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Suggested citation: Kenya Ministry of Health (MOH) and IntraHealth International, 2012. Report
of the Rapid Training Needs Assessment of the Health Workforce in Kenya. Nairobi, Kenya:
MOH.
Rapid Training Needs Assessment of the Health Workforce in Kenya iii

TABLE OF CONTENTS

EXECUTIVE SUMMARY.................................................................................................... 9
INTRODUCTION ............................................................................................................ 13
Study limitations................................................................................................................................... 15
Ethical considerations......................................................................................................................... 15
RESULTS ......................................................................................................................... 16
TRAINING PRIORITIES ................................................................................................... 17
Priority Training Needs ................................................................................................ 17
Training Priorities According to Health Facility Manager........................................ 18
Health Workers Trained and to be Trained ............................................................... 19
Training Priorities by Cadre According to the MOH Divisions................................. 21
CAPACITY TO TRAIN..................................................................................................... 22
Availability of trainers/lecturers................................................................................. 22
Training Providers................................................................................................................................. 24
Clinical Preceptors.............................................................................................................................. 24
Training Resources ...................................................................................................... 28
Access to training services and status of condition ...................................................................... 31
Teaching materials.............................................................................................................................. 31
Financing training................................................................................................................................ 32
PERSPECTIVE OF REGULATORY BODIES ....................................................................... 33
Availability of training guidelines ...................................................................................................... 33
Availability of training curricula......................................................................................................... 35
Length of training using approved curricula .................................................................................. 36
Approved CPD providers for training in priority areas.................................................................. 38
Accredited/approved trainers, training institutions and consulting firms .................................. 38
Professional members attained training standards for re-licensure............................................ 39
Determining training needs for health workers .............................................................................. 40
Post training support ........................................................................................................................... 40
Post Training Support Provided To Training Institutions................................................................... 41
Methods of evaluation....................................................................................................................... 42
DISCUSSIONS AND CONCLUSIONS............................................................................. 43
Training priorities .................................................................................................................................. 43
Number of health workers to be trained......................................................................................... 43
Trainers in priority areas ...................................................................................................................... 43
Training venues.................................................................................................................................... 44
Access to services and equipment.................................................................................................. 44
Financing of Training........................................................................................................................... 44
Areas of training experience by training institutions...................................................................... 45
Average Training days and ability to supply curriculum by training institutions........................ 45
Availability of guidelines, curricula and CPD providers ................................................................ 45
Professional members attaining re-licensure .................................................................................. 46
Post training support to trainees and training institutions ............................................................. 46
APPENDIX A: PRIORITY AREAS AND SUBTOPICS TO BE COVERED ............................................... 47
APPENDIX B: NAME OF TRAINING FACILITIES BY REGION AND CITY ............................................ 49
Rapid Training Needs Assessment of the Health Workforce in Kenya iv

APPENDIX C: AVAILABLE TRAINING RESOURCES .................................................................... 50
APPENDIX D: ACCREDITED/APPROVED TRAINERS AND INSTITUTIONS....................................... 51
APPENDIX E : List of Participating Institutions ............................................................ 53
APPENDIX F: Introduction and Consent ................................................................... 56
APPENDIX G MOH APPROVALS ............................................................................... 91
Rapid Training Needs Assessment of the Health Workforce in Kenya v

