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Author Notes:

Corresponding author: Melinda K Higgins: mkhiggi@emory.edu

Ashley Appiagyei is a couples’ voluntary HIV counselling and testing programme manager with Emory University Rwanda Zambia HIV Research Group, Lusaka, Zambia. Rose Kiriinya is a data analyst, Jessica Gross is a research communications officer, and Andrew Kamenju is a software engineer with the Emory University Kenya Health Workforce Project, Nairobi, Kenya. David Wambua is the Data Manager and Elizabeth Oywer is the Registrar of the Nursing Council of Kenya, Nairobi, Kenya.

Melinda Higgins is an associate professor for research and Martha Rogers is research professor at Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA, USA. Patricia Riley is a senior nurse midwife with the Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV/AIDS, Atlanta, GA, USA.

AAA, MFR and JMG developed the study design. AAA, DNW, and EOO facilitated the research and reviewed the manuscript. RNK and MKH conducted the data analysis, assisted by AKK. AAA conducted the research and drafted the manuscript. PLR, MFR and JMG participated in the oversight for the study and manuscript review and revision. All authors read and approved the final manuscript.

The authors of this study would like to thank Deborah McFarland for her input in the publication of this work, as well as Agnes Waudo, Project Director of the Emory University Kenya Health Workforce Project, for her assistance in facilitating this research. We acknowledge the nurse administrators, lecturers and faculty that participated in the study.

We would also like to acknowledge the support of CDC Kenya, specifically Tom Oluoch for his technical advice. A special thanks to Dr. Francis Kimani, Director of Medical Services in the Ministry of Medical Services, for supporting this research.


Research Funding:

This article was supported under a cooperative agreement from the Centers for Disease Control and Prevention (CDC) through the Association of Schools and Programs of Public Health (ASPPH) Grant Number 1U36OE000002. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of CDC or ASPPH.


  • Nursing workforce
  • Kenya
  • Training
  • Scale-up

Informing the scale-up of Kenya’s nursing workforce: a mixed methods study of factors affecting pre-service training capacity and production


Journal Title:

Human Resources for Health


Volume 12, Number 1


, Pages 47-47

Type of Work:

Article | Final Publisher PDF


Background Given the global nursing shortage and investments to scale-up the workforce, this study evaluated trends in annual student nurse enrolment, pre-service attrition between enrolment and registration, and factors that influence nurse production in Kenya. Methods This study used a mixed methods approach with data from the Regulatory Human Resources Information System (tracks initial student enrolment through registration) and the Kenya Health Workforce Information System (tracks deployment and demographic information on licensed nurses) for the quantitative analyses and qualitative data from key informant interviews with nurse training institution educators and/or administrators. Trends in annual student nurse enrolment from 1999 to 2010 were analyzed using regulatory and demographic data. To assess pre-service attrition between training enrolment and registration with the nursing council, data for a cohort that enrolled in training from 1999 to 2004 and completed training by 2010 was analyzed. Multivariate logistic regression was used to test for factors that significantly affected attrition. To assess the capacity of nurse training institutions for scale-up, qualitative data was obtained through key informant interviews. Results From 1999 to 2010, 23,350 students enrolled in nurse training in Kenya. While annual new student enrolment doubled between 1999 (1,493) and 2010 (3,030), training institutions reported challenges in their capacity to accommodate the increased numbers. Key factors identified by the nursing faculty included congestion at clinical placement sites, limited clinical mentorship by qualified nurses, challenges with faculty recruitment and retention, and inadequate student housing, transportation and classroom space. Pre-service attrition among the cohort that enrolled between 1999 and 2004 and completed training by 2010 was found to be low (6%). Conclusion To scale-up the nursing workforce in Kenya, concurrent investments in expanding the number of student nurse clinical placement sites, utilizing alternate forms of skills training, hiring more faculty and clinical instructors, and expanding the dormitory and classroom space to accommodate new students are needed to ensure that increases in student enrolment are not at the cost of quality nursing education. Student attrition does not appear to be a concern in Kenya compared to other African countries (10 to 40%).

Copyright information:

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

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