Human Resources for Health (HRH) Kenya Baseline Assessment ResultsMombasa County Summary Status Report, July 2017

This publication is made possible by the support of the American people through the United States Agency for International Development (USAID).The contents are the responsibility of IntraHealth International and do not necessarily reflect the views of USAID or the United States Government

Kisauni

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Changamwe

Mvita

Likoni

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2Mombasa County Summary Status Report, July 2017

Human Resources for Health (HRH) Kenya Baseline Assessment Results

1.0 About HRH Kenya MechanismThe Human Resources for Health (HRH) Kenya is a Mechanism funded by the Presidents Emergency Fund for AIDS Relief (PEPFAR) through the United States Agency for International Development (USAID). The mechanism is implemented by IntraHealth International Inc. and its partners Amref Health Africa and Strathmore University Business School (SBS).

The aim of the mechanism is to strengthen health workforce management to achieve improved health outcomes in 27 PEPFAR focus counties. It is anticipated that by 2021: 1) Health workers training colleges will have increased numbers of market ready graduates who are responsive to Kenya’s disease burden; 2) National and County leadership will have efficient HRH management systems to address workforce challenges including reduction of staff shortages; and, 3) National and County Governments will make HRH decisions based on market – driven data and disease epidemiology to improve health outcomes.

2.0 HRH Kenya Baseline Assessment The assessment was undertaken between June - July 2017 to assess the status of HRH management systems and development (HRM &D) including iHRIS data demand and use in the 27 PEPFAR focus counties. The findings from the assessment will inform HRM&D interventions in Mombasa County.

Assessment Areas Baseline assessment in Mombasa covered the following areas;

i. HRH maturation where maturation was based on the premise that organizations, functional areas, processes and systems evolve through a process of development and growth towards a more advanced state accomplished in 4 stages.

HRH Maturation measured the stage of devel-opment and sustainability of HRM&D systems. The tool had 7 components; HRM&D capacity; HRM strategy; HRM policy and practice; perfor-mance management; HRM data; staff training & development and HRM gender mainstreaming.

Selected county health management team (CHMT) members and health workers, separate-ly ranked the county status on a scale of 1-4 representing the maturation stage as follows; 1: starting 2: developing 3: consolidating or 4: sustaining stage. An average rating was then estimated for the county for each component

ii. iHRIS data demand and use measured techni-cal, individual and organizational aspects of HRH data and analytics as well as the iHRIS sustain-ability index. For the sustainability index, 6 com-ponents were considered: status of infrastruc-ture; institutionalization; data quality; financing; personnel capacity and data use. Selected CHMT members ranked the county on each component using a scale of 1-4, as above.

iii. Institutionalization of In-service Training (IST) was measured using a tool that assessed presence of key milestone parameters of an in-stitutionalized IST. The following 9 components were assessed: Coordination structure; capacity to conduct training needs assessment; training plans and projections; training budget and ca-pacity to mobilize resources; system for receiving training requests; system of approval of training requests, functional IST management system and procedure for bonding and, regular reporting to MoH Human Resources Department (HRD). The CHMT also responded to the interview questions on whether the components were available or not.

Below is a summary of the HRH status for Mombasa County as at July 2017.

3.0 Key Findings

3.1.1 HRH Maturation Index

Mombasa County’s best performing HRM&D indicator was HRH capacity rated at 2.9. HRH policy and strategy were rated at 2.5 and 2.3 respectively followed by HRH performance management and HRM data within the county department of health at 2.0. The lowest performing indicators were staff training and gender mainstreaming rated at 1.8 and 1.6 respectively.

Overall, Mombasa’s HRH maturation index was 2.3.

The figures below show the ratings for the components and sub components.

2.9

Capa

city

Mat

urat

ion

scor

e

Average HRH maturation

4.0

3.0

2.0

1.0

0.0

Stra

tegy

2.3

Polic

y

2.5

Perf

orm

ance

2.0

HRM

dat

a

2.0

Staf

f tra

inin

g

1.8G

ende

r m

ains

trea

min

g1.6

3.1.1 HRM&D Capacity

3

HRH

Uni

tMat

urat

ion

Scor

e

Indicators

4

3

2

10

HRH

sta

ff

3

Staf

f at

sub-

coun

ty

2

HRM

bud

get

2

HRH

sta

ffing

3

Lead

ersh

ip

4

Advi

sory

4

Supe

rvis

ion

2

3 Mombasa County Summary Status Report, July 2017

Human Resources for Health (HRH) Kenya Baseline Assessment Results

3.1.2 HRM Strategy

2St

rate

gic

plan

Mat

urat

ion

Scor

e 4

3

2

1

0

HRM

D p

lann

ing

1

Rela

tions

hip

(uni

ons)

3

Com

plia

nce

3

3.1.3 HRM Policy and Practice

Mat

urat

ion

Scor

e

Indicators

4

3

2

10

HR

docu

men

t sy

nerg

y

3

HR

polic

y

1

Recr

uitm

ent/

hi

ring

4

Com

pens

atio

n/

bene

fits

2

CHD

or

gano

gram

3

Dis

cipl

ine

proc

edur

e2

3.1.4 Performance Management

The assessment measured the following sub components and rated as follows; Job Descriptions-2.5; Supportive Supervision – 4; Performance Management System– 3 & Staff rewards - 3.