List of Tables and Figures
Table 1 - Respondents by Type ................................................................................................................. 15
Table 2 - Priority Training needs identified by MOH Divisions and Health Facility Managers........... 18
Table 3 - Breakdown of Priority Areas by Province for Health Facilities .............................................. 19
Table 4 - Staff Critical to Training by Cadre per MOH Divisions............................................................ 22
Table 5 - Number of Trainers Trained by Region for all Priority Areas by MOH Divisions ................... 23
Table 6 - Number of trainers/lecturers available by training priority areas (n=17)............................ 23
Table 7 - Total Number of Health Workers Trained in Last 12 Months.................................................. 28
Table 8 - Training Facility Total Capacities by Region ........................................................................... 30
Table 9 - Availability of Guidelines for Training in Key Training Areas.................................................. 34
Table 10 - Availability of Curricula from Regulatory Bodies .................................................................. 35
Table 11 - Availability of Curricula from Training Institutions ................................................................. 36
Table 12 - Comparing Average Training Lengths by Priority Areas ..................................................... 37
Table 13 - Availability of Approved CPD Providers by Training Priority Areas .................................... 38
Table 14 - Professional Members Attaining Standards for Re-Licensure ............................................. 39
Table 15 - MOH Training priority areas and subtopics ........................................................................... 47
Table 16 - Training priority areas and sub-topics to be covered according to health facility
managers............................................................................................................................................. 48
Table 17 - Training facilities by region and city....................................................................................... 49
Table 18 - MOH Divisions and Health Facilities teaching resources..................................................... 50
Table 19 - Names of Approved Training Providers According to Regulatory Authorities ................ 51
Table 20 - Recommended training providers according to MOH Divisions....................................... 52
Figure 1 - Total number of health workers at health facilities sampled .............................................. 20
Figure 2 - Percentage of Key Providers Trained in Priority Areas.......................................................... 21
Figure 3 - Training Providers According to Health Facility Managers.................................................. 24
Figure 4 - Total numbers of preceptors by training priority areas for interviewed institutions.......... 25
Figure 5 - Areas of training experience by cadre for training institutions ........................................... 26
Figure 6 - Number of Regulatory Boards that have approved CPD Providers in key training priority
areas..................................................................................................................................................... 27
Figure 7 - Training Venues Available to MOH Divisions, Training Institutions and Health Facilities .. 29
Figure 8 - Available Training Facilities by Region.................................................................................... 30
Figure 9 – MOH Divisions, Health Facilities and Training Institutions with Access to Training Services
............................................................................................................................................................... 31
Figure 10 - Financing Training - Health Facility Manager Perspective ................................................ 32
Figure 11 - Membership of Sampled Regulatory Bodies ....................................................................... 33
Figure 12 - Post-Training Support to In-service Trainees According to Regulatory Authorities ........ 40
Figure 13 - Effectiveness of Post-training Support for Health Workers.................................................. 41
Figure 14 - Effectiveness of Post-training Support Provided to Training Institutions by Regulatory
Authorities ............................................................................................................................................ 42
Rapid Training Needs Assessment of the Health Workforce in Kenya vi

ACKNOWLEDGEMENTS
This Training Needs Assessment (TNA) involved a wide variety of stakeholders. We wish to
acknowledge and thank the Permanent Secretaries of both Ministry of Medical Services (Ms,
Mary W. Ngari, CBS) and Public Health and Sanitation (Mr. Mark K. Bor, CBS) for giving us an
opportunity to carry out this important assessment. Sincere thanks to the Heads of Departments
of Human Resource and Development of the two ministries, Mr. David Njoroge and M/s Grace
Odwako who facilitated the approval processes and guided the assessment.
We also acknowledge USAID and IntraHealth-Chapel Hill for financing and giving technical
advice. This Training Needs Assessment could not have been successful without the respondents
from Ministries of Health technical divisions, Health facility managers that included provincial
directors, training institutions and regulatory bodies. We are grateful to Dr. Leigh Shamblin,
Anne Fitzgerald, Flavia Bianchi, Dr. James Mwanzia, Dr. Norbert Rakiro, Prof. Steve Okeyo, David
Maingi, Martin Kinyua, Norbert Boruett, Emily Mungai, Joelle Mumley, June Mwende, Wanjiru
Kangara, Dr. Hazel Mumbo and Dr. Anastasiah Kimeu for the role they played in this assessment
that included technical support in development and review of the questionnaires, data
collection, data analysis, report writing and editorial work. We acknowledge the authors; Peter
Milo, Assistant Director – Regional Strategy, and Joyce Kinaro, Assistant Director – Monitoring
and Evaluation both of FUNZOKenya Project, IntraHealth International.
Rapid Training Needs Assessment of the Health Workforce in Kenya vii

