Health workforce mobility in decentralised systems: A comparative examination of experiences in Kenya and other selected countries
1
Strathmore University, Ruiru,Nairobi, Kenya
Popul. Med. 2026;8(Supplement Supplement 1):A1858
ABSTRACT
BACKGROUND:
Decentralization reforms have reshaped health workforce governance in many low- and middle-income countries by transferring recruitment and deployment authority to subnational levels like districts and counties. This has affected health worker mobility, adding a layer of complexity to what was already a major challenge across many health systems. Previous studies have reported inadequacies in governance mechanisms for health workforce mobility. While devolution of health service delivery to 47 counties in Kenya strengthened social accountability and community voice, it caused fragmentation of health workforce management.
OBJECTIVES:
To understand how policy and institutional frameworks affect workforce mobility in decentralized systems. This entailed comparing experiences across selected countries, analysing Kenya’s policy frameworks and practices.
METHODS:
The study employed a multi-method approach that entailed mapping and analysing policy documents, focusing on Kenya, Uganda and the Philippines a nationwide online survey of health workers and primary data collection in Kenya using focus group discussions and key informant interviews with health workers, health system managers, and partners across six select counties. Preliminary results The review revealed fragmented workforce mobility practices in the Philippines and Uganda, with inadequate policy guidance and variations across subnational administrative units. For Kenya, early findings from the ongoing data collection reveal similar challenges, including the absence of a harmonized inter-county mobility framework. From the interviews, transfers have been weaponized in certain instances, where staff are deployed to areas seen as less desirable. Formal transfer requests are lengthy processes taking months, with low success rates.
CONCLUSIONS:
Preliminary findings point to low success rates for inter-county transfers. These mainly result from the absence of mobility guidelines and policies, resulting in governance challenges, low staff morale, and inefficiencies within the health system. More insights will emerge following the completion of primary data collection and analysis.
Decentralization reforms have reshaped health workforce governance in many low- and middle-income countries by transferring recruitment and deployment authority to subnational levels like districts and counties. This has affected health worker mobility, adding a layer of complexity to what was already a major challenge across many health systems. Previous studies have reported inadequacies in governance mechanisms for health workforce mobility. While devolution of health service delivery to 47 counties in Kenya strengthened social accountability and community voice, it caused fragmentation of health workforce management.
OBJECTIVES:
To understand how policy and institutional frameworks affect workforce mobility in decentralized systems. This entailed comparing experiences across selected countries, analysing Kenya’s policy frameworks and practices.
METHODS:
The study employed a multi-method approach that entailed mapping and analysing policy documents, focusing on Kenya, Uganda and the Philippines a nationwide online survey of health workers and primary data collection in Kenya using focus group discussions and key informant interviews with health workers, health system managers, and partners across six select counties. Preliminary results The review revealed fragmented workforce mobility practices in the Philippines and Uganda, with inadequate policy guidance and variations across subnational administrative units. For Kenya, early findings from the ongoing data collection reveal similar challenges, including the absence of a harmonized inter-county mobility framework. From the interviews, transfers have been weaponized in certain instances, where staff are deployed to areas seen as less desirable. Formal transfer requests are lengthy processes taking months, with low success rates.
CONCLUSIONS:
Preliminary findings point to low success rates for inter-county transfers. These mainly result from the absence of mobility guidelines and policies, resulting in governance challenges, low staff morale, and inefficiencies within the health system. More insights will emerge following the completion of primary data collection and analysis.
| eISSN: | 2654-1459 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
