Why tribalism is making hospitals worse - experts

It is often reassuring when a health worker in a hospital speaks your language or comes from your tribe.

But a new study suggests that while this may make you feel more comfortable, it does not necessarily mean you will receive better care.

Instead, hospitals with staff drawn from many different ethnic communities provide better services.

The researchers interviewed 182 healthcare workers, including doctors, nurses, laboratory staff and administrators, at one unnamed public referral hospital. They also interviewed 210 outpatients about the care they received.

 They measured ethnic diversity and compared departments with a wide mix of ethnic groups with those that had fewer.

 The results showed that more diverse teams performed better.

 "Public healthcare facilities experience improved service delivery results when they adopt ethnic diversity as a positive factor," the researchers reported last week in the Health Science Reports journal.

Staff in the ethnically diverse departments reported being more creative, more adaptable and more satisfied with their jobs. Statistical analysis showed that ethnic diversity explained nearly one-fifth of the differences in staff performance.

The study was led by Collins Ogolla and colleagues from the Jaramogi Oginga Odinga University of Science and Technology (JOOUST). They said diversity should be viewed as a strength rather than a problem.

Patients also gave higher ratings to departments with more ethnically diverse staff. They said workers were friendlier, communicated better and showed greater understanding of people from different backgrounds.

Patients in highly diverse departments gave an average satisfaction score of 4.36 out of five, compared with 3.98 in departments with lower diversity.

The authors do not identify the hospital by name, referring to it only as "a Kenyan tertiary hospital". However, the workforce profile strongly suggests the study was carried out at a major hospital in Kisii county, as nearly half (48.9 per cent) of the healthcare workers surveyed were Kisii, followed by Luo (27.5 per cent) and Luhya (14.3 per cent).

The study comes at a time when multiple reports from the National Cohesion and Integration Commission (NCIC) have warned of growing tribalism in public sector employment, especially in county governments.

 Last year, the NCIC 2025 Ethnic and Diversity Audit showed that five of Kenya's largest ethnic communities continue to dominate government employment opportunities, accounting for more than 70 per cent of positions in state corporations.

 The report revealed that the Kikuyu, Kalenjin, Luo, Luhya and Kamba communities hold the majority of senior government jobs, leaving little room for representation among the other 38 ethnic groups.

 NCIC commissioner Danvas Makori said public hospitals are among the most affected.

 “Moi Teaching and Refferal Hospital is absolutely non-compliant by far...with 67 per cent,” Makori said.

 NCIC chairperson Samuel Kobia said; “There has been a clear demonstration that we don’t have equitable distribution of opportunities.”

 According to the JOOUST study, having staff from different communities brings fresh ideas and experiences that help solve problems.

 "Ethnically diverse teams contribute to improved adaptability, creativity and overall job effectiveness in healthcare settings," the study says.

 "The integration of diverse cultural perspectives and experiential knowledge appears to enhance problem-solving capacity and responsiveness to patient needs, which are critical in complex service environments such as public hospitals."

 The study is titled Influence of Ethnic Diversity on Service Delivery Outcomes in Kenyan Public Healthcare. It was co-authored by Caroline Sitienei and Josephine Opondo, both of JOOUST.

 However, the researchers found that diversity also presents challenges.

 Departments with greater ethnic diversity reported higher levels of creativity, but they also experienced more disagreements among staff.

 Nearly one in four healthcare workers said ethnic bias or favouritism sometimes affected teamwork or decision-making.

 The researchers said this shows that diversity alone is not enough.

They recommend that hospitals invest in inclusive leadership, fair recruitment, effective communication and training in cultural competence so that workers from different communities can work together effectively.

 Still, the authors cautioned against drawing broad conclusions from the findings.

 The research was conducted in only one public hospital, meaning the results may not represent all hospitals in Kenya.

 Because it was a cross-sectional study, it also cannot prove that ethnic diversity directly causes better healthcare. It only shows an association between the two.

 The study also relied partly on staff reporting their own performance, which may not always be completely accurate.

 Temporary workers, interns and critically ill patients were excluded, meaning some experiences may have been missed.

 The researchers recommend larger studies involving many hospitals across Kenya and using additional measures such as patient waiting times, treatment outcomes and hospital records before drawing conclusions for the country.

 INSTANT ANALYSIS

 A study by researchers from Jaramogi Oginga Odinga University of Science and Technology found that ethnically diverse teams in a Kenyan public referral hospital delivered better healthcare services than less diverse teams. Patients rated diverse departments more highly for communication, friendliness and understanding, while staff reported greater creativity, adaptability and job satisfaction. However, the study also found higher levels of workplace disagreements. Researchers recommend inclusive leadership, fair recruitment and cultural competence training, while cautioning that the findings are based on one hospital and cannot be generalised nationwide.