HRH Retention, Recruitment & Motivation; Capacity Kenya Experience

AFRICA CHRISTIAN HEALTH ASSOCIATIONS PLATFORM (ACHAP)

Workshop on Advocacy and Human Resources for Health March 29-31, 2010; CHAK Conference Centre, Nairobi

Doris Mwarey

Terminologies

Retention refers to the ability to keep employees in an

organization and is usually as a result of employee job satisfaction

Motivation refers to the tendency to initiate and sustain effort toward a goal and is usually achieved through incentives and results in improved employee performance

(Clark & Estes, 2002)

Relationship between Retention & Motivation (Luoma, IntraHealth

International)

Management Action

Internal State

Workplace Result

Incentives Motivation Improved Performance

Workplace Climate

Job Satisfaction

Retention

Kenya Retention Study Findings,2008

Study Objectives: Conduct a document review on HRH situation Explore tested incentive schemes in health, education

and agriculture sectors Establish the most promising incentive packages Document perspectives from final year medical and

nursing students Establish the preferred incentive package of employed

health workers Make recommendations to assist in the development

of incentive schemes

55

Study Sample and ToolsRespondent Category

ToolNumber

Key informant interviews

Interview Guide

14

Health care providers Questionnaire 486

Final year students

Questionnaire 184

Focus group discussions (FGDs )

FGD guide 7

Job Satisfaction and Motivation

Are you a motivated health worker?

7

1 Health care

2 Career advancement

3 Salary top up

4 Salary increment

5 Subsidized utilities

6 House allowance

7 Transport allowance

8 Transport

9 Housing

10 Annual appraisal

11 Hardship allowance

12 Supervision

13 Education allowance

14 Career Advancement tied to hardship post

15 Refreshments

16 Internet Access

17 Deployment and transfer to area of choice

18 Access to loans

19 Rest and recuperation

20 Decentralized recruitment

21 Fixed term posting

22 DSTV where there is no TV

Order of priority incentives

Four primary domains of WCI

• Health Worker teams – non financial incentives, job descriptions• Service delivery environment – HW safety, health

& wellness, stock management, referral systems, infrastructure

• Leadership and management practices –supervision, feedback• Client – provider relationship – customer service,

training of HWs, community involvement ₁

Key Findings / Gaps Areas Assessed: Problems identified:

Employee perception of fairness at work Levels of compensationSense of lack of equityLack of fair treatment by supervisorsPoor attitudes of colleagues

Employee understanding of job expectations

Lack of job descriptionsUnclear work plansPerformance objectives not defined

Feedback on work performance Inadequate feedback from supervisor irregular client surveys

Perceptions of meaningfulness of work to organization

Efforts in daily duties not recognized or valuedOrganization vision and mission unclear

Perceptions on existence of opportunities for career development

No clear career paths

Employee insights on adequacy of health facility and service delivery

Lack of health systems supportsPoor work environment

Work station

Occupational Hygiene

Storage

TB fume chamber Segregation/disposal

Infection Control

Hospital kitchen Fire extinguisher

Fire safety

Kenya Pilot Program; 2008

• The USAID funded Capacity Project worked with the MOH & FBO sector to Pilot simple WCI interventions in 10 rural health facilities in 4 provinces in Kenya• The varied interventions were fairly low- cost , simple, and fast to implement

Examples of Interventions Applied

Departmental work plans, daily work plans

Develop standard operating procedures

Signboards with work hours & available services

Team meetings, share info, team problem solving

Waste disposal and IP protocols

Inventory management to avoid stock-outs

Formation of facility safety committee

Improved signage: work hours, available services, locations

Supervision guidelines, train district/facility managers

Paint/refurbish facilities

Organized client flow procedures

Develop/implement referral guidelines

Equipment purchased Cleaned up yards Free tea/coffee for staff

More equitable staff shifts

Cleaner toilets/facilities

Post vision and mission

Results• Due to improved leadership and management

skills, district and facility managers were paying attention to HW needs and facilitating support where needed

• The facilities formed multidisciplinary teams (doctors, nurses, nutritionists, counselors etc) leading to better feedback among staff

• There was improved facility conditions: signage, job aids, provision of equipment/supplies

Results Cont..

