Unequal sharing of doctors hurting Kenya’s healthcare

Kenya’s persistent healthcare crisis has been found to have a big professionals distribution problem that has left Nairobi with nearly half of all practising doctors and more than 70 per cent of dentists, a newly released sector report says.

The findings of the national survey released last Thursday indicate that the Kenyan capital has nine times the number of healthcare workers as there are in some of the farflung regions, confirming reports of entrenched inequality in access to health services across the country. 

The Kenya Health Workforce Survey found that the country has a total of 5,660 practising medical doctors and 603 dentists, nearly half of whom are based in Nairobi.

There are 9.5 doctors for every 10,000 people in Nairobi, while the coastal county of Mombasa is a distant second with 2.8 doctors for every 10,000 people.

Uasin Gishu, which hosts the North Rift’s biggest city of Eldoret, is third with 2.1, followed by Kisumu (1.6), Nyeri (1.3), Kiambu (1.1), and Isiolo (1.1). The national average stands at 1.5 for every 10,000.

The remaining 40 counties have a ratio of less than one doctor for every 10,000 people. The survey also found that Nairobi has the highest number of health training institutions at more than 14.

The report also offers important insights into the distribution of the medics among the various income groups having found that more than 70 per cent of dentists are, for instance, in private practice — where they mainly serve middle- and upper class clients.

The high concentration of dentists in Nairobi is particularly critical given the small number of practitioners — the national ratio being 0.2 dentists for every 10,000 people.

These numbers mean that Kenya is still very far from meeting the 44.5 physicians, nurses and midwives per 10,000 people recommended by the World Health Organisation and remains at a low ratio of 13.8 per 10,000.

Still, Nairobi has the highest ratio of nurses to the population at 9.7 for every 10,000 people followed by Uasin Gishu (8.5), Tharaka Nithi (7.9), Isiolo (5.2) and TaitaTaveta (5).

The report exposes the level of inequalities in the provision of primary healthcare having found that a number of counties including Mandera (0.1), Wajir (0.2), Tana River (0.2), Nandi (0.4), Samburu (0.5), Narok (0.8), Turkana (0.9) and Busia (0.9) have less than one nurse per 10,000 people.

The national ratio of clinical officers, who make the second-largest group of skilled health professionals, stands at 2.7 per 10,000 people.

On this front, however, Nyeri County tops the list with 7.3 clinical officers per 10,000 aged below 60. Kisii (6.9) followed by Baringo (6.7), Elgeyo Marakwet (5.2), and Busia (4.4).

Turkana, with 0.3 clinical officers per 10,000 people, Mandera (0.6), Garissa (0.6), Wajir (0.6), and Tharaka Nithi make the bottom of the pile.

The survey found that the disparities have persisted despite the huge rise in the number healthcare workers since 2006. The number of medical doctors graduating from local universities almost doubled from 287 in 2006 to 501 in 2015, leaving an average output of 466 a year.

The number of dentists graduating every year averaged 43 during the same period.

The increase in the number of medical and dental graduates was the product of a growth in the number of medical and dental training schools from two in 2006 to 10 in 2015.

During the same period, the number of nursing colleges increased from 77 to 102 but their distribution once again remained in favour of Nairobi.

The survey found that a number of counties such as Mandera, Busia, Taita Taveta, Isiolo and Mandera. Tana River, Wajir, Kajiado, Elegeyo Marakwet, Lamu, Marsabit and Laikipia do not have a single health training institution — a situation that continues to adversely impact on availability of health professionals in local dispensaries and hospitals.

Most of the 13 counties without a nursing school have lower ratios of retained nurses.

The report says Nairobi tops the list of counties with the highest number of training institutions at 28 followed by Kiambu (14), Kisumu (11), Uasin Gishu (8) and Kisii (7).

The survey found that the government owns the majority of health training schools, accounting for 73 or 49 per cent of the total. Faith-based training schools are 36 while 39 are private.

The report also raises questions about counties with severe health challenges but have the same number of healthcare workers as some of their counterparts.

The lakeside county of Homa Bay, for instance, has the highest prevalence of HIV among the adult population standing at 27.1 per cent in 2014, according to the National Aids Control Council, and therefore had to recruit more nurses to manage the epidemic.