Currently, for every 5,000 Kenyans there is only one doctor to see them.
These are the numbers that could make or break Kenya’s ambition for Universal Health Coverage (UHC).
The country produces 7,650 new health workers every year. But a new study finds that even if Kenya was to hire all of them, the addition would still be is a drop in the ocean.
The country has about 226,434 health workers but needs 70,000 more to ensure every Kenya who needs care has access to it, according to a new analysis released on January 6.
This shortage is expected to grow to more than 114,000 by 2030 and a staggering 170,000 by 2035 unless urgent action is taken to expand training programmes and increase hiring.
The assessment, titled “Modelling the health labour market outlook in Kenya: Supply, needs and investment requirements for health workers, 2021–2035” was conducted by the World Health Organization, Unicef, the Ministry of Health, Kenya Bureau of Statistics, the University of Nairobi and South Africa’s North-West University.
It was published on January 6 in the PLOS Global Public Health journal. “Kenya is advancing toward Universal Health Coverage (UHC) with investments in health systems but faces critical health workforce challenges,” said Prof James Avoka, a health modelling and workforce planning expert with WHO, who led the exercise.
“A 2022 Health Labour Market Analysis highlights a projected shortage of 114,000 workers by 2030. To bridge the gap, annual health workforce investments must grow by 10.5 per cent, with funding needs rising from $2.29 billion in 2021 to $3.9 billion by 2030,” he added.
The new modelling study is based on Kenya’s Health Labour Market Analysis (HLMA), conducted by the Ministry of Health in 2022. In 2021, the country required at least 254,220 health workers to meet its population’s healthcare needs, but it fell short by nearly 60,000 professionals. That figure has grown to about 70,000 this year.
The new study warns that while the health workforce is growing at an annual rate of 3.4 per cent, the demand for health services is rising even faster, at 4.7 per cent. The growing need stems from Kenya’s growing population, coupled with an evolving disease burden that demands more skilled healthcare professionals across diverse specialisations. Kenya made notable strides in expanding its health workforce over the past two decades, especially following the devolution of health services.
For instance, between 2006 and 2021, the density of health workers per 10,000 people more than doubled, from 14.47 to 30.14. However, budgetary restrictions on public sector hiring have left many counties with unfilled vacancies, even as unemployment among skilled health workers remains high, at 14 per cent as of 2021. Between 2014 and 2019, the health sector wage bill surged by 44 per cent, reaching Sh7.14 billion.
Yet, this increase has not translated into adequate hiring, as concerns over wage bill sustainability have constrained further expansion. “Low financial space due to restrictive public financial management rules is a major bottleneck,” the report states.
Prof Avoka and his colleagues warned that unless Kenya allocates an additional 10.5 per cent annually to its health workforce budget, it will be unable to bridge the funding gap needed to employ sufficient health workers to meet demand.
Compounding the problem is the steady attrition of health workers. Each year, four per cent of skilled professionals leave the workforce due to migration, retirement, or other factors. A bilateral agreement to export 30,000 nurses to the United Kingdom could further exacerbate domestic shortages, putting additional strain on an already overburdened system, the report says.
The Kenyan government has emphasised Human Resources for Health as a priority, but achieving meaningful progress will require more than policy declarations, the report indicates. A needs-based analysis from the study projects that by 2035, Kenya will require 476,278 health workers to meet UHC goals, yet its projected workforce by then will be just 304,351.
“This shortfall poses a significant barrier to realising the constitutional right to health for all Kenyans,” the authors caution. They argue that merely increasing training numbers is not a solution unless accompanied by measures to improve retention, address geographic imbalances, and create sustainable employment opportunities.
The report offers several recommendations to tackle the crisis. Key among them is the need for a paradigm shift in health workforce planning, moving away from a “one-size-fits-all” approach. By aligning training outputs with actual workforce needs and budget capabilities, Kenya can address inefficiencies and improve outcomes.
Public and private sectors must work together to increase investments in health employment. In 2021, the combined budget space for health workforce employment was $2.29 billion. This needs to rise to at least $3.58 billion by 2030 to meet projected needs, the experts said. The report’s authors issue a stark warning: “Achieving UHC is impossible without addressing the health workforce crisis. Kenya must act decisively to expand its training capacity, improve employment opportunities, and prioritise health in its national budget.”
The analysis indicated that in 2021, Kenya had 11,129 medical officers but needed 25,100. It projected that in 2031 Kenya would need 51,087 medical officers. On the other hand, Kenya had 109,659 Kenya Registered Community Health Nurses, against a need of 136,321, projected to rise to 191,005 in 2031. The country had 21,797 Registered Clinical Officers, against a need of 35,101, expected to rise to 44,222 in 2031.
However, there is oversupply in some cadres, but the trend shows a growing need leading to shortage in those cadres too.
For instance, the country has 11,429 trained Pharmaceutical Technologists against an estimated need of 4,685.
There is also an oversupply of Medical Laboratory Technologists, currently 18,198, against the need of
11,909.