Nursing Workforce Distribution in Kenya Open Access

Thompson, Megan Jo (2014)

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A heavy concentration of health workers in urban sites is a problem all over the world, while attracting and retaining health workers in rural and marginalized communities remains a challenge. This study examined and compared characteristics of nurses in rural, peri-urban, and urban deployed in public health facilities in Kenya to assess rural nursing profiles and potential incentives to rectify maldistribution.


This study used a mixed methods approach with data from the Kenya Health Workforce Information System, the Regulatory Human Resources Information System, and data from key informant interviews with nurses deployed in public sector district hospitals for the quantitative and qualitative analyses, respectively. The counties were assigned rural, peri-urban or urban labels. The associations between deployment by county type and education cadre, duration of employment, age, county of origin and gender were analyzed, including their strength, using chi-square for categorical data and ANOVA for discrete data. In depth interviews were conducted to determine push and pull factors to rural sites and potential incentives for rural deployment.


Of the 15,570 nurses, 21.1% were deployed to urban counties, 34.7% to peri-urban counties, and 44.2% of nurses are deployed in rural counties. The nurse to population ratio was higher in rural (.38/1000) and peri-urban (.42/1000) when compared with urban (.26/1000) (p =0.0001.) However, nurses in rural facilities were more likely to be younger, less experienced, from a rural county and possess a certificate in nursing. Key factors identified by the nursing staff at district hospitals included poor remuneration and inadequate resources in health facilities. Potential incentives mentioned included improved pay, health facilities, and access to educational opportunities.


Making rural locations competitive with urban locations will be a challenge. However, the maldistribution of nurses hinders the development of the health system and its ability to provide accessible, quality health care. Recognizing the traits associated with rural nurse deployment should inform the design of incentive programs to recruit and reward nurses more likely to work in rural locations. To improve the image of rural deployment, policy makers will need to address issues such as adequate compensation and equipped health facilities.

Table of Contents

Table of Contents

Literature Review 1

Methods 31

Results 40

Discussion 53

Appendix-Graphics 72

Bibliography 81

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