By Rodgers Omondi, Busia
Kenya’s health system is grappling with major shortfalls in staffing, safety standards, and documentation, a new government-backed survey has revealed systemic weaknesses that threaten the country’s goal of achieving universal health coverage (UHC).
The “Quality of Care and Human Resources for Health Main Report 2024,’’ jointly conducted by the Ministry of Health, the Council of Governors, and the Kenya National Bureau of Statistics, assessed more than 3,000 health facilities across the country.
It paints a stark picture of a system where uneven workforce distribution, poor patient safety surveillance, and high absenteeism compromise service delivery, especially in rural and lower-level hospitals.
“Human resources remain the backbone of any health system. Kenya must urgently strengthen recruitment, retention, and equitable deployment of health workers if we are to achieve UHC,” said Dr. Patrick Amoth, the Director General for Health, in the report’s foreword.
The assessment found that Kenya has 120,547 health workers, with registered nurses making up 28 percent, clinical officers 13 percent, and laboratory technologists 10 percent. However, key specialists such as occupational therapists and medical officer interns accounted for less than 1 percent.
The workforce is also strikingly young, where over two-thirds are below 40 years old, a sign of progress in recruitment but also a warning about inexperience and high attrition. “It remains up to the government to train and retain this workforce and manage attrition,” the report notes, urging sustained investment in mentorship and professional development.
Significant absenteeism among health workers was reported in counties such as Marsabit, Elgeyo Marakwet, Tharaka Nithi, and Kericho, leading to situations where underqualified cadres, including community health promoters and laboratory technicians attended to patients. “This raises serious concerns about patient safety and quality of care,” said a senior official at the Ministry of Health who requested anonymity.
Only 26 percent of facilities conduct surveillance for patient safety incidents such as surgical or medication errors. While 74 percent of facilities monitor medication errors, just 14 percent track blood transfusion errors, a potentially deadly oversight.
The situation is worse in counties such as Vihiga and Tana River, where no facility reported conducting patient safety surveillance. By contrast, Nyamira and Kajiado recorded the highest rates at 80 and 74 percent respectively.
“The lack of structured systems to detect, document, and respond to patient safety incidents undermines accountability and endangers both patients and health workers,” said Dr. Mercy Mwangangi, a former Health Chief Administrative Secretary.
Only one in four health facilities (25 percent) had implemented the “National Policy on Patient Safety, Health Worker Safety and Quality of Care 2022”. Larger facilities, such as county referral hospitals, were more likely to have it in place — 51 percent of level 5 hospitals compared to 21 percent of dispensaries.
While maternal and perinatal death reviews were conducted in 84 percent of facilities offering in-patient services, neonatal and surgical death reviews lagged behind, with only 35 percent of hospitals reviewing surgical-related deaths.
The report recorded 427 maternal deaths between October and December 2023, with most occurring in level 4 facilities which are the backbone of county health systems. Public hospitals accounted for nearly 80 percent of these deaths.
“Every maternal death must be audited, not just recorded,” said Dr. Isabella Oyier, a reproductive health specialist. “These reviews are vital to understanding systemic failures — from blood shortages to delayed referrals.”
The Ministry has urged counties to institutionalize Maternal and Perinatal Death Surveillance and Response (MPDSR) committees in all facilities, particularly private ones where establishment rates stand at only 48 percent.
Health workers continue to face long hours, delayed promotions, and exposure to physical and psychological risks. The report cites “fatigue, burnout, and workplace assaults” as key contributors to demotivation and declining productivity.
“Protecting healthcare workers is protecting patients,” the report states, echoing WHO’s 2020 call for governments to link health worker safety with patient safety policies.
Across all clinical areas – from HIV and tuberculosis care to maternal health, the assessment found incomplete or missing documentation in 67 to 74 percent of patient files. In postpartum care, only 31 percent of records were complete, with critical omissions such as blood pressure readings and postpartum haemorrhage checks.
“These gaps have life-or-death implications,” said Dr. Caroline Gathoni, a maternal health expert. “Without complete documentation, you can’t trace errors, measure quality, or protect patients.”
The report recommends digital record systems, quarterly data quality audits, and targeted training to improve compliance.
The assessment also exposed vast regional inequalities. While counties such as Bomet, Kisumu, and Nairobi performed relatively well in quality improvement systems, others including Mandera, Marsabit, and Tana River — fell far below national averages in both staffing and safety compliance.
In some counties, facilities were found to be misclassified — labelled as level 4 hospitals despite lacking doctors or theatres. “Misclassification not only misleads the public but also distorts funding and planning,” the report warns.
The Ministry of Health says the findings will inform reforms under the Social Health Authority and upcoming UHC rollout. “This assessment is a mirror to our health system,” said Principal Secretary for Public Health Mary Muthoni. “We must confront these gaps head-on — from absenteeism and burnout to inequities and documentation failures.”
The report calls for a national strategy to strengthen human resources for health, invest in safety and digital systems, and enforce accountability in both public and private sectors.
“Quality care is not about buildings or machines,” Dr. Amoth said. “It’s about people — the workers who serve and the patients they protect.”