• Missions and visions of the facilities were made clear to develop a sense and purpose and value to work

• The set up of recreation centers at the facilities led to informal interactions and thus relieving tension and strengthening relationships

• Formation of the safety and health committees to implement safety/health activities

Success stories – resource centersResource Centre – Friends Kaimosi Hospital

Resource Centre – Lugari District Hospital

St Lukes chapel before "face-lift" ….After “face lift”

Success stories…

RECRUITMENT

Recruitment refers to “the activities undertaken by the organization to attract quality job candidates”.

There are formal systems, monitored and used in all hiring, transfer and promotion decisions.

Aim is to assure a fair and open process that is based on a candidate’s job qualifications

(MSH; HRM assessment tool)

The Emergency Hiring Program (EHP)

The Problem; Kenya faces declining health indicators caused in part by severe shortage of health workers1.Prolonged freeze in hiring of public sector health workers led to about 50% vacancy rate.2.Rural and remote parts of Kenya most affected3.GoK initiatives constrained by funding shortfalls4.Operational inefficiencies limit GoK capacity to address need in a timely and sustainable manner which leads to low retention rates

EHP Formulated to Address a Dire HRH Situation

USAID funded Capacity Project approached to support a rapid response by mobilizing health workers

Key targets of the Emergency Hiring Plan (EHP) were to: Mobilize 831 health workers on a 3 year contract to address

critical service gaps in HIV/AIDS especially in rural and remote areas

3 year fiscal space enables GOK to budget and be able to absorb these workers by the end of their contract

Reduced turn-around time for public recruitment Equip these workers with minimum skills needed to deliver

care Ensure these workers remain in post for the entire 3 year

period

Process• Deployment plan agreed with all key stakeholders and user-

points • Staff Attraction; using newspaper advertisement and

highlighting specific location of vacancies. • Multiple publicity to reach many especially “local” applicants• Screening and selection based on pre-agreed criteria acceptable

to all• Hiring cycle shorted to 2-3 months compared to 6-8 months in

GOK hiring• Induction organized within 3 weeks of reporting to station• All applicants receive specialized training in HIV/AIDS • Deployment follows pre-agreed plan with facility heads fully

oriented on the management processes for these workers • Timely processing of salaries, leave and other personnel needs • Supportive supervision arrangement agreed and implemented

with GOK taking lead

Outcomes and lessons learnt

• 595 workers already absorbed into GOK payroll. Another 237 to be absorbed in the next phase.

• Retention Improved through;– Harmonized terms and condition of service with central

GOK– Efficient induction completed and basic skills prepared

staff for new roles – Mobilization and selection of applicants closer to facility

sites– Timely processing of salaries, leave and other personnel

needs – Supportive supervision to align staff capacity with job

expectations/targets.

Q&A

www.capacitykenya.org

Enhancing Retention through Competitive Packages

Salary survey in Mission Hospitals in Salary survey in Mission Hospitals in KenyaKenya

Objectives of the StudyObjectives of the Study Review current salaries, benefits and

HR practices within selected FBOs to form the basis for developing a suitable salary structure that should enable retention of staff;

Develop FBO salary (25th, 50th and 75th percentiles) and benefits structures that will help facilities benchmark their remuneration systems against each other

Approach and Approach and MethodologyMethodology

Phase I: Mobilisation and Project

PlanningInitial meeting with FBO

management representativesOutline our approach and agree on

key milestones Select working committee from

representatives of the FBOs

Phase II: Phase II: Data Collection & Data Collection & AnalysisAnalysisPreparation for the surveyDevelop Questionnaire (data collection tool)Collect data from the FBOsInput the data into the analysis database;Construct the appropriate matrices to allow

comparison of the comparators’ salary and benefits data.

