Health workforce retention in First Referral Hospitals of Kenya, South Africa, and Uganda: Implications for equitable and sustainable health systems
1
Centre for Health Policy & South African Research Chairs Initiative (SARChI), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
2
School of Public Health, Makerere University, Kampala, Uganda
3
KEMRI-Wellcome Trust Institute, Nairobi, Kenya
4
Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
5
School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
First Referral Hospitals (FRHs), also known as district hospitals, play a critical role in supporting primary health care, and in providing equitable access to essential hospital services in sub-Saharan Africa (SSA). However, persistent challenges in retaining health professionals compromise continuity of care, undermine service quality, and exacerbate inequities, particularly in rural and underserved areas. AFRHiCARE is a multi-country, collaborative research project that investigates the complex relationship among the health system building blocks of FRHs, health workforce outcomes, and responsiveness to patient needs.
OBJECTIVES:
1. Examine the role of financial incentives, and the factors influencing the retention of healthcare workers in first referral hospitals in sub-Saharan Africa 2. Identify context specific challenges affecting retention across Kenya, South Africa, and Uganda.
METHODS:
This themed session combines the results of a realist review on how financial incentives influence health workforce retention in SSA and an empirical study among frontline patient-facing healthcare workers in Kenya, South Africa and Uganda. The survey covered inter alia demographics, job satisfaction, working conditions, supervision and management, and intention to leave. We recruited 1533 frontline staff in Kenya, 814 in South Africa, and 650 in Uganda. The key findings of the realist review will foreground the empirical findings from each of the study countries on the determinants of healthcare workers’ retention in the profession, the FRH, and the country. The short presentations will be followed by an interactive audience discussion. An independent expert will conclude the session by highlighting key insights and lessons from the realist review and the empirical multi-country baseline studies. Expected results The workshop will highlight the role of incentives in health workforce retention and provide empirical insights on the complex interplay of job satisfaction, management, working conditions and retention, thus contributing to the global discourse on equitable and sustainable health systems.
First Referral Hospitals (FRHs), also known as district hospitals, play a critical role in supporting primary health care, and in providing equitable access to essential hospital services in sub-Saharan Africa (SSA). However, persistent challenges in retaining health professionals compromise continuity of care, undermine service quality, and exacerbate inequities, particularly in rural and underserved areas. AFRHiCARE is a multi-country, collaborative research project that investigates the complex relationship among the health system building blocks of FRHs, health workforce outcomes, and responsiveness to patient needs.
OBJECTIVES:
1. Examine the role of financial incentives, and the factors influencing the retention of healthcare workers in first referral hospitals in sub-Saharan Africa 2. Identify context specific challenges affecting retention across Kenya, South Africa, and Uganda.
METHODS:
This themed session combines the results of a realist review on how financial incentives influence health workforce retention in SSA and an empirical study among frontline patient-facing healthcare workers in Kenya, South Africa and Uganda. The survey covered inter alia demographics, job satisfaction, working conditions, supervision and management, and intention to leave. We recruited 1533 frontline staff in Kenya, 814 in South Africa, and 650 in Uganda. The key findings of the realist review will foreground the empirical findings from each of the study countries on the determinants of healthcare workers’ retention in the profession, the FRH, and the country. The short presentations will be followed by an interactive audience discussion. An independent expert will conclude the session by highlighting key insights and lessons from the realist review and the empirical multi-country baseline studies. Expected results The workshop will highlight the role of incentives in health workforce retention and provide empirical insights on the complex interplay of job satisfaction, management, working conditions and retention, thus contributing to the global discourse on equitable and sustainable health systems.
| eISSN: | 2654-1459 |
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