Background

Background – KHHRAC

Background

Understanding the foundations, establishment, and mandate of KHHRAC within Kenya's health system.

The United Nations 2030 Agenda for Sustainable Development has 17 goals that have the power and potential to transform our world, addressing the root causes of poverty, inequality and instability.

Fundamental to the 2030 Agenda is Goal 3 — to 'ensure healthy lives and promote wellbeing for all at all ages'.

SDG Target 3.c on health workforce aims to substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries, especially in least developed countries and small island developing States.

The Constitution of Kenya recognizes the highest attainable standard of health as a right. Kenya has integrated international health commitments including SDGs into:

1
Kenya Vision 2030 — the country's blueprint for development
2
Fourth Medium-Term Plan IV (MTP IV) — prioritizing Universal Health Coverage

As part of implementing the Constitution of Kenya 2010, the Government adopted a devolved system of 47 County Governments in 2013 with significant decision-making autonomy. County Governments were assigned health service delivery functions including management of human resources for health, while the Ministry of Health retained policy formulation and national referral services.

The Health Act 2017 was enacted to establish a unified health system and coordinate the inter-relationship between the national and county government health systems.

The healthcare sector is labor intensive and human resources represent the most critical input into the provision of healthcare, as well as the largest proportion of healthcare expenditure.

The Health Act 2017 Sections 30–44 established KHHRAC to manage and rotate healthcare specialists and maintain a master register for all health practitioners in Kenya.

KHHRAC's work is expected to:

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Make available competent and adequate health workers as per health system needs
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Facilitate production, development and sustenance of a quality health workforce at all levels of care
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Facilitate equitable distribution and retention of health workforce
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Promote and maintain high standards in health workforce performance
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Promote evidence-based health workforce decision-making

KHHRAC is an intergovernmental and multiagency body drawing its membership from the national and county governments, as well as public and private healthcare worker training institutions.

The Council is composed of 12 board members including the Chief Executive Officer as an ex-officio member, supported by a secretariat from the Ministry of Health.

The Council is expected to provide the required leadership to help deliver improvements in the health of the Kenyan population by developing, implementing, evaluating, and refining programs that strengthen the nation's healthcare workforce.

The Council was inaugurated by His Excellency, the President of the Republic of Kenya in June 2023 and received budgetary allocation from the National Treasury for recurrent expenditure. The Council has also developed a Strategic Plan to provide a clear and actionable roadmap for strengthening Kenya's health workforce over the next five years.

1
Facilitating informed decision-making through the National Health Workforce Accounts (NHWA) and maintenance of a master register for all health practitioners
2
Supporting quality healthcare through optimal staffing using Workload Indicators for Staffing Needs (WISN)
3
Generating evidence through periodic Health Labour Market Analysis (HLMA)
4
Protecting Kenya's health system through safe, orderly and regulated workforce migration guidelines
5
Improving equity in distribution of healthcare specialists through a Framework for Management of Specialist Healthcare Workers
6
Improving welfare of the health workforce through better contract management and negotiation
7
Building leadership capacity for healthcare workers to harmonize multi-directional goals and coordinate multidisciplinary teams

Stakeholder engagement is critical to the work of KHHRAC. The Council believes that stakeholders' participation is important in guiding decision-making and supporting it in various ways to achieve the set strategic objectives.

Identified stakeholder groups:

Government Ministries & Agencies Council of Governors County Governments Parliament World Health Organization Regulatory Bodies Professional Bodies Health Workers Unions Training Institutions Research Institutions Development Partners Health Service Providers Civil Society Healthcare Professionals

Background

Global Perspective
The United Nations 2030 Agenda for Sustainable Development has 17 goals that have the power and potential to transform our world, addressing the root causes of poverty, inequality and instability. Fundamental to the 2030 Agenda is Goal 3, to ‘ensure healthy lives and promote wellbeing for all at all ages’. SDG Target 3.c on health workforce aims to substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries, especially in least developed countries and small island developing States.

Legal and regulatory foundations
The Constitution of Kenya recognizes the highest attainable standard of health as a right among other constitutional provisions related to health. Kenya has appropriately integrated international commitments related to health including Sustainable Development Goals (SDGs) in the country's blue print for development - the Kenya Vision 2030 and the Fourth Medium-Term Plan IV (MTP IV) of Kenya Vision 2030. Universal Health Coverage (UHC), which is one of priority investment areas of the MTP IV aims to ensure access to quality and affordable healthcare for all Kenyans.

