Factors Influencing Retention of Health Workers in Primary Health Care Facilities (A Case Study of Kakamega County, Kenya)

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DOI: 10.21522/TIJPH.2013.06.03.Art004

Authors : Songa Jairo Fredrick


Background: Kenya continues to experience a growing gap of health workers at all levels of service provision within its health infrastructure. As a consequence, this gap is a big impediment in her quest to achieve the health objectives and the global Sustainable development goals. This study examines factors influencing retention of health workers in primary health care facilities.

Methods: A cross sectional study design using semi - structured questionnaire tools involving 85 healthcare workers of different cadres at government rural health facilities was used in the County. Descriptive data analysis was used to profile the characteristics of the respondents; while Chi square tests were used to determine the differences between respondents who had stayed at their working station for at least two years. Multinomial Logistic Regression was used to analyse each factor that was considered significant in determining whether healthcare personnel stayed or left.

Results: Age, duration of working, and ability to balance work and personal life, fair evaluation, supervisor’s competence, manageable work load and availability of equipment and logistics were statistically associated with whether healthcare workers would leave or continued staying at their current work stations.

Conclusion: The results show that financial incentives are not the only factors in retention of health workers. The above factors need to be addressed in retention strategies for the retention of health workers at primary health facilities.

Keywords: Retention, Motivation, Primary Health care, Benefits, Leavers, Stayers, Incentives.


[1].Adano Ummuro. 2008. The health worker recruitment and deployment process in Kenya: an emergency hiring program. Human Resources for Health Available at:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2557010/?tool=pubmed. Accessed on 20th May 2009.

[2].Bancroft Emily. 2006. Uganda Health Workforce Retention study manual. Created for the Health Workforce Advisory Board of the Uganda Ministry of Health and The Capacity Project

[3].Bailey. P, Farmer D. Jessop, (2008). Business principles and management, 3rd edition, Pitman, London, UK

[4].Britten N. 1995. Qualitative Research: Qualitative interviews in medical research. British Medical Journal; 311:251-253.

[5].Buchan J. 2005. Scaling up Health and Education Workers: Increasing the performance and Productivity of an Existing Stock of Health Workers. DFID Health Systems Resource Centre

[6].Centres for Disease Control. 2010. Kenya’s Health Workforce Training Capacity: A situation Analysis. Available at:

www.google.com/search?client=safari&rls=en&q=Kenya+health+workforce+project+2010&ie=UTF-8&oe=UTF-8 Accessed on 23rd February 2012.

[7].Centres for Disease Control – Malaria.

Available at: http://www.cdc.gov/malaria/cdcactivities/kenya.htm - Accessed on 20th May 2009.

[8].CREHA Newsletter, December 2008. Improving Health workforce performance

[9].Cameroon, K. and P.M. Pierce, (2007). Building profit through people: Making your workforce the strongest link in the value-profit chain. Alexandria. Virginia: Society for Human Resource Management.

[10]. Chandran, E. (2009). Research Methods, Nairobi: Star bright services limited, Kenya

[11]. Cooper, D.R and Schindler, P.S (2010). Business Research Methods, Tata McGraw-Hill, 8th Edition, New Delhi, India.

[12]. Dambisya M. Yoswa, May 2007. A Review of Non-Financial incentive for Health worker retention in East and Southern Africa. ECONET discussion paper No. 4.

[13]. Dieleman M, Cuong P, Anh L, Martineau T. 2003. Identifying factors for job motivation of rural health workers in North Viet Nam. Human Resources for Health; 1:10.

[14]. Dieleman M, Harnmeijer JW. 2006. Improving health worker performance: in search of promising practices. Geneva: World Health Organization.

[15]. Dieleman M, Toonen J, Toure H, Martineau T. 2006. The match between motivation and performance management of health sector workers in Mali. Human Resources for Health; 4:2.

[16]. Dussault G, Franceschini MC. 2006. Not enough there, too many here: understanding geographical imbalances in the distribution of the health workforce. Human Resources for Health, 4:12.

[17]. Gakunju E.M. 2003. Determinants of Health status in Kenya. Available at: http://www.google.com/search?client=safari&rls=en&q=Gakunu+E.M+Determinants+of+Health+status+in+Kenya&ie=UTF-8&oe=UTF-8 - Accessed on 23rd January 2009.

[18]. Glaser, Barney G & Strauss, Anselm L., 1967. The Discovery of Grounded Theory: Strategies for Qualitative Research, Chicago, Aldine Publishing Company.

[19]. GOK., 2005. Millennium Development goals in Kenya needs & costs, prepared by the Ministry of Planning and National Development, Courtesy of the UNDP, Kenya, and the Government of Finland, Government of Kenya.

[20]. GOK.,1994. National Food Policy. The ministry of Agriculture and Central Bureau of Statistics (Citation - J, Keino. Susan in; Nutrition and the Millennium Development goals- A Kenyan Perspective on the eradication of Extreme Poverty and Hunger).

[21]. Hsieh H-F, Shannon SE. 2005. Three Approaches to Qualitative Content Analysis. Qualitative Health Research; 15:1277-1288.

[22]. Kenya National Bureau of Statistics (KNBS) and ICF Macro. 2010. Kenya Demographic and Health Survey 2008-09. Calverton, Maryland: KNBS and ICF Macro.

