Cabinet Secretary Mailu,
Principal Secretary Muraguri,
Governor of Kisii County and Chair of Human Resources Committee Ongwae,
Governor of Kisii County and Chair of the Health Committee Ranguma,
Ladies and gentlemen,

On behalf of the United States Agency for International Development, or USAID, we are very pleased to participate in this important stakeholder forum about lessons learned in human resources for health.

For over a decade USAID has been partnering with the Government of Kenya to invest in the health workforce. Investing in the health workforce is critical because, even if we strengthen all other aspects of the health system, if there aren’t qualified health workers motivated to care for patients and placed where they are needed, Kenya will not meet its health goals.

When we started this work ten years ago, the human resources for health system was weak and there was an inadequate health workforce, especially for HIV service delivery. As partners, we have greatly improved quality of care over time through pre-service and in-service training; worked with regulators to ensure quality curriculum and performance regulations; and partnered with the Ministry of Health to support the human resources information system. As a result, Kenya has steadily increased the number of qualified health workers providing life-saving services to its people.

Together, we have come a long way toward improving health outcomes over the last 10 years. Kenya is the only country in the world on track to meet all five maternal and child nutrition World Health Assembly targets; Kenya’s 5-year intermediate Family Planning 2020 targets have been surpassed; and the country has achieved statistically significant reductions in under-five mortality and infant mortality.

But data show that Kenya continues to experience critical shortages of health workers. Currently there are only 1.5 health workers per 1000 Kenyans. Kenya needs to double its health workforce in order to meet the World Health Organization’s recommended standard for the country. In addition, there is a 24 percent rate of absenteeism among health workers, and the distribution of the health workforce—both in numbers and skill-set—is not equitable across the country.

Devolution has presented new challenges and new opportunities. National government allocations to counties are limited, and on average, 70 percent of the recurrent health budget goes to personnel costs. Much remains to be done to advocate for adequate resources from both the public and private sector to support the health workforce.

USAID is strengthening county governments’ human resource for health management systems with the goal of having adequate health workers equitably distributed across the country and within each county. To provide quality services at the county level, health workers also need to be sufficiently motivated and working in well-resourced facilities. It is critical to focus our efforts on two priorities: to increase our focus on underserved and high disease burden regions and to seek sustainable solutions.

Regions with few resources and a high disease burden have the greatest health workforce gaps. Accessing pre-service training remains a major impediment for adequate health workers in these regions. Many students from areas that are marginalized do not qualify to join medical colleges; the few who qualify do not have the resources to attend school and many who do join medical colleges drop out mid-way through the program due to inability to pay tuition fees. Future efforts in human resources for health must prioritize these parts of Kenya to reduce the disease burden and help Kenyans realize their right to health as enshrined in the Constitution.

Addressing Kenya’s workforce challenges sustainably will require additional and considerable resources. We need to look at new areas of investment while maintaining the progress already being made to develop an effective health workforce management system, particularly at the county level. Since the level of donor support is not the same in every county, it is important that we understand workforce issues in all counties and how finances are being mobilized to support gaps. Using the Human Resource Information System and other data to generate evidence for advocacy and resource mobilization will be instrumental in this process. In addition, the development and implementation of county level HRH strategic plans will strengthen county management of the health workforce, including financing and hiring of health workers.

Partnerships with the private sector are critical. The Afya Elimu Fund is an example of this type of successful partnership, which USAID, together with the Government of Kenya and the private sector, established to increase the number of students in medical training colleges. The fund not only provides an immediate benefit for students who are given an opportunity to pursue a medical education and secure gainful employment— it ultimately ensures future generations benefit from a qualified health workforce. This long-term payoff can be sustained beyond any one donor’s or partner’s support.

The fund is also enabling access medical training for more women and people from remote and low-resource areas of Kenya — it’s helping to even the playing field for health workers. This is especially important because, while Kenya makes tremendous strides in health and other sectors, this progress is not evenly distributed across the country.

This is our challenge as committed stakeholders and partners. I look forward to the spirited discussions that will take place today, and anticipate that you all will forge new partnerships and nurture innovations that will more sustainably and equitably move Kenya’s health workers—and the country as a whole— forward.

On behalf of USAID, I thank the Ministry of Health, county governments, and other stakeholders present today for your collective commitment to realizing a robust Kenyan health workforce. I also want to congratulate and thank our partner, Intrahealth International, for your admirable efforts and partnership over the years and for organizing today’s meeting.

Thank you.