As part of the implementation of the Constitution of Kenya 2010, the Government in 2013 adopted a devolved system of government consisting of 47 County Governments, with significant decision-making autonomy, and minimal central level control. Within the health sector, the constitution assigned to County Governments health service delivery functions, including the management of human resources for health, while the Ministry of Health at the national level was assigned the roles of health policy and standards formulation, training for health workers, and management of national referral services. Further, the Health Act 2017 was enacted to establish a unified health system, to coordinate the inter-relationship between the national government and county government health systems, to provide for regulation of health care service and health care service providers, health products and health technologies and for connected purposes.

Establishment of KHHRAC
The healthcare sector is labor intensive and human resources represent the most critical input into the provision of health care, as well as the largest proportion of health care expenditure. The Government of Kenya appreciated that performance of the health system is immensely dependent upon how best the workforce is developed, planned and utilized. The Health Act 2017 Section 30 – 44 established the Kenya Health Human Resource Advisory Council (KHHRAC) whose mandate includes the management and rotation of healthcare specialists and the maintenance of a master register for all health practitioners in the country. The need to establish a body to advise on health workforce issues was informed by the government aim to address the observed long standing and persistent challenges related to the health workforce in Kenya and its work is expected to: make available competent and adequate number health workers as per health systems need; facilitate production development and sustenance quality health workforce at all levels of care; facilitate recruitment, equitable distribution and retention of health workforce; promote and maintain high standards in health workforce performance; and promote evidence-based health workforce decision-making in improving health outcomes through the provision of quality health workforce data.

Intergovernmental nature of KHHRAC
As established, KHHRAC is an intergovernmental and multiagency body drawing its membership from the national and county governments, public and private healthcare workers’ training institutions. The Council is composed of twelve board members including the Chief Executive Officer who is an ex-official member and is supported by a secretariat, currently made up of staff deployed from the Ministry of Health. It is expected that the Council will provide the required leadership to help deliver in improving the health of the Kenyan population by developing, implementing, evaluating, and refining programs that strengthen the nation’s health care workforce.

Operationalization and execution of mandate
The Council was inaugurated by His Excellency, the President of the Republic of Kenya in June 2023 and received a budgetary allocation from the National Treasury for recurrent expenditure.

The Council has developed a strategic plan has developed this Strategic Plan to provide a clear and actionable roadmap for strengthening Kenya’s health workforce over the next five years.

In addition to activities aimed at operationalizing KHHRAC, the council has also been spearheading activities towards the execution of its mandate including:
1. Facilitating informed decision-making by progressively making health workforce data available through the annual reporting cycle of the National Health Workforce Accounts (NHWA), and the development, utilization and maintenance of a master register for all health practitioners in the country
2. Supporting provision of quality healthcare through optimal staffing of healthcare facilities by applying Workload Indicators for Staffing Needs (WISN) to determine health workforce needs based on the services being offered and actual workload;
3. Generating evidence on the relationship between supply, demand and need of the health labour force in Kenya by periodically carrying out Health Labour Market Analysis (HLMA);
4. Protecting the Kenya health system and Kenyan healthcare workers by ensuring safe, orderly and regulated health workforce migration through the development of Guidelines for Migration of Kenyan Health Workers;
5. Improving availability and equity in distribution of healthcare specialists through the development of Framework for Management of Specialist Healthcare Workers in Kenya.
6. Improving the welfare of the health workforce through better contract management and negotiation for better terms of employment
7. Building leadership capacity for healthcare workers to strengthen performance of health system by helping to harmonize the multi-directional goals and coordinate the numerous multidisciplinary teams.

Stakeholder engagement
Stakeholder engagement is critical to the work of KHHRAC. The Council believes that stakeholders’ participation is important in guiding decision-making and supporting it in in various ways to achieve the set strategic objectives. The Council has identified, mapped and is collaborating with various stakeholders including: Government Ministries, Departments and Agencies; Council of Governors and County Governments; Parliament; World Health Organization; Regulatory Bodies; Health workers professional bodies; Health Workers Unions; Training and Research Institutions; Development Partners; Health service delivery providers; Civil Society; and Healthcare professionals among other