For the last 15 years, a team in Kenya has built a robust information system that has transformed the nation’s health workforce, enabling the country to provide basic health services to Kenyans by engaging all of its nearly 100,000 health workers. The Task Force is now handing over the African Health Workforce Project (AHWP) to the Kenyan government.

Previously, Kenya had no central database of healthcare workers, leaving major gaps in its health system, but now, government officials know how many healthcare workers there are, where they are working, and the status of their credentials thanks to AHWP. 

Begun at Emory University and funded by the Centers for Disease Control and Prevention, AHWP joined The Task Force in 2007. With Kenya’s health system now fully equipped to sustain the comprehensive human resource system, the project is coming to an end. AHWP’s director, Martha Rogers, MD, and Agnes Waudo, the Kenyan Country Director for AHWP and the former Chief Nursing Officer in Kenya, reflect on how the situation has evolved since the beginning and what the future holds.

• What was the situation prior to the start of AHWP?  

Waudo: In Kenya, like the U.S., each healthcare professional, whether a nurse, pharmacist, or doctor, is required to attend the appropriate certified medical school. Once they receive their certificate, diploma and license, the Kenyan government mandates that they interface with one of the eight regulatory bodies – like the Nursing Council of Kenya, the Pharmacy and Poison Boards, or Medical Practitioners and Dentists Council – annually to make sure they keep up their credentials and training to meet the country’s health standards.

Before AHWP, each healthcare worker had to travel to the city where the appropriate regulatory body was headquartered in order to meet these requirements. This is not very easy for many health workers in hard-to-reach areas of Kenya. This meant that many did not maintain their professional license, hampering some from practicing at all and leaving some to practice without updated credentials. Regulatory boards also had a hard time tracking their health workforce and knowing how many currently licensed professionals there were, making it difficult to map out the distribution of workers around the country. Some areas would have more than they needed while others were desperately in need of more. All of this contributed to Kenyans not being able to receive sufficient health services.

• How has the health workforce situation in Kenya evolved over the course of the last 15 years?

 Rogers: It has completely transformed. Many development efforts use the word “transformational” whether or not it actually characterizes what has happened, but AHWP has really lived up to that word. When we first started working with the healthcare regulatory bodies in Kenya, they had no internet, no information technology officers, only one or two computers total, and their records of all medically licensed professionals were papers kept in shipping containers. Now, the almost 100,000 healthcare workers across the country are in a digital database that each board can access and healthcare workers can do their annual renewal via their mobile phones. AHWP also helped set up a joint consortium across all the regulatory bodies so that they could better collaborate and address issues facing the Kenyan health professionals and health facilities. 

For example, one time a nurse who was not fully licensed overprescribed medication to a newborn baby and the baby passed away as a result. The consortium was able to address the situation immediately, conducting an investigation and taking steps to ensure that that type of situation never happened again.

Waudo: Universal Health Coverage (UHC) requires an efficient health system that provides the entire population with access to good quality services, health workers, medicines, and technologies. It requires financing systems to protect people from financial hardships. The information system is helping Kenya reach its overall goal of UHC which means every Kenyan has access to basic health services.

Using the information system, the Ministry of Health can address nursing or doctor shortages in different communities. If a healthcare facility is hiring a new nurse or doctor, they can quickly check that the candidate is fully certified through the regulatory body. It took a lot of effort to bring everybody together and convince them that digitizing things wouldn’t eliminate jobs, but it has been adopted so smoothly and each board is running its own information system at full capacity now. Health professionals have also been very receptive to the transition because it has reduced the time and money it takes to renew their licenses.

Rogers: Digitizing all of those records was a Herculean task and now Kenya knows more about its own health workforce than even the U.S.

• What is an example of how this information system has helped improve care in Kenya? 

Rogers: In Kenya, they have standalone pharmacies and many of them were operating without any regulation before AHWP implemented the information system, selling drugs without prescriptions and hiring pharmacists who were not licensed. Kenyans didn’t know which pharmacies were safe and which ones weren’t. The government was aware of the problem but didn’t know how to tackle it because they had no way of verifying pharmacies that were meeting the requirements. Once the information system was implemented, pharmacies that didn’t follow standard practices were closed, and today, each pharmacy that continues to operate has fully licensed pharmacists and sells only appropriately prescribed medicines. This means Kenyans can be confident in the medicine they are getting at their pharmacy, improving the quality of service and care.

• With AHWP ending, what does the future look like for the team, the information system and Kenya’s health workforce? 

Waudo: Our team in Kenya, who have helped implement the system, will still actively work with the regulatory boards who now maintain the system fully, both financially and operationally. The Kenyan government has also set up an oversight body of the regulatory boards consortium to continue to encourage collaboration across the boards, and our team will continue to work with the oversight body to generate dashboards and reports from the information system to help Kenya stay on track with their commitment to UHC, reaching more people with more health services. 

The work we have done is also well known in the East Central Southern African region. We have already helped Zambia implement a similar information system and carried out information systems assessments in Tanzania and Uganda, so there is potential for other countries to replicate our system to track their own health workforce. Because the system helps regulatory councils/boards collect licensing fees more accurately it is completely sustainable once implemented. However, the set-up is expensive so, first, funds need to be generated to help these other countries that are eager to improve their health service delivery. 

• Has the ability to track the health workforce in Kenya helped the country’s response to COVID-19?

 Rogers: When COVID-19 started threatening Kenyan borders, the Ministry of Health was immediately able to receive reports from the regulatory boards on how many healthcare workers were available because of the information system. It could also show which healthcare workers were available to be relocated to disease hot spots. We also put online the ability for providers to do their business with the regulatory boards, so information about the pandemic and the status of cases can be sent out via text to healthcare workers across the country, keeping the health professional community updated and engaged at all times.

• What are some of your parting feelings as this project comes to a close?

 Waudo: I am very thankful to all the partners and individuals who helped make this effort possible, especially our AHWP director, Dr. Martha Rogers. It really has made a huge impact and made access to health so much more possible for the people of Kenya. The team belongs to Health Workforce Training Research Kenya which is a local organization and hopes to be utilized for consultation nationally, regionally or internationally to support similar system development.

Rogers: It is sad to see this work end and to end the working relationship I have had with my colleagues in Kenya because they really have become like a family to me, but I am proud of what we’ve accomplished. And I’d like to thank all of those who worked so hard to make it happen.