The paediatrician workforce and its role in addressing neonatal, child and adolescent healthcare in Kenya

Abstract

Objective: To examine the availability of paediatricians in Kenya and plans for their development.

Design: Review of policies and data from multiple sources combined with local expert insight.

Setting: Kenya with a focus on the public, non-tertiary care sector as an example of a low-income and middle-income country aiming to improve the survival and long-term health of newborns, children and adolescents.

Results: There are 305 practising paediatricians, 1.33 per 100 000 individuals of the population aged <19 years which in total numbers approximately 25 million. Only 94 are in public sector, non-tertiary county hospitals. There is either no paediatrician at all or only one paediatrician in 21/47 Kenyan counties that are home to over a quarter of a million under 19 years of age. Government policy is to achieve employment of 1416 paediatricians in the public sector by 2030, however this remains aspirational as there is no comprehensive training or financing plan to reach this target and health workforce recruitment, financing and management is now devolved to 47 counties. The vast majority of paediatric care is therefore provided by non-specialist healthcare workers.

Discussion: The scale of the paediatric workforce challenge seriously undermines the ability of the Kenyan health system to deliver on the emerging survive, thrive and transform agenda that encompasses more complex health needs. Addressing this challenge may require innovative workforce solutions such as task-sharing, these may in turn require the role of paediatricians to be redefined. Professional paediatric communities in countries like Kenya could play a leadership role in developing such solutions.

Keywords: general paediatrics; health services research; medical education; paediatric practice; tropical paediatrics.

Figure 1

Growth in the number of medical graduates between 1972 and 2018 aggregated within 5-year period as the two earliest established medical schools were joined by new medical schools from 2004. Source: Kenya Medical Practitioners and Dentists Board, 2019.

Figure 2

Population of those aged 18 years and younger (Y-axis) in counties with zero (n=8), one (n=13) or two (n=14) paediatricians in public sector hospitals based on data obtained in early 2019. The region of Kenya in which counties are located is indicated by the colour of the bar and explained in the legend. Additional paediatricians may be found in private or faith-based facilities in the counties represented in this figure but counties (n=12) with more than two public sector paediatricians or counties with a clinical medical school which would result in their being additional paediatricians have been excluded.