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MINISTRY OF MEDICAL SERVICES MINISTRY OF PUBLIC HEALTH AND SANITATION

EFFECTIVE STRUCTURES AND SYSTEMS FOR MANAGING THE HEALTH WORKFORCE IN LINE WITH THE CONSTITUTION

PROPOSALS FROM THE MINISTRIES OF HEALTH

APRIL 2012

Table of Content
Table of Contents............................................................................................................. 2 1. Introduction and Background.......................................................................................4 1.1. Background and rationale......................................................................................4 1.2. Process of developing the proposal on structures and systems............................ 2. !rgani"ation #tructures ............................................................................................. 2.1 Proposed $ealth #ector #tructures at %ational &evel ............................................ ......................................................................................................................................... ' 2.2 Proposed County &evel #tructure...........................................................................( ....................................................................................................................................... 1) *.+ob Profiles for key County Positions .........................................................................1) 4. ,eployment Criteria for #taff to County .....................................................................1 . Proposed Implementation Plan ................................................................................1'

Proposals for #tructures of #ystems and #ystems for -anaging the $ealth .orkforce in line .ith the Constitution -inistries of $ealth

Proposals for #tructures of #ystems and #ystems for -anaging the $ealth .orkforce in line .ith the Constitution -inistries of $ealth

!" Int#o$%&t'on an$ Ba&()#o%n$


!"!" Ba&()#o%n$ an$ #at'onale The promulgation of the Kenyas new constitution has imposed a huge imperative for reforms in the health service delivery towards a devolved management system. Kenyas Ministries of Health (MOH) have launched various initiatives to interpret this responsibility. The Ministry of Medical ervices (MOM ) and Ministry of !ublic Health and anitation (MO!H ) have been in "oint consultation under several sub#committees to ensure smooth implementation of planned activities that support the implementation of the new constitution. The constitution provides for a devolved system of health management with each county managing its own health service delivery and the national level government driving the health policy issues and national referral services. The health wor$force sub#committee is made up of representatives from both MOM and MO!H % and has been established to carry out the following& 'etermine optimal staffing levels for health facilities by cadre( )onduct an assessment of the current staffing levels in health facilities to determine gaps # *nd develop recommendations for staff redistribution( ensiti+e staff on implications of devolution of the health system( 'evelop a proposal on transitional arrangement for staff movement from ,ational to )ounty -overnment( 'etermine the capacity of health training institutions( Ma$e recommendations on& *ttracting and retaining health wor$ers .nstitutionali+ing performance management )ompetency development for health wor$ers( and /0plore the use of .)T in human resource management

To this end% the sub#committee has proposed several policy options in the draft position paper for the health sector and developed a Transition wor$ plan which clearly highlights priority transition H1H actions including the need to ensure that at both national and county level there are ade2uately s$illed and motivated health managers and wor$ers who are supported by effective and efficient H1 systems. This report aims at providing guidance in determination of the structures and systems for managing the Health wor$force in line with the constitution. .t further outlines the functional roles for national and county governments% attempts to define "ob profiles for
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Proposals for #tructures of #ystems and #ystems for -anaging the $ealth .orkforce in line .ith the Constitution -inistries of $ealth

$ey county heath positions and provides guidelines for deployment of staff to the county government. !"*" P#o&e of $e+elo,'n) t-e ,#o,o al on t#%&t%#e an$ . te/

The development of these proposals followed a comprehensive consultative process guided by the Health ector !osition !aper and other government circulars. The Health wor$force sub#committee reviewed e0isting literature including the constitution and held a wee$#long retreat supported by the 3 *.' )apacity Kenya !ro"ect with an aim of developing these proposals. 1eference was made to the following documents&
!" T-e Con t't%t'on0 *rt. 456 (7) on decentrali+ation of functions *rt. 789 (4) on staffing of )ounty -overnment *rt. 59 on conduct of state officers :ourth schedule on functions of ,ational and )ounty -overnment *" T-e Healt- M'n' t#. Po 't'on Pa,e# on I/,le/entat'on of t-e ne1 &on t't%t'on2 O#)an'3at'on an$ /ana)e/ent of &o%nt. e#+'&e 0 !osition ; <'escription of the county Health system !osition4= <Management of Health at the county !osition 44#1oles of )ounty Health Management Team !osition 47#Health management functions at the sub county level

The team concentrated on the structures of the technical units which was identified as a foundation in the development of overall institutional structures. The draft proposals were shared with sta$eholders including other sub#committees within the two Ministries of Health and Head of 'epartments. This proposal therefore has been aligned to the health sector broad direction and the )onstitution.

