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Author Notes:

Correspondence: mwakaba@kemri-wellcome.org

ME, MR, and AW conceived the original idea for the study.

ME, MR, AW, and PM facilitated obtaining the required funding.

CR, MR, AW, and RK provided support for the primary data collection, and CR provided access to the final national nursing deployment data used.

MW, JT, RK, and JO cleaned and merged the data and linked to facility codes.

MW and JT performed statistical analysis, while JO and AN undertook geographical analysis.

MW produced the first draft of the manuscript with support from ME, JT, and PM.

All authors contributed to revisions of subsequent drafts, and read and approved the final manuscript.

This work is published with the approval of the Director, Kenya Medical Research Institute (KEMRI).

We would like to thank the Director of Medical Services and the Chief Nursing Officer (Ministries of Health), the Registrar at the Nursing Council of Kenya, and the Emory University Kenya Health Workforce Project for their collaboration.

Also we wish to thank Jessica Gross for her input during review of the manuscript drafts.

The authors declare that they have no competing interests.


Research Funding:

The Centers for Disease Control and Prevention (CDC) sponsored this report through a cooperative agreement with the Association of Schools of Public Health using funding provided by CDC-PEPFAR (President’s Emergency Plan For AIDS Relief).

This review was additionally supported by Emory University’s Kenya Health Workforce Project in partnership with KEMRI-Wellcome Trust Research Programme.

The Wellcome Trust’s support to ME, by way of a Senior Research Fellowship Award (#097170), and PM, through a Wellcome Trust Strategic Award (#084538), furthered the completion of this report.


  • Science & Technology
  • Social Sciences
  • Life Sciences & Biomedicine
  • Health Policy & Services
  • Industrial Relations & Labor
  • Health Care Sciences & Services
  • Business & Economics
  • Nurses
  • Public sector
  • Human resources for health
  • County
  • Kenya

The public sector nursing workforce in Kenya: a county-level analysis


Journal Title:

Human Resources for Health


Volume 12, Number 1


, Pages 6-6

Type of Work:

Article | Final Publisher PDF


Background: Kenya's human resources for health shortage is well documented, yet in line with the new constitution, responsibility for health service delivery will be devolved to 47 new county administrations. This work describes the public sector nursing workforce likely to be inherited by the counties, and examines the relationships between nursing workforce density and key indicators. Methods: National nursing deployment data linked to nursing supply data were used and analyzed using statistical and geographical analysis software. Data on nurses deployed in national referral hospitals and on nurses deployed in non-public sector facilities were excluded from main analyses. The densities and characteristics of the public sector nurses across the counties were obtained and examined against an index of county remoteness, and the nursing densities were correlated with five key indicators. Results: Of the 16,371 nurses in the public non-tertiary sector, 76% are women and 53% are registered nurses, with 35% of the nurses aged 40 to 49 years. The nursing densities across counties range from 1.2 to 0.08 per 1,000 population. There are statistically significant associations of the nursing densities with a measure of health spending per capita (P value = 0.0028) and immunization rates (P value = 0.0018). A higher county remoteness index is associated with explaining lower female to male ratio of public sector nurses across counties (P value < 0.0001). Conclusions: An overall shortage of nurses (range of 1.2 to 0.08 per 1,000) in the public sector countrywide is complicated by mal-distribution and varying workforce characteristics (for example, age profile) across counties. All stakeholders should support improvements in human resources information systems and help address personnel shortages and mal-distribution if equitable, quality health-care delivery in the counties is to be achieved.

Copyright information:

© 2014 Wakaba et al.; licensee BioMed Central Ltd.

This is an Open Access work distributed under the terms of the Creative Commons Attribution 2.0 Generic License (http://creativecommons.org/licenses/by/2.0/).

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