The public sector nursing workforce in Kenya: a county-level analysis
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RESEARCH
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The public sector nursing workforce in Kenya: a county-level analysis Mabel Wakaba1*, Patrick Mbindyo1, Jacob Ochieng1, Rose Kiriinya2, Jim Todd4, Agnes Waudo2, Abdisalan Noor1,6, Chris Rakuom3, Martha Rogers5 and Mike English1,6,7
Abstract Background: Kenya’s human resources for health shortage is well documented, yet in line with the new constitution, responsibility for health service delivery will be devolved to 47 new county administrations. This work describes the public sector nursing workforce likely to be inherited by the counties, and examines the relationships between nursing workforce density and key indicators. Methods: National nursing deployment data linked to nursing supply data were used and analyzed using statistical and geographical analysis software. Data on nurses deployed in national referral hospitals and on nurses deployed in non-public sector facilities were excluded from main analyses. The densities and characteristics of the public sector nurses across the counties were obtained and examined against an index of county remoteness, and the nursing densities were correlated with five key indicators. Results: Of the 16,371 nurses in the public non-tertiary sector, 76% are women and 53% are registered nurses, with 35% of the nurses aged 40 to 49 years. The nursing densities across counties range from 1.2 to 0.08 per 1,000 population. There are statistically significant associations of the nursing densities with a measure of health spending per capita (P value = 0.0028) and immunization rates (P value = 0.0018). A higher county remoteness index is associated with explaining lower female to male ratio of public sector nurses across counties (P value 0.3 - ≤0.6), moderately accessible (>0.6 - ≤0.9), remote (>0.9 - ≤1.2), and very remote (>1.2 - 1.5). Further details about the methodology used for defining remote areas are described in Noor et al. [27]. Panel 2: Description of selected county indicators Urbanization
County estimates of the proportion of the population in an urban environment based on the classification employed in the census of 2009 [28]. Urban areas were defined as towns having a population of at least 2,000 inhabitants, connected to the main road network, and served as a market center for several smaller trading centers [29]. Delivery care provided by a skilled provider
County estimates of the proportion of children aged 0 to 59 months whose mothers had received care from a skilled birth attendant as based on the Kenya Integrated Household Budget Survey 2005/2006 data [30]. Health spending per capita
County estimates of spending on health per capita (Kenya Shillings) based on bed nets and illness, that is, the proportion of population that slept under a bed net by region, and the proportion of population that had a
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fever or malaria by region respectively, according to data from the Kenya Integrated Household Budget Survey 2005/2006 data [31]. Immunization rates
County estimates of the proportion of children aged 12 to 23 months that were
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