Rapid Training Needs Assessment of the Health Workforce in Kenya viii
LIST OF ACRONYMS
AMREF African Medical Research Foundation
AMSTL Active Management of Third Stage of Labour
APHIA USAID supported Projects focusing on AIDS Population and Health Integrated
Assistance
CaCx Cervical Cancer Screening
CDC Centers for Disease Control and Prevention
CHAK Christian Health Association of Kenya
CME Continuous Medical Education
CPD Continuing Professional Development
CO Clinical Officer
EMOC Essential Maternal Obstetric Care
FANC Focused Antenatal Care
ICAP International Centre for AIDS Care and Treatment Programs
IYCF Infant and Young Child Feeding
IMCI Integrated Management of Childhood Illnesses
IMAI Integrated management of adult illnesses
KEC Kenya Episcopal Conference
KEMSA Kenya Medical Supplies Agency
KHSSP Kenya Health Sector Strategic and Investment Plan
MEDS Mission for Essential Drugs and Supplies
MCM Malaria Case Management
MDR TB Multi-Drug Resistance Tuberculosis
MIYCN Micronutrients Deficiencies, Maternal, Infant and Young Child Nutrition
MO Medical Officer
MOH Ministries of Health
MSH Management Science for Health
PHO Public Health/Environmental Health Officers
PMTCT Prevention of Mother to Child Treatment
TNA Training Needs Assessment
UNICEF United Nation Children Fund
VCT Voluntary Counseling and Testing
WHO World Health Organization

FOREWORD
The Ministry of Medical Services and the Ministry of Public Health and Sanitation are committed
to improving access to affordable health care services in order to accelerate the achievement of
national health targets, Millennium Development Goals and Vision 2030. To provide quality
health care to all Kenyans, there is a need to have adequate qualified health workforce that can
address current and emerging health needs in the country. This can be achieved through
training of new health workers, addressing current in-service training needs, strengthening
training institutions to increase their admission capacity and lastly to support the regulatory
bodies to improve professionalism among the health worker force.
The Ministries of Health (MOH) are undertaking reforms that have the potential to promote
greater efficiency, accountability and decentralization of health training mechanism in the health
sector. In this rapidly changing environment, the Government of Kenya supported by
FUNZOkenya carried out a rapid Training Needs Assessment (TNA) to identify the areas of need
of the health workforce to ensure that adequate numbers of well-trained health workers are
available to provide quality services throughout the country.
The following areas were identified as the priority training needs: Cervical Cancer Screening,
Prevention of Mother to Child Transmission (PMTCT), Focused Antenatal Care (FANC), Active
management of the third stage of labor, Integrated Management of Childhood Illnesses (IMCI),
Essential Newborn Care, Pediatric HIV, Commodity Management and use of MOH Monitoring
and Evaluation tools.
We are pleased that the recommendations in this study provides the Ministries of Health with an
opportunity to make evidence based decisions when addressing skills of its workerforce in
relation to the training priority needs. Together with the Faith Based Organisations, private
sector and development partners, the Ministries are committed to increase numbers of the
workforce and improve quality of training in the health sector.
Dr. Francis M. Kimani, MB.ChB, MMed. Dr. Shaanaz Sharif, OGW, MBChB, MMed.
DLSTMH, MSc.
Director of Medical Services Director of Public Health and Sanitation
Rapid Training Needs Assessment of the Health Workforce in Kenya 9

