharmacy and Poisons BoardRPBRadiation Protection BoardSDGsSustainable Development GoalsSORKSociety of Radiography in KenyaTBTSOTuberculosisTechnical Service OrganizationU5MRUnder-Five Mortality RateWHOWorld Health Organization7

Ke ny a H e al th Work f orce R e p o r t : T h e St a t u s o f He a l t h c a r e Pr o f e s s i o n a l s i n K e n y a , 2 0 1 5Executive summaryThis report presents the first-ever comprehensive analysis of the health workforcesituation in Kenya based on data collected by the nation’s health professional regulatoryboards and councils. Health regulatory agencies are government agencies responsible forregulating the training and practice of various health professionals in Kenya. There are eighthealth regulatory agencies established through acts of Parliament. They include, NursingCouncil of Kenya (NCK), Medical Practitioners and Dentist Board (MPDB), Clinical OfficersCouncil (COC), Kenya Medical Laboratory Technicians and Technologists Board (KMLTTB),Pharmacy and Poisons Board (PPB), Public Health Officers and Technicians Council (PHOTC),Radiation Protection Board (RPB), and Kenya Nutritionists and Dieticians Institute (KNDI).Society of Radiographers of Kenya (SORK) is the only professional agency that representsradiographers in any professional forum. SORK vets radiographers for professionalregulation in training and practice.All health professionals are required to be trained in an approved training institutionand licensed to practice by their respective regulatory agency, regardless of whether ornot they are employed in the public, private or faith-based health sectors. Thus, datafrom regulatory agency databases provide the most complete picture of the entire healthprofessional workforce.Regulating the health workforce begins with the accreditation of training institutions,allocating index numbers to all students admitted to undertake a health professionalcourse of study, recommending internships, administering licensing examinations, andrecording licensed professionals in the national registry. Regulatory agencies overseelicensure renewal and compliance with the mandatory continuous professional developmenttraining requirements, disciplinary actions, and the immigration and out-migration of healthprofessionals. Thus, regulatory agencies provide data not only on the training and entry ofnew healthcare professionals, but also on the quality and quantity of the actual practicing(active) professional workforce. These data are critical for use in improving workforcemanagement and health program planning.The regulatory agencies use the regulatory Human Resource Information System (rHRIS)to monitor and collect data on the health workforce. This family of information systems wasdeveloped beginning in 2002 for nurses, and 2007 for five other major professions (doctors,dentists, clinical officers, laboratory technicians and technologists, and pharmacists andpharmaceutical technologists). Since systems from the three other regulatory agencies(KNDI, RPB/SORK, and PHOTC) are still under development, only minimal data are reportedat this time.Health training institutionsThe majority of Kenya’s health professional training institutions are concentrated inmajor cities such as Nairobi, Kiambu, Mombasa and Kisumu. Of the 47 counties, 36 have atleast 1 health training institution. The eleven counties without any health training institutionare Busia, Elgeyo-Marakwet, Isiolo, Kajiado, Laikipia, Lamu, Marsabit, Mandera, TaitaTaveta, Tana River, and Wajir Counties. The government of Kenya is the major sponsor ofhealth training institutions in Kenya with control of 49.3%, while faith-based institutionscomprise 24.3% and private sponsored institutions comprise 26.4% of health traininginstitutions in Kenya. As of 2015, Kenya had numerous public, private and faith-based8

Executive summaryinstitutions and programs accredited to train health workers, including 102 for nurses,36 for clinical officers, 10 for doctors, 2 for dentists, 42 for laboratory technologists andtechnicians, and 32 for pharmacists and pharmaceutical technologists.Indexing of students entering training schoolsThree of Kenya health professionals’ regulatory agencies (i.e. NCK, COC and KMLTB)index new students, or track their entry into pre-service education as health professionalstudents. Other regulatory agencies have just begun to index new students. In the last tenyears, 30,993 nursing students were indexed after admission in various nursing programs.In 2015, 280 certificate-level nursing students were indexed, 3,944 diploma-level, and 604degree-level nursing students were indexed. There has been a rise in nurse indexing figures,likely due to the establishment of new nurse training programs and institutions.The COC reports a declining trend on indexing of students undertaking diploma inclinical medicine partly because of more stringent regulation of training institutions;however, there is a rising trend in indexing of degree-level clinical medicine students asnew programs are being opened. However, the total number of indexed clinical officers hasdeclined for the last five years from a high of 1,833 in 2011 to a low of 1,254 in 2015.The KMLTTB reports a twofold increase in the number of indexed medical laboratoryprofessionals within the last 3 years. There were 8,095 students enrolled into medicallaboratory and technologists (MLTs) training institutions at pre-service in Kenya duringthe period 2010 - 2015. Of these, 4,653(57.5%) were enrolled into diploma program, 2,124(26.2%) in a certificate, and 1,318 (16.3% %) in a degree program.The Pharmacy and Poisons Board (PPB) indexes students admitted to traininginstitutions but has experienced challenges in tracking the numbers. To estimate thetraining capacity, the number of pharmacists and pharmaceutical technologists thatgraduated in each of the 3 years for which data were available indicates that 827pharmaceutical technologists graduated in 2013, 793 in 2014 and 825 in 2015. In 2013, 253pharmacists graduated, 175 in 2014, and 219 in 2015.Although the MPDB has only recently begun indexing, new students entering trainingcan be estimated by the number of students graduating each year. The number of medicaldoctors graduating almost doubled from 287 in 2006 to 501 in 2015, giving an averageoutput of 466 doctors per year. The number of dentists graduating in a year averages 43dentists annually with a high of 60 in 2013. This increase in medical and dental graduates islikely due to the increase in number of medical and dental training schools in Kenya from 2in 2006 to 10 in 2015.InternshipsOnly bachelor’s trained nurses (BScNs), doctors, dentists, clinical officers (diplomas andBSC), nutritionists and pharmacists are required to complete a 1-year internship followinggraduation. All other professionals enter the labor market immediately after graduation,but their clinical or other practical experience/internship is part of their training curricula.At least 40 of the 47 counties in Kenya have an approved internship center for at leastone profession, but only 10 (21.3%) counties have internship centers for all 6 professions.Foreign-trained medical students applying for licensure in Kenya are also required tocomplete an internship. Application for internship by foreign-trained medical students is onthe decline. The increase in number of medical institutions in Kenya may reduce the demandfor Kenyans to train outside the country.9