[23]. Lehmann Uta, Marjollein Dieleman, Tim Martineau. 2008. Staffing remote rural areas in middle - and low - income countries: A literature review of attraction and retention. Available at: http://www.biomedcentral.com/1472-6963/8/19Accessed on 23rd January 2009.

[24]. Lemiere Christophe. 2009. Evaluating and Designing Policy Options for Rural Retention: Some insights from Niger. February 3.

[25]. Lyn N Henderson and Jim Tulloch. 2008.Incentives for retaining and motivating health workers in Pacific and Asian countries. Available at:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2569066/ Accessed on 23rd January 2009.

[26]. Ministry of Health. 2006. Norms and Standards for Health Service Delivery. Nairobi: Health Sector Reform Secretariat

[27]. Manongi R, Marchant T, Bygbjerg IC. 2006. Improving motivation among primary health care workers in Tanzania: a health worker perspective. Human Resources for Health 4:6.

[28]. Mathauer I, Imhoff I: 2006. Health worker motivation in Africa: the role of non-financial incentives and human resource management tools. Human Resources for Health; 4:24.

[29]. Ministry of Health. 2005. The Second National Health Sector Strategic Plan of Kenya

a.     Reversing the Trends (NHSSP II 2005-10). Nairobi: Ministry of Health.

[30]. Mullei Kethi, Sandra Mudhune, Jackline Wafula, Eunice Masamo, Michael English Catherine Goodman, Mylene Lagarde, Duane Blaauw. 2010. Attracting and retaining health workers in rural areas: investigating nurses’ views on rural posts and policy interventions (BMC Health Services Research: 10(Suppl.1):S1. Available at: http://www.biomedcentral.com/1472-6963/10/S1/S1 Accessed on 31st March 2011.

[31]. Mwaniki DL, Dulo Charles O. 2008. Migration of Health workers in Kenya: The impact on health service delivery. Discussion paper 55. March, Mustang Management Consultants.

[32]. Nair N.K (2009). Simplified Business management, 2nd print: Vikas publishing Cox, T. Jr., (2008). The Importance of research in determining organizational Effectiveness, International Journal of Management Reviews, Vol. 2 No.4.

[33]. Ndetei DM; Khasakhala, L; Omolo, JO. 2008. Incentives for health worker retention in Kenya: An assessment of current practice Discussion Paper 62: Available at: www.equinetafrica.org/bibl/docs/DIS62HRndetei.pdf - Accessed on 23rd January 2009.

[34]. Orute, R. O., Mutua, S. M., Musiega, D. & Masinde, S. W. (2015). Leadership style and employee job satisfaction in Kakamega County, Kenya, International Journal of Management Research & Review, 5 (10), pp. 876

[35]. Olusegun, S.O. (2013). Influence of Job Satisfaction on Turnover Intentions of Library Personnel in Selected Universities in South West Nigeria. Library Philosophy and Practice (e-journal).

[36]. Oyugi, B. O. (2015). Potential impact of devolution on motivation and job satisfaction of health care workers in Kenya: Lessons from early implementation in Kenya and experiences of other sub-Saharan African countries, The Journal of Global Health Care Systems, 5 (1), pp. 1-30

[37]. Okthari, C.R. (2009). Research Methods: Methods and techniques, 3rd Edition. New age international publishers

[38]. Shattuck –Willis Mischa, Posy Bidwell., Steve Thomas, Laura Wyness, Daune Blaauw and Prudence Ditlopo. 2008. Motivation and retention of health workers in developing countries: a systematic review. BMC Health Services Research 8:247:

Available at: http://www.biomedcentral.com/1472-6963/8/247Accessed on 23rd January 2009.

[39]. Thaxton Mellisa, 2007. Integrating Population Health and Environment in Kenya. Available at: http://www.prb.org/pdf07/phe-kenya.pdf. Accessed on 20th May 2009.

[40]. The Private health care consortium, 2007. Private Health Sector Policy

[41]. Development - Presentation Thursday, 6th December -presented by Dr. Aida Samirand John A. M. Maliti. Available at:

www.hdwgkenya.com/new/index.php?option=com_docman&task=doc_download&Itemid=&gid=121. Accessed on 23rd January 2009.

[42]. The Yeshiva University fatherhood Project, Introducing Qualitative Hypotheses–Generating Research. Available at: http://www.nyupress.org/webchapters/0814706940chapt1.pdf. Accessed on 30th May 2010.

[43]. Wheeler Erica,2009. Health Workforce retention and the Kampala declaration; Global workforce Alliance

[44]. World Bank. 2008. Kenya Poverty and Inequality Assessment. Volume1: Synthesis report. Available at: http://siteresources.worldbank.org/INTAFRREGTOPGENDER/Resources/PAKENY A.pdf Accessed on Feb 23rd 2012.

[45]. World Health Organization. 2009. Increasing access to health workers in remote and Rural areas through improved retention WHO global recommendations 1st expert meeting 2-4 February Geneva.

[46]. World Health Organization. 2006. Health Report - working together, WHO World Health Organization. 2006.Fact sheet N° 302 April. Available at:

http://www.who.int/mediacentre/factsheets/fs302/en/print.html Accessed on 15th October 2008.

[47]. Zurn Pascal, 2008. Retention of Health workers with a focus on rural areas, 20-21 October. G

[48]. Zurn Pascal, Dolea Carmen, Stilwell Barbara. 2005. Recruitment: developing a motivated workforce. WHO.