The First Global Forum on Human Resources for Health (HRH) in 2008 raised concerns about inadequate inter-sectoral coordination for HRH planning and governance. Participating countries were asked to adopt the World Health Organization’s Country Coordination and Facilitation (CCF)  approach to guide HRH activities and maximize utilization of scarce resources among partners. CCF required establishing and supporting necessary governance structures for inter-sectoral coordination and collaboration to plan, implement, and monitor health workforce planning, development, and retention. In Kenya, the Ministry of Health (MOH), with support from development partners, established the National HRH Inter-agency Coordinating Committee (HRH-ICC) in February 2010 to improve health services through effective and efficient HRH planning, management, and system and policy development. The MOH chaired the committee, while the membership included donors, implementing partners, health and HR regulatory bodies, medical training institutions, health sector trade unions and professional associations, the Public Service Commission, and representation from the private and faith-based sectors. The committee anchored its operations in the sector-wide approach that Kenya had adopted in 2005 to guide the coordination of health initiatives toward achieving the goals of the Kenya Health Sector Strategic Plan and Kenya Vision 2030.
Achievements of the HRH Inter-agency Coordinating Committee
The HRH-ICC, with technical assistance from IntraHealth International through funding from USAID, expanded its mandate to focus on implementation of the first National HRH Strategic Plan 2009-2012. The committee established three technical working groups (TWGs)—HR management, HR development, and HR information systems—to provide input on HRH technical issues, and assigned a secretariat supported by IntraHealth. The HRH-ICC monitored implementation of the HRH strategic plan and conducted an end-term evaluation that concluded the plan’s design suitably targeted the country’s HRH needs and that it had substantially achieved its intended outcomes.
Aligned with the Country Coordination and Facilitation approach, the HRH-ICC provided a platform for developing and sustaining synergy, minimizing duplication of interventions, ensuring the focus remained on the critical HRH priorities envisioned in the national strategic plan, and leading in the coordination of a sector-wide HRH reform agenda. The HR Development TWG established a platform for coordination of pre- and in-service health training programs, contributing to completion of the first national health workforce forecast, which led to structuring of an HR development plan. The HRH-ICC also supported the MOH to map partners involved in hiring contract health workers in the public sector to harmonize their HR practices. The HRH-ICC and its partners were instrumental in developing Kenya’s 2013 HRH commitments declared during the Third Global Forum on HRH , and the 2014-2018 Kenya Health Sector HR strategy.
Devolution and the need for inter-county HRH coordination
Under the Constitution of Kenya 2010, the country transitioned from a centralized system to a decentralized system in 2013, with health services fully devolved to the 47 counties. The transition took place within six months instead of the three years recommended by the MOH’s HRH transition plan . Despite the formation of constitutional bodies such as the Transitional Authority, Commission for Implementation of the Constitution, Council of Governors, and Inter-governmental Coordination Committee on devolution—as well as the HRH-ICC’s instrumental role in coordinating HRH transition planning—it soon became evident that the coordination mechanism to manage the health system, and particularly the health workforce, at county level was inadequate. The health workforce was also unsettled as they were unwilling to be devolved. As a result, Kenya saw several labor disputes grow into full-scale strikes affecting health outcomes in counties and, in some instances, nationally.
An HR management rapid situation analysis conducted by IntraHealth in 2014 highlighted the lack of a smooth transition to devolved workforce management, including inadequate HR guidelines, structures, and procedures; delays in salary payment, third party and statutory deductions; and pension issues, giving rise to industrial unrest. Lack of coordinated communications strained relationships between county departments of health and the national MOH. In terms of HRH capacity at the county level, the analysis found insufficient HR management within health departments; limited access to HR policies and guidelines and lack of a repository to host the policies; a weak HR regulatory framework with HR functions being managed by non-HR professionals; weak coordination mechanisms within the departments responsible for HR functions; and inadequate HR practices in areas including recruitment, performance management, disciplinary and grievance procedures, and employee relations. Undefined reporting structures led to conflicts related to roles among the various levels of leadership in the county health departments.