Ke ny a H e al th Work f orce R e p o r t : T h e St a t u s o f He a l t h c a r e Pr o f e s s i o n a l s i n K e n y a , 2 0 1 5Licensing examinationsThe NCK, COC, PPB, and KMLTTB require all qualified students (i.e. new graduatesthat completed internship, where required) to pass a national licensing examination toreceive a license for clinical practice. This means all nurses, clinical officers, pharmacists,pharmacy technicians, laboratory technologists, and laboratory technicians take nationallystandardized licensure exams, enabling them to practice. MPBD only requires licensingexams for foreign-trained medical students. Kenyan-trained medical doctors and dentistsare not currently required to take entry-to-practice exams prior to licensure. Regulatoryagencies experienced an increase in the number of applications for qualifying examination,given the increase in health professional students.Newly registeredThere is an increasing trend in the registration of health professionals, except forpharmacists, whose numbers have fluctuated. From 2006–2015, 19,994 newly qualifiednurses were registered with NCK to practice in Kenya. The annual number of newly qualifiednurses entering the labour force increased by 68.5% from 1,745 in 2006 to 2,941 in 2015;the annual number of newly qualified doctors entering the workforce doubled from 285 in2006 to 611 in 2015. A similar rise was seen among dentists, with 52 dentists registeredin 2015 compared to 25 dentists in 2006. The annual number of new qualified clinicalofficers entering the labour force increased by 45.9%, from 751 in 2011 to 1,395 in 2015.However, the number of newly registered pharmaceutical technologists has been fluctuatingbetween the year 2011 and 2015 from a high of 994 in 2011 to a low 399 in 2013. In 2015,857 pharmaceutical technologists were registered. However, the number of newly registeredpharmacists maintained a steady rise over the period. The proportion of medical laboratorytechnologists entering the workforce has been increasing over the years, from 531 in 2011 to1,344 in 2015.Ever-registeredThe majority of ever-registered health professionals in Kenya are nurses. There are atotal of 51, 649 nurses below 60 years of age who have been ever registered compared withever-registered medical doctors (9,497), dentists (1,066), clinical officers (13,913), medicallaboratory technologists (6,626) and medical laboratory technicians (4,445), pharmacists(2,377), and pharmaceutical technologists (7,243 ) in Kenya.Retention/currently practicingThe retention of health professionals represents the active health workforce. Retentionis based on the renewal period established by each regulatory agency. For example, nursesrenew their licenses every 3 years. From 2012 to 2014, NCK issued 31,896 renewal licensesfor nurses practicing in Kenya. The ratio of currently practicing nurses to population in Kenyais 8.3 nurses per 10,000 population compared with the WHO recommendation of 25 nursesper 10,000. By 2015, Kenya had 5,660 doctors and 603 dentists retained in the countrywhich translated to approximately 1.5 doctors and 0.2 dentists to 10,000 population, againstthe WHO recommended minimum staffing level of 36 doctors per 10,000 population.There were 10,562 clinical officers retained in 2015; 1,616 pharmacists and 4,671pharmaceutical technologists from non-governmental facilities, and 5,203 medical10

Executive summarylaboratory technologists and 3,213 medical laboratory technicians. This translates to 2.7clinical officers and 2.2 medical laboratory officers per 10,000 population. The ratio ofpharmacists and pharmaceutical technologists to population could not be fully determinedusing retention data since only those from non-governmental facilities are required torenew. Data from

Technologists Board (KMLTTB) Kenya Nutritionists and Dieticians Institute (KNDI) Radiation Protection Board (RPB) Society of Radiographers of Kenya (SORK) Public Health Officers and Technicians Council (PHOT

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