Reflect the minimum, median and maximum salaries for each benchmark position;

Identify the 25th, 50th and 75th percentile salaries per benchmark position

Phase III:Phase III: Development of Development of Remuneration StructureRemuneration Structure

Development of salary and benefits structures at the 25th, 50th and 75th percentile according to the classification of the facilities.

This will enable the FBOs to decide where to peg their individual salary structures depending on their internal compensation policies and strategies.

Classification CriteriaClassification CriteriaDuring the inception workshops held with both

KEC and CHAK affiliated facilities at the onset of the assignment, it was agreed upon that facilities would be categorised based on location and level.

We did not receive sufficient data to carry out analysis based on facility level. We therefore categorised facilities based on location as indicated below:

1. Facilities operating in urban / rural urban areas

2. Facilities operating in rural areas3. Facilities operating in arid / semi arid areas

Benchmark PositionsBenchmark Positions1. Medical Officer2. Specialists3. Dentist4. Pharmacist5. Matron / Nursing Officer in Charge6. Unit in Charge (ward, lab, pharmacy, xray,engineering etc)7. Registered Nurse8. Community Oral

Benchmark Positions Benchmark Positions Cont..Cont..9. Enrolled Nurse10.Anesthetists11.Clinical Officer13.Community Oral Health Officer14.Technicians (Dental, Laboratory,

Pharmaceutical)15.Technologists (Dental, Laboratory,

Pharmaceutical)16.Physiotherapist17.Occupational Therapist18.Medical Engineer19.Radiographer/ Sonographer20.Nutritionist21.Social Worker22.Hospital Ad

Benchmark Positions Benchmark Positions Cont..Cont..13.Community Oral Health Officer14.Technicians (Dental, Laboratory,Pharmaceutical)15.Technologists (Dental, Laboratory,Pharmaceutical Orthopedic )16.Physiotherapist17.Occupational Therapist18.Medical Engineer19.Radiographer/ Sonographer20.Nutritionist21.Social Worker22.Hospital Administrator

Benchmark Positions Benchmark Positions Cont..Cont..23. Medical Records Officer24. Attendants (mortuary attendants, porter,25.Clerks 26.Artisans (carpenters, plumbers, electricians

etc)27.Financial Controller28.Non-clinical unit in charge (IT, HRM,

Procurement etc)29.Chaplain30. Accountant / HR Officer31.Housekeeping / Catering At least a32.Security Officer33.Driver

Preliminary FindingsPreliminary FindingsThe most common allowances

provided by the facilities include:• House allowance• Risk allowance primarily to theatre and

clinical staff• Annual leave allowance• Responsibility allowance• On Call allowance• Non practicing allowance to Doctors,

Clinical Officers and in some facilities to Nurses

• Uniform allowance or uniform

Some of the common benefits and welfare programs provided by the comparators include:1. Medical attention at the facility

2. Uniform or uniform allowance to uniformed staff and in some facilities to all staff

3. End of year parties and / or gifts

4. Professional indemnity cover

5. Funeral assistance for staff and dependants

Findings Cont..Findings Cont..

Findings Cont..Findings Cont..Most facilities do not offer benefits

such as loans, insurance to their staff and this appears to be the market practice in the FBO sector.

The facilities generally comply with the statutory requirements in regards to leave. The few that do not should ensure that they comply so as to avoid the risk of litigation.

Retention StrategiesRetention StrategiesMost of the facilities indicated that the skills

most difficult to retain are primarily clinical personnel.

Some of the retention strategies indicated by the comparator facilities include:◦ Housing◦ Free medical attention at the facility◦ Good working conditions◦ Training◦ Staff meetings◦ Improving remuneration

Possible Uses of the Possible Uses of the Findings Findings FBOs have a sound basis for

developing a suitable salary structure that should enable retention of staff;

FBOs have clear bench marks for reworking compensation packages on the basis of salary structures (25th, 50th and 75th percentiles) and for non-salary benefits