Muchangi Josphat Martin, Kithuki Kioko, Kosgei Sarah Jebet, Mathenge Mary, Kioko Deborah, Sifuma Bryson, Sawenja Billian, Kamau Samuel
AMREF Health Africa, Nairobi, Kenya.
Reinit Research, Nairobi, Kenya.
Front Med (Lausanne). 2025 Jan 7;11:1466383. doi: 10.3389/fmed.2024.1466383. eCollection 2024.
Health systems based on primary healthcare (PHC) have reduced costs and are effective for improved health outcomes. Kenya's health system grapples with providing equitable access to essential health services, but there is increasing commitment by the government to strengthen primary healthcare. The aim of this paper is to provide a baseline assessment of the capacity and training needs of healthcare workers (HCWs) in Nakuru and Nyeri Counties and identify priorities for intervention.
A cross-sectional study was carried out among 171 healthcare workers in Nyeri and Nakuru counties. Multistage sampling was employed to select sub-counties in the first stage and health facilities by level within each sub-county in the second level. Systematic random sampling was then employed to select HCWs from each level of facility. We targeted healthcare workers of all cadres within the health facilities, and included all who consented to participating. Structured self-administered pen-and-paper questionnaires were used for data collection, and a five-point Likert scale was used to measure the perceived capacity of the healthcare workers to provide primary healthcare. As for the training needs data, the participants selected any of the 12 components that they needed training in. Descriptive statistics was employed, and stacked bar charts were used to visualize the capacity and training needs for the components of PHC adopted in Kenya.
In total, we obtained questionnaires from 95 participants in Nakuru and 76 participants in Nyeri. Nakuru HCWs rated themselves higher than their Nyeri counterparts in maternal and newborn child healthcare, local endemic disease control, appropriate treatment of common diseases and injuries, provision of essential basic medication, dental health, HIV/AIDs & TB management, and primary eye care. In both counties, there were significant differences in capacity between the different levels of health facilities. We observed substantial capacity gaps for HIV/AIDs & TB management, mental health and dental health services in both counties.
This study found a substantial capacity gap in several of the elements of PHC, especially in Nyeri County. Critical areas for intervention are HIV/AIDs & TB management and mental health training for both counties. Within the health system, there is need to strengthen the capacity of HCWs in lower-level health facilities to reduce the volume of referrals to secondary care facilities. We strongly recommend training programs in dental health, mental health, primary eye care, nutritional services and HIV/AIDs &TB management, that are carefully designed to emphasize skills and abilities.
基于初级卫生保健（PHC）的卫生系统降低了成本，并且在改善健康结果方面很有效。肯尼亚的卫生系统在努力提供公平获取基本卫生服务的机会，但政府加强初级卫生保健的决心日益增强。本文的目的是对纳库鲁县和内罗毕县医护人员的能力和培训需求进行基线评估，并确定干预重点。
在纳库鲁县和内罗毕县的171名医护人员中开展了一项横断面研究。第一阶段采用多阶段抽样选择子县，第二阶段在每个子县内按级别选择卫生设施。然后采用系统随机抽样从每个级别的设施中选择医护人员。我们将卫生设施内所有干部级别的医护人员作为目标，并纳入所有同意参与的人员。使用结构化的自填式纸笔问卷进行数据收集，并用五点李克特量表来衡量医护人员提供初级卫生保健的感知能力。至于培训需求数据，参与者从他们需要培训的12个组成部分中选择任何一项。采用描述性统计，并使用堆积条形图来直观展示肯尼亚采用的初级卫生保健组成部分的能力和培训需求。
我们总共收到了来自纳库鲁县95名参与者和内罗毕县76名参与者的问卷。在孕产妇和新生儿保健、当地地方病控制、常见疾病和损伤的适当治疗、基本基本药物的提供、牙齿健康、艾滋病毒/艾滋病和结核病管理以及初级眼保健方面，纳库鲁县的医护人员对自己能力的评价高于内罗毕县的同行。在两个县，不同级别的卫生设施在能力方面存在显著差异。我们观察到两个县在艾滋病毒/艾滋病和结核病管理、心理健康和牙齿健康服务方面存在很大的能力差距。
本研究发现初级卫生保健的几个要素存在很大的能力差距，尤其是在内罗毕县。两个县的关键干预领域是艾滋病毒/艾滋病和结核病管理以及心理健康培训。在卫生系统内，需要加强基层卫生设施中医护人员的能力，以减少转介到二级保健设施的数量。我们强烈建议开展牙齿健康、心理健康、初级眼保健、营养服务以及艾滋病毒/艾滋病和结核病管理方面的培训项目，这些项目要精心设计，以强调技能和能力。