EXECUTIVE SUMMARY
Background
In 2010 the Ministries of Health (MOH) noted that the training programs in the health sector did
not give the desired results and therefore discontinued trainings of the health workers that were
supported by USAID supported APHIAPlus projects with the exception of orientation training.
This left a huge backlog of trainings in the health sector and when FUNZOKenya came into the
scene early 2012, it was compounded with a long list of training needs that required validation.
It was therefore critical to identify top priority needs as perceived by Ministries of Health (MOH)
and also ensure that partners understood the broader needs of the Government through the
line ministries. Against this backdrop, the Ministry embarked on a Training Needs Assessment
(TNA) and mandated FUNZOKenya which is another USAID funded IntraHealth led project to
conduct the assignment to establish and confirm the needs emanating from the APHIAPlus and
other USG funded projects working in the health sector.
Objectives of the TNA
1 To find out what are the top five training priorities? This assessment question was
presented to MOH divisions and health facility managers.
2 For training Institutions the focus on the ability to train/teach the training priority areas
identified based on availability of lecturers, clinical preceptors and curricula. Access to
resources and equipment such as internet, skill laboratories and teaching aids and their
post training evaluation and feedback mechanism was asked.
3 Regulatory authorities were assessed on the following parameters as regards training
priority areas; ability to supply guidelines, curricula and presence of approved CPD
providers. Lastly, professional members attaining standards for re-licensure and post
training support to training institutions and in-service trainees.
Methodology
The TNA was undertaken within a period of 100 days, hence the term rapid Training Assessment.
The methodology applied in this study was mixed method that adopted a cross-sectional survey
that targeted a total of 77respondence; 8 health technical divisions in the ministry, 46 health
facility managers that included provincial directors of health in both ministries at the provincial
and district levels that included public, faith based and private health facilities, 17 training

institutions and 6 regulatory authorities. Four sets of questionnaires were designed for each
cadre of respondent such that the assessment was tailored to extract key information from each
group. Respondents were identified through two methods of sampling: purposive non
probability sampling technique in which the probability of getting any particular sample does
not have to be calculated and random sampling techniques because this was representation of a
larger population and each individual was chosen entirely by chance and each member of the
population had an equal chance of being included in the sample.
Summary Findings
Priority training needs
The assessment identified the following as the priority training needs that should be addressed
by the ministries of Health; Cervical Cancer Screening training, HIV –PMCT, focused antenatal
care, Integrated Management of Childhood Illness (IMCI), new born care, active management of
third stage of labour (AMSTL), commodity management and HIV pediatric care. The survey
established that less than 12 % of the health workforce had been trained in the priority areas.
The survey also established that the Ministries of health facilitators were more engaged in in-
service training than other trainers, much of the trainings were hotel based and that most of the
trainings were donor funded while more than a third of the health workforce financed their own
training.
Training institutions
In the assessment of training institutions, the findings showed that most of them offered nursing
courses compared to other health related courses. It also showed that most of the in-service
trainings were for a period of less than 2 week. As post training support, the results found that
majority of the institutions used trainers’ follows ups and sending of update as opposed to
mentorship and coaching methods. It was also established that majority of the training
institutions were attached to health facilities countrywide yet they lacked adequate lecturers to
train in the priority areas. More than a third of the training institutions also had access to
internet as a resource for learning.
Regulatory Authorities
Findings on Regulatory Authorities showed that only the nursing council of Kenya and NASCOP
had guiding framework that identified training priority areas for in-service training except in
HIV/AIDS courses. With the exception of nurses, all the other five regulatory bodies combined
represents less than half of health professional members who attain standards required for re-
licensure. The results also showed that regulatory authorities provided ineffective post training
support to training institutions and in-service trainees.

Key Recommendations
Based on this Training Needs Assessment, these were the key recommendations;
• As the ministries of health focus on the top training priorities areas in an attempt to
improve training, they should also consider the regional specific training needs.
• In order to reach a wider group of in-service health workers, there is greater need for
innovative learning methodologies such as on-the job training, mentorship, e-learning
and distance learning.
• Training institutions, Ministries of health facilitators, technical departments and divisions
should build their capacity to bring in-service training needs to the standards required.
• For sustainability and cost effectiveness, the ministries of health should use alternative
training venues and training institutions instead of hotels.
• The Government should allocate more resources to expand training institutions and
more health workers in-service training.
• There should be faculty development in post training support
• Regulatory authorities to expand CPD to include a broad range of other in-service
trainings which are currently not offered
• Development of databases to capture data on training of in-service trainees
• Regulatory authorities to avail CPD courses in the locality of the health care providers
and thus increasing opportunities for re-licensure
• Encourage regulatory bodies to provide equal opportunities for CPD activities/programs
with same number of CPD points to all cadres of health workers.