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O#)an'3at'on St#%&t%#e

*"! P#o,o e$ Healt- Se&to# St#%&t%#e at Nat'onal Le+el The )onstitution of Kenya outlines that the role of national government in relation to health will focus primarily on health policy and management of national referral health facilities. The need to maintain a lean structure at national level was also considered in the development of the proposed structure. .n addition% the subcommittee discussed $ey health policy issues that tie into development of national structures at the central level

Figure 1: Proposed Organizational Structure for the Health Sector at National Level
Proposals for #tructures of #ystems and #ystems for -anaging the $ealth .orkforce in line .ith the Constitution -inistries of $ealth

*SAGAs Semi Autonomous Government Agencies

The different health programs will be lin$ed to the respective functional unit and will be managed at ,ational >evel. The team also elaborated the need to have clear guidelines for seconding staff to the different programmes which should be based on s$ills and 2ualifications re2uired. !olicy issues that will be dealt with by each unit were ta$en into consideration and have been categori+ed into 9 broad thematic areas as shown in the table below&

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Proposals for #tructures of #ystems and #ystems for -anaging the $ealth .orkforce in line .ith the Constitution -inistries of $ealth

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D'#e&to#ate of C%#at'+e an$ Re-ab'l'tat'+e Se#+'&e

The directorate will oversee policy formulation and implementation review in curative and rehabilitative services. The $ey policy areas include&

?lood transfusion and tissue transplantation 1ehabilitation urgical )linical services !harmacy )hild and *dolescent Health @@ 'ental /mergency Medical ervices 1eferral *lternative medicine 1adiological Medical engineering 'iagnostic and :orensic

*"!"* D'#e&to#ate of P#e+ent'+e an$ P#o/ot'+e Se#+'&e The directorate will oversee the preventive and promotive strategic issues including policy formulation. Key policy areas will include&
Mental health and substance abuse ,on#)ommunicable disease 1eproductive Health )hild and *dolescent Health@@ )ommunity Health Aaccines and immuni+ation ,utrition and dietetics ,ational health programmes 'isease surveillance .nfection prevention and control Oral health Ophthalmic health !ollution control Bater safety anitation Occupational Health and afety

'isaster and ris$ reduction !ort Health 1efuse (Baste) Management :ood afety Health !romotion Aeterinary !olicy@@@@@@@

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D'#e&to#ate of Stan$a#$ an$ 5%al't. A %#an&e

The directorate will e0ecute $ey roles in policy formulation and overseeing implementation of standards and 2uality in the Ministry of Health in the country. Key !olicy areas for the directorate include&
Health ,orms and tandards Medical (Health care) .nfrastructure )linical -uidelines Medical productsCdevices and technology 1egulatory services Health 1esearch and 'evelopment('irect 1esearch) Duality *ssurance and Management Health .nspection )ontinuous !rofessional 'evelopment ()!')

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D'#e&to#ate of Pol'&.7 St#ate). an$ Inte#nat'onal Healt-

The directorate will guide the planning and monitoring for the Ministry of Health. The $ey role will be to ensure a right mechanism is in place for proper planning and monitoring of all and related health interventions within the health sector. Key policy areas include:
trategic planning *nnual Operation !lans !erformance )ontracting Health .nformation ystem Medium Term /0penditure :ramewor$ Monitoring and /valuation policies

Proposals for #tructures of #ystems and #ystems for -anaging the $ealth .orkforce in line .ith the Constitution -inistries of $ealth

1esearch and development (.mplementation ) /#Health !ublic private partnership Hospital reform )!' .nternational /merging .nitiatives

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D'#e&to#ate of 9Gene#al: A$/'n' t#at'on ; F'nan&e

The directorate will oversee the support services to complement the health technical activities. The directorate will ensure smooth support functions for the Ministry at ,ational >evel and policy formulation in general administration and finance. Key policy areas include&
Human 1esource Management Human 1esource 'evelopment .)T !rocurement .nternal *udit -ender mainstreaming 'isability mainstreaming :inance management !rocurement MM3 !erformance )ontracting !lanning *ccounts >egal 3nit

