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Human resource constraints and roll-out of male circumcision in Kenya
G. Odingo1, P. Perchal2, M. Pavin2
1EngenderHealth, Nairobi, Kenya, 2EngenderHealth, New York, United States
Background: The Kenyan Ministry of Health recently launched its National Guidance on Voluntary Male Circumcision (MC). Being a new HIV prevention approach, MC roll-out will require sophisticated logistics and managerial oversight at every point of service delivery. Current human resource (HR) capacity in the health sector will affect the scope and speed of MC scale-up. Given the ongoing internal and external migration of doctors and nurses in Kenya, retention and deployment of trained health providers can be expected to be a key constraint on MC roll-out.
Methods: To support the development of a national strategic plan for MC, EngenderHealth undertook a study, from May-November, 2008, to assess the HR capacity development and training needs associated with MC roll-out in Kenya. The assessment was conducted using a combination of qualitative and quantitative methods including: i) key informant interviews ii) focus group discussions iii) desk review of pertinent national and international documents; and iv) audits of health facilities in Nyanza Province, Kenya.
Results: Our findings revealed significant HR shortages due to untrained health providers and the limited availability of existing medical and clinical officers to perform male circumcisions. While an untapped pool of employed and unemployed nurses currently exists, current laws are ambiguous regarding their approval to perform surgical procedures, including MC. Limitations on task shifting were also identified due to gaps in current training systems.
Conclusions: The Government of Kenya is well positioned to address current HR shortages through specific short term actions and general health system strengthening. Policy makers and program planners should develop concrete national MC human resource and training strategies that could be supported and implemented systematically by donors and implementing partners. Other recommendations include: ensuring nurses are allowed to perform MC, establishing accreditation/certification guidelines for MC, and conducting research to estimate the associated HR costs of different MC service delivery models.
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