INTRODUCTION
The goal of the Ministries of Health is to improve access to and provide quality health workforce
training by supporting increased number of new health workers trained; identifying current
health workers training needs; strengthening capacity of training institutions to increase the
admissions capacity of pre-service students and regulatory bodies to accredit and monitor
trainings. The ministries are also working towards increasing access to loans and scholarships for
students; improving training delivery and linking training to health worker re-licensure. It
focuses on the needs of health workers across the entire health system (public and private) and
intends to equip health workers with the appropriate competencies to respond to health
demands and to provide responsive, integrated comprehensive services. The ministries of health
are working closely with FUNZOKenya, USG-funded health programs, leading health training
institutions in Kenya, the National Health Human Resource Development (HRD) Working Group,
and at least 8 regional training hubs to strengthen training capacity, address the quality and
accessibility of training for current health workers, as well as support training facilities and
regulatory bodies.
In the year 2010, the USAID supported APHIAPlus partners were discontinued from carrying out
further training in order to enable for the ministries to come up with a well coordinated and
harmonized way of training in the health sector. Due to the absence of the training, however, a
backlog was created in APHIAPlus supported facilities which negatively impacted on service
delivery. The priority training needs identified ranged from HIV/AIDS, reproductive /maternal
health, family planning, nutrition, integration of service, and commodity management among
many others. The ministries tasked FUNZOKenya which is also a USAID funded project, to take
over the trainings and validate the list of priority training needs from MOH and partners, which
led to the conducting of this training needs assessment. The assessment was to be conducted
within a period of 100 days, hence called a rapid training needs assessment. This would then
lead to the implementation of trainings in the health sector.
Objectives of the training needs assessment
1. To identify the top training priorities that the Ministries of health should address when
clearing the training backlog
2. To confirm that the training needs identified by partners were in line with the national and
regional training priorities of MOH for effective service delivery.
3. To identify challenges and opportunities that Ministries of health should address and take
advantage of while increasing access to high quality in-service training to the health
workforce.
METHODOLOGY
The study applied a mixture of qualitative and quantitative methods that adopted a cross-
sectional survey. Mixed methods research offers the best of both worlds: the in-depth,
contextualized, and natural but more time-consuming insights of qualitative research coupled