Overall, Mombasa County’s rating was 3.1 on this component

3.1.5 HRM Data

1Employee data

ICT for HRH

Personnel files 3

2

0 1 2 3 4

3.1.6 Staff Training & Development

2

e-le

arni

ng C

PDs

Mat

urat

ion

Scor

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4

3

2

10

Staf

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Lead

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2

Link

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ISTs

2 2

Staf

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3.1.7 Gender mainstreaming in HRM

Mat

urat

ion

Scor

e

4

3

2

10

Gen

der

Incl

usio

n

2

Gen

der

Stra

tegy

1

Dis

crim

-in

atio

n

1

Ratio

s

2

Equi

ty

2

3.2 HR Data Demand and Use

3.2.1 Data quality

The county had moderate data quality concerns on completeness of both physical and electronic personnel records, accuracy and timeliness with which staff information was submitted. However, there were low concerns for the uniqueness, consistency and validity of HRH data.

2

3

2

3

3

2

Consistency

Data quality concerns

Data quality rating

Timeliness

Accuracy

Uniqueness

Validity

Completeness

0 1 2 43

3.2.2 iHRIS Sustainability Index

Institutionalization was rated as being at the sustaining stage within the county. Data quality, data use and personnel capacity were at consolidating stage while at the time of the baseline assessment, infrastructure and data use of iHRIS was at starting stage.

The county scored an average of 2.7 on iHRIS sustainability as shown in the figure below.

2

Infr

astr

uctu

re

Ratin

g

iHRIS sustainability index

4

3

2

10

4

Inst

itutio

naliz

atio

n

Dat

a qu

ality

3

Fina

ncin

g

3 3

Pers

onne

l cap

acity

2

Dat

a us

e

4Mombasa County Summary Status Report, July 2017

Human Resources for Health (HRH) Kenya Baseline Assessment Results

Contact Information: Chief of Party HRH Kenya – Country Director IntraHealth International | P. O. Box 66726-00800, Nairobi- Kenya | Mobile, +254 722203615, +254733000564 | Tel., +254 20 3645000 | Website, www.intrahealth.org/page/kenya

3.3 Institutionalization of In-service Training

Components Assessed Present None Comment

County IST Coordination structure CHMT, Training Committee & Training Policy

County Capacity to conduct TNA Lack personnel, skill set inventory and financial resources for optimal performance in health

Existing Training Plans & projections CHMT determines priority trainings for certain officers without consultation with National Government in response to health priorities

Existing Training budget & capacity to mobilize County unable to mobilize additional resources

for trainingExisting system for receiving training requests System of approval of training requests Functional IST management system Lack mechanism to coordinate all partners

involved in trainingProcedure for bonding Regular reporting of trainings to MOH-HRD

Recommendations• Designate HR staff specifically charged with HR

as a primary duty at the sub-county level & high volume facilities to facilitate the decentralization of HR issues for enhanced efficiency and quality HR service delivery.

• Long term planning to ensure sustainable fund-ing for adequate HRH staffing as per MOH norms & standards should be considered to ad-dress the current HRH gaps.

• The county should have regular Integrated HR supervision in conjunction with other depart-ments in different levels in the county.

• Link HRH strategic plan to HRM & D planning. A deliberate effort by the county’s Health Depart-ment to link the existing HRH strategic plan to staffing plans, appropriate remuneration, affir-mative action on gender, recruitment, training, staff performance and CPDs should be made. This could entail heads of specific departments (HIV/AIDS, public health, malaria, laboratory, nursing etc.) developing and ensuring their op-erational plans are based on and comply with the strategic plan.

• The county should have a HR policy manual that is disseminated to all its employees and is used as a point of reference to answer all questions pertaining employment. They also should ensure that an audit system exists to monitor and evalu-ate adherence to the compensation and benefits system.

• The county should put in place mechanisms to support timely and up to date data. This can be done through improving the infrastructure through procurement of adequate hardware (computers, modems etc.) supported by critical number of trained staff to ensure timely data entry.

• The county should ensure ICT equipment and information management systems are in place, widely available and used as the standard tool by well trained staff with up to date HRH infor-mation.

• The county should plan, forecast and develop a blueprint for e-learning training infrastructure. This should take into account the current and an-ticipated future e-learning needs of the county (and any neighboring counties that would ben-efit from such an initiative). Further, it should es-tablish formal systems/partnerships with in-ser-vice training institutions to strengthen health worker supportive supervision.

• Health workers registration and licensure should be up to date to ensure they are duly accredited and recognized by both the relevant governing bodies and signed off by the county health de-partment.

• The county should either develop their own or customize the national gender strategy/policy/guidelines and integrate them into the County HRH plan and/or County HR manual. This gender strategy would help to streamline issues like op-timum gender ratios the county had not attained at the time of the assessment. The department of health should also disseminate (share wide-ly) through existing and new channels to ensure all health workers receive sufficient accurate in-formation on issues around reporting and doc-umenting gender discrimination and/or harass-ment at the CDH.

• The county should ensure there is a practice that provides gender equity in opportunities for in- service education, promotions, transfers, mater-nity/paternity leave uptake including special cir-cumstances like health workers’ lifecycles and a system that monitors the adherence to it.