<< Note t-at t-e e ,ol'&. a#ea fall 1't-'n t1o D'#e&to#ate " *"* P#o,o e$ Co%nt. Le+el St#%&t%#e The proposed structure for the county level is in line with the Health ector !osition !aper on .mplementation of the )onstitution which stipulates that minimum management capacity
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Proposals for #tructures of #ystems and #ystems for -anaging the $ealth .orkforce in line .ith the Constitution -inistries of $ealth

should be established, for operational management of County health services. The County Executive Committee (CEC) member designated as responsible for health should provide the political lin age to the CEC, and !or !ith this minimum management capacity to manage health. The "ealth #or force $ub% committee proposed that the county health management should be comprised of the follo!ing units&

)ounty $ecretary, "ealth $ervices !reventive and 'romotive $ervices )urative and 1ehabilitative $ervices

Figure 2: Proposed Structure at the county level

4" =ob P#of'le fo# (e. Co%nt. Po 't'on


The H1H Transition wor$ plan outlines the development of Eob !rofile for $ey county positions as another milestone towards the establishment of the county offices as well as guiding recruitment and appointment of staff( planning and budgeting for the staffing costs and other re2uirements( and performance management. 3sing the H1H Transition wor$ plan and the !osition !aper on .mplementation of the )onstitution in the Health ector% members developed "ob profiles for 8 )ounty management positions. 1eferences were also made to current "ob profiles and schemes of services for positions. Eob profiles for 8 county positions are shared below&
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Proposals for #tructures of #ystems and #ystems for -anaging the $ealth .orkforce in line .ith the Constitution -inistries of $ealth

4"! Co%nt. Se&#eta#.7 Healt- Se#+'&e D%t'e an$ Re ,on 'b'l't'e The )ounty ecretary% Health ervices will be responsible to the )ounty -overnor for organi+ation% control and coordination of health services at the county level. Che will be responsible for providing leadership% management and coordination of all health services at the county level.

Ma>o# #e ,on 'b'l't'e 1'll enta'l0 (i) !rovide technical advice to the )ounty -overnor on matters of health( (ii) !rovide strategic leadership and stewardship for overall health management in the county( (iii) )oordination and implementation of national health programmes at the county level( (iv) 1esource mobili+ation for county health services( (v) )oordination of the referral functions across all levels of facilities in the county( (vi) *dvice and recommend licensing and accreditation of health providers and institutions( (vii) >iaison with the national government on all health matters( (viii) /nsuring delivery of 2uality services and adherence to policy guidelines and standards. (i0) )oordination of county health services Re?%'#e/ent fo# a,,o'nt/ent :or appointment to the position of the )ounty 'irector of Health one must possess the following 2ualifications& a) * ?achelors degree in health related sciences from a recogni+ed university( b) (*t least a Masters in !ublic Health from a recogni+ed 3niversity.) *t least a Masters degree in health related sciences from a recogni+ed university( * Masters in !ublic Health or its e2uivalent will be an added advantage( c) erved for a minimum period of 4F years in the health sector% and 8 of which must have served been in Eob -roup GD and above or its e2uivalent in the private sector( d) ?e 1egistered by the relevant regulatory bodies and must be of good professional standing( e) 3ndergone a leadership and management course for a minimum of H wee$s from a recogni+ed institution( f) Must be person integrity. 4"* Co%nt. D'#e&to#7 P#o/ot'+e ; P#e+ent'+e Se#+'&e The )ounty 'irector% !romotion and 'isease prevention will be responsible to the )ounty ecretary of Health ervices. Che will be responsible for providing leadership% management and coordination of the health promotion and disease prevention initiatives at county level and will be in charge of the following broad technical services(
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Proposals for #tructures of #ystems and #ystems for -anaging the $ealth .orkforce in line .ith the Constitution -inistries of $ealth

,on#communicable diseases Malaria control !ediatrics()hild Health) and adolescent health 1eproductive health ,utrition .mmuni+ation Tuberculosis and leprosy control Aector borne and neglected diseases !ublic Health >aboratories 'isease surveillance 'isaster prevention and ris$ reduction !reventive ophthalmology Health !romotion and communication !olicy advocacy anitation and hygiene :ood afety and Duality Bater safety Occupational health and safety !ollution control and housing !ort health. )ommunity Health ervices 1efuse removal% 1efuse dumps and olid Baste Management Aeterinary ervices

