HRH Retention, Recruitment & Motivation; Capacity Kenya Experience

1. HRH Retention, Recruitment & Motivation; Capacity Kenya Experience Doris Mwarey AFRICA CHRISTIAN HEALTH ASSOCIATIONS PLATFORM (ACHAP) Workshop on Advocacy and Human Resources for Health March 29-31, 2010; CHAK Conference Centre, Nairobi

2. Terminologies Retention refers to the ability to keep employees in an organization and is usually as a result of employee job satisfaction Motivation refers to the tendency to initiate and sustain effort toward a goal and is usually achieved through incentives and results in improved employee performance (Clark & Estes, 2002)

3. Relationship between Retention & Motivation (Luoma, IntraHealth International)

4. Kenya Retention Study Findings,2008 Study Objectives: Conduct a document review on HRH situation Explore tested incentive schemes in health, education and agriculture sectors Establish the most promising incentive packages Document perspectives from final year medical and nursing students Establish the preferred incentive package of employed health workers Make recommendations to assist in the development of incentive schemes

5. Study Sample and Tools 5

6. Job Satisfaction and Motivation Are you a motivated health worker?

7. Order of priority incentives

8. Four primary domains of WCI Health Worker teams – non financial incentives, job descriptions Service delivery environment – HW safety, health & wellness, stock management, referral systems, infrastructure Leadership and management practices – supervision, feedback Client – provider relationship – customer service, training of HWs, community involvement ₁

9. Key Findings / Gaps

10. Work station Occupational Hygiene Storage

11. Segregation/disposal Infection Control TB fume chamber

12. Fire extinguisher Fire safety Hospital kitchen

13. Kenya Pilot Program; 2008 The USAID funded Capacity Project worked with the MOH & FBO sector to Pilot simple WCI interventions in 10 rural health facilities in 4 provinces in Kenya The varied interventions were fairly low- cost , simple, and fast to implement

14. Examples of Interventions Applied

15. Results Due to improved leadership and management skills, district and facility managers were paying attention to HW needs and facilitating support where needed The facilities formed multidisciplinary teams (doctors, nurses, nutritionists, counselors etc) leading to better feedback among staff There was improved facility conditions: signage, job aids, provision of equipment/supplies

16. Results Cont.. Missions and visions of the facilities were made clear to develop a sense and purpose and value to work The set up of recreation centers at the facilities led to informal interactions and thus relieving tension and strengthening relationships Formation of the safety and health committees to implement safety/health activities

17. Success stories – resource centers Resource Centre – Friends Kaimosi Hospital Resource Centre – Lugari District Hospital

18. ….After “face lift” Success stories… St Lukes chapel before "face-lift"

19. RECRUITMENT Recruitment refers to “the activities undertaken by the organization to attract quality job candidates”. There are formal systems, monitored and used in all hiring, transfer and promotion decisions. Aim is to assure a fair and open process that is based on a candidate’s job qualifications (MSH; HRM assessment tool)

20. The Emergency Hiring Program (EHP) The Problem; Kenya faces declining health indicators caused in part by severe shortage of health workers Prolonged freeze in hiring of public sector health workers led to about 50% vacancy rate. Rural and remote parts of Kenya most affected GoK initiatives constrained by funding shortfalls Operational inefficiencies limit GoK capacity to address need in a timely and sustainable manner which leads to low retention rates

21. EHP Formulated to Address a Dire HRH Situation • USAID funded Capacity Project approached to support a rapid response by mobilizing health workers • Key targets of the Emergency Hiring Plan (EHP) were to: • Mobilize 831 health workers on a 3 year contract to address critical service gaps in HIV/AIDS especially in rural and remote areas • 3 year fiscal space enables GOK to budget and be able to absorb these workers by the end of their contract • Reduced turn-around time for public recruitment • Equip these workers with minimum skills needed to deliver care • Ensure these workers remain in post for the entire 3 year period

22. Process • Deployment plan agreed with all key stakeholders and user-points • Staff Attraction; using newspaper advertisement and highlighting specific location of vacancies. • Multiple publicity to reach many especially “local” applicants • Screening and selection based on pre-agreed criteria acceptable to all • Hiring cycle shorted to 2-3 months compared to 6-8 months in GOK hiring • Induction organized within 3 weeks of reporting to station • All applicants receive specialized training in HIV/AIDS • Deployment follows pre-agreed plan with facility heads fully oriented on the management processes for these workers • Timely processing of salaries, leave and other personnel needs • Supportive supervision arrangement agreed and implemented with GOK taking lead

23. Outcomes and lessons learnt • 595 workers already absorbed into GOK payroll. Another 237 to be absorbed in the next phase. • Retention Improved through; • Harmonized terms and condition of service with central GOK • Efficient induction completed and basic skills prepared staff for new roles • Mobilization and selection of applicants closer to facility sites • Timely processing of salaries, leave and other personnel needs • Supportive supervision to align staff capacity with job expectations/targets.

