The determinants of staff retention after Emergency Obstetrics and Newborn Care training in Kenya: A cross- sectional study

Abstract

Introduction Kenya’s maternal mortality ratio is relatively high at 342/100,000 live births. Confidential enquiry into maternal deaths showed that 90% of the maternal deaths received substandard care with health workforce related factors identified in 75% of 2015/2016 maternal deaths. Competent Skilled Health Personnel (SHP) providing emergency obstetric and newborn care (EmOC) in an enabling environment reduces the risk of adverse maternal and newborn outcomes. The study objective was to identify factors that determine the retention of SHP 1 – 5 years after EmOC training in Kenya.Methods A cross-sectional review of EmOC SHP in five counties (Kilifi, Taita Taveta, Garissa, Vihiga and Uasin Gishu) was conducted between January-February 2020. Data was extracted from a training database. Verification of current health facilities where trained SHP were deployed and reasons for non-retention were collected. Descriptive data analysis, transfer rate by county and logistic regression for SHP retention determinants was performed. Results A total of 927 SHP were trained from 2014-2019. Most SHP trained were nurse/midwives (677, 73%) followed by clinical officers (151, 16%) and doctors (99, 11%). Half (500, 54%) of trained SHP were retained in the same facility. Average trained staff transfer rate was 43%, with Uasin Gishu lowest at 24% and Garissa highest at 50%. Considering a subset of trained staff from level 4/5 facilities with distinct hospital departments, only a third (36%) of them are still working in relevant maternity/newborn/gynaecology departments. There was a statistically significant difference in transfer rate by gender in Garissa, Vihiga and the combined 5 counties (p<0.05). Interval from training in years (1 year, AOR=4.2 (2.1-8.4); cadre (nurse/midwives, AOR=2.5 (1.4-4.5); and county (Uasin Gishu AOR=9.5 (4.6- 19.5), Kilifi AOR=4.0 (2.1-7.7) and Taita Taveta AOR=1.9 (1.1-3.5), p<0.05, were significant determinants of staff retention in the maternity departments.Conclusion Retention of EmOC trained SHP in the relevant maternity departments was low at 36 percent. SHP were more likely to be retained by 1-year after training compared to the subsequent years and this varied from county to county. County policies and guidelines on SHP deployment, transfers and retention should be strengthened to optimise the benefits of EmOC training.

It’s complicated…: Exploring the missed opportunities and reasons for non-performance of assisted vaginal births in Kenya

“…The rotation of staff to different departments was commented on in several of the interviews in this study and is likely to contribute to difficulties for staff in consolidating newly acquired knowledge and skills, such as AVB. Further evidence on the rotation of healthcare staff was found by Shikuku et al [28] in their review of staff retention following an EmOC training programme, in five counties in Kenya. They found that only one third of the 621 staff trained in EmOC were still working in a maternity department.…”

Self-perceived competency of midwives in Kenya: A descriptive cross-sectional study

“…39,40 Furthermore, there is a need for the health institutions and managers to provide support systems to the midwives in maintaining their competence in practice and strive to change the organisational culture to ensure that the health facilities are learning institutions through facility-based mentoring. 41 A multi-disciplinary team composed of family physicians, obstetricians and midwives' experts working in tertiary level facilities should provide mentorship and outreach programmes at county, sub-county and primary level facilities to support the professional development of the midwives for the achievement of the MNH SDGs. Also, there should be a staff rotation programme to the tertiary level of care to reduce the disparity and inequalities in the exposure of skills and knowledge.…”

An evaluation of the effectiveness of an updated pre-service midwifery curriculum integrated with emergency obstetrics and newborn care in Kenya: a cluster randomised controlled trial

“…Evidence shows that midwifery graduates are inadequately prepared with limited support and requisite WHO and ICM competencies needed to function adequately as skilled health personnel after graduation (9,(12)(13)(14)(15)34). A multi-country (including Kenya) longitudinal cohort study to determine retention of knowledge and skills after standardised "skills and drills" training in EmONC showed signi cant variation in pre-training scores for various cadres between countries (35).…”