Ma"or responsibilities will entail& (i) !rovide technical advice to the county director on public health matters( (ii) 'esigning% planning% organi+ation% coordination and management of the health !romotion and disease prevention programs and initiatives at county level( (iii) Monitoring and reporting of the Health promotion and 'isease prevention programs and initiatives at the county level( (iv) !rovide leadership and management of primary health care services and adherence to policy and clinical guidelines and standards. Re?%'#e/ent fo# a,,o'nt/ent :or appointment to this grade one must possess the following& a) ?achelors degree in health related areas from a recogni+ed institution( b) Masters degree in !ublic Health% )ommunity or /nvironmental Health from a recogni+ed institution( c) erved in the health sector for a minimum period of 49 years% (8 years of which must be Eob -roup G!) or its e2uivalent(

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Proposals for #tructures of #ystems and #ystems for -anaging the $ealth .orkforce in line .ith the Constitution -inistries of $ealth

d) 3ndergone a leadership and management course for a minimum of H wee$s from a recogni+ed institution( e) ?e a registered member of a regulatory (professional) body and must be of good professional standing( f) ?e a person of high integrity.

4"4 Co%nt. D'#e&to#7 C%#at'+e an$ Re-ab'l'tat'+e Se#+'&e The )ounty 'irector% )urative and 1ehabilitative ervices will be responsible to the )ounty 'irector of Health. Che will be responsible for organi+ation% control and coordination of the medical services unit at the county level and will be in charge of the following broad technical services(
.nternal medicine !ediatrics()hild Health) and adolescent health )linical nutritional and dietetics 1eproductive health 1adiography T?CMalaria H.AC*.' % T. treatment and management Mental health ObstetricsC-ynecology urgical (orthopedicCophthalmologyC/,T) 'ental services )linical services ,ursing ervices Orthopedic technology services !hysiotherapy services Occupational therapy services 'isaster management /ye and /,T !harmaceutical services

Ma>o# #e ,on 'b'l't'e 1'll enta'l0 (i) trategic operations management and coordination of provision of Medical ervices in the county( (ii) /nsure delivery of 2uality services and adherence to policy and clinical guidelines and standards( (iii) Monitoring of clinical care and emergency services% referral systems within and outside the county( (iv) Oversee implementation of clinical policies in the county(
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Proposals for #tructures of #ystems and #ystems for -anaging the $ealth .orkforce in line .ith the Constitution -inistries of $ealth

(v) Oversee rehabilitative and ambulance services. CHe will also be in charge of regulation of health service providers in the county. Re?%'#e/ent fo# a,,o'nt/ent :or appointment to this position% one must have& a) ?achelor degree in health related area from a recogni+ed university( b) Masters 'egree in any curative or rehabilitative services from a recogni+ed university( c) erved in the health sector for a minimum period of 49 years% 8 years of which must be in Eob -roup G! and above or its e2uivalent( d) 3ndergone a leadership and management course for a minimum of H wee$s from a recogni+ed institution( e) ?e registered by the relevant regulatory bodies and must be of good professional standing( f) ?e a person of integrity( 4"6 Co%nt. Healt- Plann'n) an$ Mon'to#'n) Un't The Head% Health !lanning and Monitoring 3nit will be responsible to the )ounty Health ecretary for organi+ation% control and coordination of health planning and monitoring at the county and will be in charge of the following broad technical services(
Technical !lanning 1esearch coordination Health information management system .nternational health Monitoring and evaluation tandards and 2uality assurance ector coordination !erformance contracting and reporting

Ma>o# #e ,on 'b'l't'e 1'll enta'l0 (i) !rovide technical advice to county director in planning% monitoring% reporting at the county level( (ii) )oordination of strategic and operational planning% monitoring and evaluation of health interventions at the county level( (iii) )oordination of health surveys on emerging health issues( (remove repeated word) (iv) )oordination of performance management and reporting( (v) Management of health information records including analysis and ensuring efficient use of .)T at the county level( (vi) )oordinate health research relevant for planning of service delivery and the supporting systems at the )ounty level. Re?%'#e/ent fo# a,,o'nt/ent :or appointment to this position% one must have& technologis
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Proposals for #tructures of #ystems and #ystems for -anaging the $ealth .orkforce in line .ith the Constitution -inistries of $ealth

a) b) c) d) g) e)

?achelors 'egree in health related science or (/conomics% !lanning% tatistics%) or its e2uivalent from a recogni+ed university( Masters 'egree in !ublic Health% Health /conomics% Health !lanning% Health /conomics or Health ystems or its e2uivalent from a recogni+ed institution( Must have served in the public sector of a minimum period of 49 years% 8 years of which must be in Eob -roup G! in the health sector and above or its e2uivalent( 3ndergone a H wee$s leadership and management course from a recogni+ed institution( ?e a person of integrity as stipulated in chapter si0 of the constitution( ?e registered by the relevant regulatory bodies and must be of good professional standing.

