HRH Retention, Recruitment & Motivation; Capacity Kenya Experience
AFRICA CHRISTIAN HEALTH ASSOCIATIONS PLATFORM (ACHAP)
Workshop on Advocacy and Human Resources for Health March 29-31, 2010; CHAK Conference Centre, Nairobi
Doris Mwarey
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)
Relationship between Retention & Motivation (Luoma, IntraHealth
International)
Management Action
Internal State
Workplace Result
Incentives Motivation Improved Performance
Workplace Climate
Job Satisfaction
Retention
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
55
Study Sample and ToolsRespondent Category
ToolNumber
Key informant interviews
Interview Guide
14
Health care providers Questionnaire 486
Final year students
Questionnaire 184
Focus group discussions (FGDs )
FGD guide 7
Job Satisfaction and Motivation
Are you a motivated health worker?
7
1 Health care
2 Career advancement
3 Salary top up
4 Salary increment
5 Subsidized utilities
6 House allowance
7 Transport allowance
8 Transport
9 Housing
10 Annual appraisal
11 Hardship allowance
12 Supervision
13 Education allowance
14 Career Advancement tied to hardship post
15 Refreshments
16 Internet Access
17 Deployment and transfer to area of choice
18 Access to loans
19 Rest and recuperation
20 Decentralized recruitment
21 Fixed term posting
22 DSTV where there is no TV
Order of priority incentives
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
Key Findings / Gaps Areas Assessed: Problems identified:
Employee perception of fairness at work Levels of compensationSense of lack of equityLack of fair treatment by supervisorsPoor attitudes of colleagues
Employee understanding of job expectations
Lack of job descriptionsUnclear work plansPerformance objectives not defined
Feedback on work performance Inadequate feedback from supervisor irregular client surveys
Perceptions of meaningfulness of work to organization
Efforts in daily duties not recognized or valuedOrganization vision and mission unclear
Perceptions on existence of opportunities for career development
No clear career paths
Employee insights on adequacy of health facility and service delivery
Lack of health systems supportsPoor work environment
Work station
Occupational Hygiene
Storage
TB fume chamber Segregation/disposal
Infection Control
Hospital kitchen Fire extinguisher
Fire safety
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
Examples of Interventions Applied
Departmental work plans, daily work plans
Develop standard operating procedures
Signboards with work hours & available services
Team meetings, share info, team problem solving
Waste disposal and IP protocols
Inventory management to avoid stock-outs
Formation of facility safety committee
Improved signage: work hours, available services, locations
Supervision guidelines, train district/facility managers
Paint/refurbish facilities
Organized client flow procedures
Develop/implement referral guidelines
Equipment purchased Cleaned up yards Free tea/coffee for staff
More equitable staff shifts
Cleaner toilets/facilities
Post vision and mission
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
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
Success stories – resource centersResource Centre – Friends Kaimosi Hospital
Resource Centre – Lugari District Hospital
St Lukes chapel before "face-lift" ….After “face lift”
Success stories…
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)
The Emergency Hiring Program (EHP)
The Problem; Kenya faces declining health indicators caused in part by severe shortage of health workers1.Prolonged freeze in hiring of public sector health workers led to about 50% vacancy rate.2.Rural and remote parts of Kenya most affected3.GoK initiatives constrained by funding shortfalls4.Operational inefficiencies limit GoK capacity to address need in a timely and sustainable manner which leads to low retention rates
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
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
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.
Q&A
www.capacitykenya.org
Enhancing Retention through Competitive Packages
Salary survey in Mission Hospitals in Salary survey in Mission Hospitals in KenyaKenya
Objectives of the StudyObjectives 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
Approach and Approach and MethodologyMethodology
Phase I: Mobilisation and Project
PlanningInitial meeting with FBO
management representativesOutline our approach and agree on
key milestones Select working committee from
representatives of the FBOs
Phase II: Phase II: Data Collection & Data Collection & AnalysisAnalysisPreparation for the surveyDevelop Questionnaire (data collection tool)Collect data from the FBOsInput 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
Phase III:Phase III: Development of Development of Remuneration StructureRemuneration 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.
Classification CriteriaClassification CriteriaDuring 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 areas3. Facilities operating in arid / semi arid areas
Benchmark PositionsBenchmark Positions1. Medical Officer2. Specialists3. Dentist4. Pharmacist5. Matron / Nursing Officer in Charge6. Unit in Charge (ward, lab, pharmacy, xray,engineering etc)7. Registered Nurse8. Community Oral
Benchmark Positions Benchmark Positions Cont..Cont..9. Enrolled Nurse10.Anesthetists11.Clinical Officer13.Community Oral Health Officer14.Technicians (Dental, Laboratory,
Pharmaceutical)15.Technologists (Dental, Laboratory,
Pharmaceutical)16.Physiotherapist17.Occupational Therapist18.Medical Engineer19.Radiographer/ Sonographer20.Nutritionist21.Social Worker22.Hospital Ad
Benchmark Positions Benchmark Positions Cont..Cont..13.Community Oral Health Officer14.Technicians (Dental, Laboratory,Pharmaceutical)15.Technologists (Dental, Laboratory,Pharmaceutical Orthopedic )16.Physiotherapist17.Occupational Therapist18.Medical Engineer19.Radiographer/ Sonographer20.Nutritionist21.Social Worker22.Hospital Administrator
Benchmark Positions Benchmark Positions Cont..Cont..23. Medical Records Officer24. Attendants (mortuary attendants, porter,25.Clerks 26.Artisans (carpenters, plumbers, electricians
etc)27.Financial Controller28.Non-clinical unit in charge (IT, HRM,
Procurement etc)29.Chaplain30. Accountant / HR Officer31.Housekeeping / Catering At least a32.Security Officer33.Driver
Preliminary FindingsPreliminary FindingsThe 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
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
Findings Cont..Findings Cont..
Findings Cont..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.
Retention StrategiesRetention StrategiesMost 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
Possible Uses of the Possible Uses of the Findings 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