Developing a nursing database system in Kenya

Health Services Research, June, 2007 by Patricia L. Riley, Stephen M. Vindigni, John Arudo, Agnes N. Waudo, Andrew Kamenju, Japheth Ngoya, Elizabeth O. Oywer, Chris P. Rakuom, Marla E. Salmon, Maureen Kelley, Martha Rogers, Michael E. St. Louis, Lawrence H. Marum

Improving the health of the world requires investment in human resources. Human resources for health (HRH) are increasingly recognized as an essential component for overcoming diseases and ensuring global health (Buchan and Calman 2004; Friedman 2004; JLI 2004; Liese and Dussault 2004). To underscore its importance, the World Health Organization (WHO) dedicated the 2006 World Health Day and its accompanying World Health Report to the HRH issue and workforce disparities confronting the global community (WHO World Health Day 2006; WHO The World Health Report 2006). In their 5-year review of the Millennium Development Goals (MDGs), the United Nations Population Fund (UNFPA) has not only recognized the importance of HRH but has determined the health of the world's population to be inextricably linked to the health and migration of its health workforce (UNFPA 2005).

The global health workforce shortage--and especially the global nursing workforce shortage--has been well documented in both lay and scientific media (Buchan and Calman 2004; Chen et al. 2004; Dugger 2004). In the recent UNFPA (2005) document, International Migration and the Millennium Development Goals, Dovlo rightly noted that international labor markets must consider health workers as core assets to be protected in order to sustain development in an unfairly globalized world. The awareness of an inadequate health workforce comes at a time when the U.S. Government and other major international donors have developed an ambitious agenda for addressing global health issues. Most prominent among these is HIV/AIDS treatment and care to approximately three million people in sub-Saharan Africa, the region most affected by this disease. In order for these interventions to succeed, increased investments in HRH are required.

The struggles countries face today with providing nursing services are particularly illustrative of global HRH challenges. Although nurses comprise the majority of Africa's health care workforce, many of the continent's countries are experiencing acute nursing shortages. Recent reports document the out-migration of Africa's best-trained nurses and physicians to more developed countries--most notably the United States and the United Kingdom (Friedman 2004). This trend, coupled with the impact of HIV/AIDS on Africa's health care workers, has highlighted the need for governments to assess workforce capacity and identify solutions that can effectively redress staffing shortages.

Assessing HRH capacity in developing countries has confounded global organizations and workforce experts alike, mainly due to a dearth of accurate workforce data. Despite widespread agreement that HRH data sources are paltry, especially in developing countries, there are few examples that can document any one country's attempts to grapple with data system enhancements. The lack of reliable systems to monitor key workforce information and trends is widespread, thereby limiting the effectiveness and accuracy of both programmatic and policy-making decisions. Inaccurate and missing workforce information poses enormous challenges at national and global levels (Chen et al. 2004; East Central and Southern African [ECSA] Health Community 2004; Hongoro and McPake 2004; JLI 2004; Nursing Sector Study Corporation 2005). This lack of accurate workforce information impairs HRH management and development, and ultimately hinders progress with global health interventions.

The actual data needed for ongoing HRH surveillance and analysis include information about both the supply and the demand (or required staffing levels) for health workers. The importance of understanding the actual numbers and types of providers (i.e., physicians and nurses), as well as their education and capabilities was underscored in a report published by the Joint Learning Initiative (JLI), a network of global health leaders vested in HRH issues and supported by major international donors. The JLI (2004) cited the need to build the global workforce knowledgebase and specifically noted that current HRH data collection systems lack international standards. Similarly, a recent overview of the global nursing shortage noted, "The prerequisite for an effective deployment of staff is an information system that enables management and nurses to review patterns of activity and variations in workload, so that they can use informed judgment to make decisions on day-to-day staffing levels ..." (Buchan and Calman 2005).

The following discussion provides an overview of the database system that was recently developed and is currently operating in Kenya. It explains the collection, computerization, and linkage of supply and worksite-level nursing data and offers a descriptive analysis of Kenya's nursing workforce. This workforce analysis represents the first-ever opportunity for Kenya's decision makers to develop HRH policies in tandem with evidence-based workforce information. The paper concludes by offering recommendations for overall enhancement of sub-Saharan data systems in HRH.