6" De,lo./ent C#'te#'a fo# Staff to Co%nt.


H1H play a critical role in service delivery in the Health ector. Kenyas Health sector is currently characteri+ed with staff shortages with more pronounced staffing gaps in hard#to#reach areas. The transition to the new constitution introduces new organi+ational structures re2uiring a re#distribution of e0isting staff and recruitment of new staff to fill in the gaps and the new identified areas. The sub#committee identified the need to develop a standard approach to deployment of staff to counties that will help to ensure uniformity across the board and enhance principles of e2uity and fairness in the process. The following was proposed to guide deployment of staff& ,eed to ensure that capacity for ,ol'&. en)a)e/ent an$ /ana)e/ent ' &o/,#o/' e$ in the proposed transition to )ounties not

,eed to ensure a /'n'/%/ ,a&(a)e of ,#ofe 'onal e@,e#t' eAHealt- e#+'&e in each )ounty or ad"acent counties Once devolved function and structures are determined # taff'n) an$ $e,lo./ent to follo1 t#'&tl. on $e+ol+e$ f%n&t'on and structures /2uity principles in the new constitution re2uire evident #e2$' t#'b%t'on ,ol'&. to a$$#e '/balan&e Re$' t#'b%t'on to be 'nfo#/e$ b. taff'n) no#/ an$ tan$a#$ < )urrent ,I re2uires revision /nsure )en$e# balan&e if possible across cadres and regions ,ew positions at county level to be established and staffed based on a &lea# >ob $e &#',t'on an$ $ef'ne$ ?%al'f'&at'on an$ e@,e#'en&e ,eed to improve a&&e a#ea to ,e&'al'3e$ e#+'&e 'n $' a$+anta)e$ an$ /a#)'nal'3e$

H%/ane &on '$e#at'on 2 deployment of staff to counties should ta$e into account genuine staff concerns where possible < for retention and productivity

Proposals for #tructures of #ystems and #ystems for -anaging the $ealth .orkforce in line .ith the Constitution -inistries of $ealth

8" P#o,o e$ I/,le/entat'on Plan

Co/,onent

Re?%'#e$ A&t'on

Pe# on Re ,on 'ble

T'/e f#a/e Yea# *B!! O&t No+

De&

!roposed ,ational and )ounty tructures

?aseline MOH staff

of

Eob 'escriptions

'eployment and redistribution of staff

Transitional wor$ plan

!resentation of the proposed structures to an inter#ministerial HO' forum( ta$eholder forums to share the proposed structures and see$ for more input ( 1efine the proposals( 'eveloping structures for other national positions. hare MoH baseline data for discussion( 3nderta$ing further analysis of the MoH staffing data and regularly updating the analysis( !reparing 2uarterly reports on the MoH baseline data to guide decision ma$ing. !resentation of proposed structures to an inter#ministerial HO' meetingCforum( 1efine the E' ( 'eveloping E' for other $ey county positions( *pproval and adoption( Orientation of the appointed Officers. !resentation of the proposed deployment criteria to HO's for further input and consensus( 3nderta$ing a departmental structure and staffing *nalysis( *ctual deployment of staff. /diting and finali+ation of the plan( >aunch and dissemination of the Transitional wor$ plan( 1esource mobili+ation for the H1H Transitional wor$ plan.

! MOM %! MO!H % 'M %'!H %''H1 M#MO!H and ''H1M MOM

''H1M#MO!H and ''H1M MOM

! MOM %! MO!H % 'M %'!H %''H1 M#MO!H and ''H1M MOM

! MOM %! MO!H % 'M % ''H1M#MOMs and MO!H

)hair <HB ub )ommittee % ! MO!H and MOM % ''H1M MO!H and MOM

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Proposals for #tructures of #ystems and #ystems for -anaging the $ealth .orkforce in line .ith the Constitution -inistries of $ealth