Journal article
Examining the absorption of post-internship medical officers into the public sector at county-level in devolved Kenya: a qualitative case study
- Abstract:
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Background
After Kenya’s decentralization and constitutional changes in 2013, 47 devolved county governments are responsible for workforce planning and recruitment including for doctors/medical officers (MO). Data from the Ministry of Health suggested that less than half of these MOs are being absorbed by the public sector between 2015 and 2018. We aimed to examine how post-internship MOs are absorbed into the public sector at the county-level, as part of a broader project focusing on Kenya’s human resources for health.
Methods
We employed a qualitative case study design informed by a simplified health labour market framework. Data included interviews with 30 MOs who finished their internship after 2018, 10 consultants who have supervised MOs, and 51 county/sub-county-level managers who are involved in MOs’ planning and recruitment. A thematic analysis approach was used to examine recruitment processes, outcomes as well as perceived demand and supply.
Results
We found that Kenya has a large mismatch between supply and demand for MOs. An increasing number of medical schools are offering training in medicine while the demand for MOs in the county-level public sector has not been increasing at the same pace due to fiscal resource constraints and preference for other workforce cadres. The local Department of Health put in requests and participate in interviews but do not lead the recruitment process and respondents suggested that it can be subject to political interference and corruption. The imbalance of supply and demand is leading to unemployment, underemployment and migration of post-internship MOs with further impacts on MOs’ wages and contract conditions, especially in the private sector.
Conclusion
The mismatched supply and demand of MO accompanied by problematic recruitment processes led to many MOs not being absorbed by the public sector and subsequent unemployment and underemployment. Although Kenya has ambitious workforce norms, it may need to take a more pragmatic approach and initiate constructive policy dialogue with stakeholders spanning the education, public and private health sectors to better align MO training, recruitment and management.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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(Preview, Version of record, pdf, 1.1MB, Terms of use)
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- Publisher copy:
- 10.1186/s12913-023-09928-0
Authors
- Publisher:
- BioMed Central
- Journal:
- BMC Health Services Research More from this journal
- Volume:
- 23
- Issue:
- 1
- Article number:
- 875
- Place of publication:
- England
- Publication date:
- 2023-08-19
- Acceptance date:
- 2023-08-16
- DOI:
- EISSN:
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1472-6963
- Pmid:
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37596663
- Language:
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English
- Keywords:
- Pubs id:
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1512648
- Local pid:
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pubs:1512648
- Deposit date:
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2023-08-31
Terms of use
- Copyright holder:
- Zhao et al.
- Copyright date:
- 2023
- Rights statement:
- © The Author(s) 2023, corrected publication 2023. Open Access. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
- Notes:
- A correction to this article is available online from BioMed Central at: https://doi.org/10.1186/s12913-023-09992-6
- Licence:
- CC Attribution (CC BY)
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