24. Q&A www.capacitykenya.org

26. Salary survey in Mission Hospitals in Kenya Enhancing Retention through Competitive Packages

27. Objectives of the Study • Review current salaries, benefits and HR practices within selected FBOs to form the basis for developing a suitable salary structure that should enable retention of staff; • Develop FBO salary (25th, 50th and 75th percentiles) and benefits structures that will help facilities benchmark their remuneration systems against each other

28. Approach and Methodology Phase I: Mobilisation and Project Planning • Initial meeting with FBO management representatives • Outline our approach and agree on key milestones • Select working committee from representatives of the FBOs

29. Phase II: Data Collection & Analysis • Preparation for the survey • Develop Questionnaire (data collection tool) • Collect data from the FBOs • Input the data into the analysis database; • Construct the appropriate matrices to allow comparison of the comparators’ salary and benefits data. • Reflect the minimum, median and maximum salaries for each benchmark position; • Identify the 25th, 50th and 75th percentile salaries per benchmark position

30. Phase III: Development of Remuneration Structure • Development of salary and benefits structures at the 25th, 50th and 75th percentile according to the classification of the facilities. • This will enable the FBOs to decide where to peg their individual salary structures depending on their internal compensation policies and strategies.

31. Classification Criteria • During the inception workshops held with both KEC and CHAK affiliated facilities at the onset of the assignment, it was agreed upon that facilities would be categorised based on location and level. • We did not receive sufficient data to carry out analysis based on facility level. We therefore categorised facilities based on location as indicated below: • 1. Facilities operating in urban / rural urban areas • 2. Facilities operating in rural areas • 3. Facilities operating in arid / semi arid areas

32. Benchmark Positions 1. Medical Officer 2. Specialists 3. Dentist 4. Pharmacist 5. Matron / Nursing Officer in Charge 6. Unit in Charge (ward, lab, pharmacy, xray, engineering etc) 7. Registered Nurse 8. Community Oral

33. Benchmark Positions Cont.. 9. Enrolled Nurse 10.Anesthetists 11.Clinical Officer 13.Community Oral Health Officer 14.Technicians (Dental, Laboratory, Pharmaceutical) 15.Technologists (Dental, Laboratory, Pharmaceutical) 16.Physiotherapist 17.Occupational Therapist 18.Medical Engineer 19.Radiographer/ Sonographer 20.Nutritionist 21.Social Worker 22.Hospital Ad

34. Benchmark Positions Cont.. 13.Community Oral Health Officer 14.Technicians (Dental, Laboratory, Pharmaceutical) 15.Technologists (Dental, Laboratory, Pharmaceutical Orthopedic ) 16.Physiotherapist 17.Occupational Therapist 18.Medical Engineer 19.Radiographer/ Sonographer 20.Nutritionist 21.Social Worker 22.Hospital Administrator

35. Benchmark Positions Cont.. 23. Medical Records Officer 24. Attendants (mortuary attendants, porter, 25.Clerks 26.Artisans (carpenters, plumbers, electricians etc) 27.Financial Controller 28.Non-clinical unit in charge (IT, HRM, Procurement etc) 29.Chaplain 30. Accountant / HR Officer 31.Housekeeping / Catering At least a 32.Security Officer 33.Driver

36. Preliminary Findings The most common allowances provided by the facilities include: • House allowance • Risk allowance primarily to theatre and clinical staff • Annual leave allowance • Responsibility allowance • On Call allowance • Non practicing allowance to Doctors, Clinical Officers and in some facilities to Nurses • Uniform allowance or uniform

37. Findings Cont.. Some of the common benefits and welfare programs provided by the comparators include: 1. Medical attention at the facility 2. Uniform or uniform allowance to uniformed staff and in some facilities to all staff 3. End of year parties and / or gifts 4. Professional indemnity cover 5. Funeral assistance for staff and dependants

38. Findings Cont.. • Most facilities do not offer benefits such as loans, insurance to their staff and this appears to be the market practice in the FBO sector. • The facilities generally comply with the statutory requirements in regards to leave. The few that do not should ensure that they comply so as to avoid the risk of litigation.

39. Retention Strategies • Most of the facilities indicated that the skills most difficult to retain are primarily clinical personnel. • Some of the retention strategies indicated by the comparator facilities include: • Housing • Free medical attention at the facility • Good working conditions • Training • Staff meetings • Improving remuneration

40. Possible Uses of the Findings • FBOs have a sound basis for developing a suitable salary structure that should enable retention of staff; • FBOs have clear bench marks for reworking compensation packages on the basis of salary structures (25th, 50th and 75th percentiles) and for non-salary benefits