with the more-efficient but less rich or compelling predictive power of quantitative research. The
study conducted a desk review and developed four sets of questionnaires that targeted different
cadres of respondents. These were administered to a total of 77respondence who included; 8
staff from the health technical divisions of the ministry, 46 health facility managers at the
provincial and district levels of the public and faith based facilities. The respondents among
these categories included provincial directors of health in both ministries. Also covered were the
facility managers from private health facilities. In other categories, 17 respondents from training
institutions and 6 from the regulatory authorities were also covered.
The questionnaires were used to extract specific information from the respondents. This in turn
led to identification of key informant interviews with purposefully selected individuals such as
heads of institutions, medical tutors and service providers that included; the staff of Ministry of
health technical divisions charged with responsibility of programmatic disease areas, health
facility managers at all levels of service delivery and cutting across public, faith based and
privately owned facilities. Others included staffs of regulatory authorities and lastly training
institutions. It was envisaged that, with this type of arrangement, information from all key
players would be validated and triangulated giving a clear picture of the training needs. These
interviews aimed at generating discussion on broad training need areas and to identify
performance gaps in service delivery of the health worker in relation to lack of requisite
knowledge and skills. Priority training areas were broadly categorized into the following
thematic areas; HIV/AIDS, maternal and child health, reproductive health and integration of
services.
Data collection instruments
Four sets of questionnaires were developed that targeted the technical departments of Ministry
of Health (MOH), in this case divisions of health were to give the national training priorities as
far as their mandates were concerned. Regulatory authorities were to provide information on
training priority areas that were accredited and hence led to earning of CPD points. Health
facility managers were to input on critical training areas that led to enhanced service delivery at
facility levels and training institutions were to give inputs on their ability to service training
needs identified. The actual training needs assessment commenced in early June 2012 with data
collection.
Sampling approach
Respondents were identified through two methods of sampling: purposive non-probability
sampling and random sampling techniques. Purposive and random samplings were both done
because the study aimed at gathering information from all technical divisions of MOH. This
includes the departments of family health and disease control and prevention, the six regulatory
authorities including the Kenya Medical Practitioners and Dentists Board (KMPDB), Nursing
Council of Kenya (NCK), Pharmacy and Poisons Board (PPB),Kenya Medical Laboratory
technologists and Technicians Board (KMLTTB), Clinical Officers Council (COC) and Kenya
Nutritionist and Dietician Council (KNDC), forty six (46) facility managers that targeted all

provincial directors in the Ministry of Medical Services (MOMS) and Ministry of Public Health
and Sanitations (MOPHS), medical superintendents of all provincial general hospitals, randomly
selected district medical officers of health and medical superintendents of district hospitals,
private and faith based hospitals and seventeen (17) training institutions randomly selected.
Of the 17 training institutions interviewed, eight (47%) were public, five (29%) were affiliated
with faith-based organizations, three (18%) were privately owned, and one (6%) was a non-
governmental organization. Six regulatory authorities were also interviewed.
Training needs assessment respondents
TABLE 1 - RESPONDENTS BY TYPE
Respondent type Sample
MOH division 8
Training institution 17
Regulatory body 6
Health facility manager (faith based) 6
Health facility manager (private) 6
Health facility manager (public) 34
Total 77
Data collection and analysis
A total of seventy seven (77) respondents were interviewed. Data was collected on self-
assessment questionnaires that had been sent out two weeks earlier to respondents. The
research assistant further interviewed the respondent through face to face interviews and
telephone where face-to-face contact was not possible. Data entry was done on EPI INFO and
data analysis carried out on both EPI INFO and SPSS platform by a data analyst. Prior to data
collection research assistants were trained on data collection.
Study limitations
It was a rapid TNA and therefore could not give insight on the trends considering that not all
training institutions with health science training programmes were interviewed. Neither were all
health facility managers interviewed. Given the small sample size, this may not be a true
reflection of what is happening in all the training institutions and health facilities. Lastly, the
training needs assessment exercise experienced lack of precise data on staffing and the statistics
of employees trained from all levels of the respondents.
Ethical considerations
All research assistants involved in data collection undertook an online course on protecting
study participants on the National Institute of Health (NIH) official website and respondents
were requested to give consent before being interviewed for compliance with ethical
considerations of research. The study protocol and instruments of data collection were reviewed
by IntraHealth staff and MOH for appropriateness and authorized.

RESULTS
The TNA findings are reported in the following order:
• Training priorities identified by respondents
• Current training capacity in the health system
o Availability of trainers
o Availability of facilities and equipment
• Ability of Regulatory Bodies to provide performance monitoring support

TRAINING PRIORITIES
Priority Training Needs
A total of 54 respondents, including 8 from the MOH Technical Division and 46 Health Facility
Managers were presented with a list of 25 potential training topics (including “other”) that had
been identified as areas of needs by APHIAPlus projects and other partners and asked to identify
the top 5 priority training needs for health workers. As shown in Table 2 below cervical cancer
screening training was identified as the most pressing priority with 43% of respondents selecting
it as an important training area. It is likely that cervical cancer was considered a greater training
priority due to the growing awareness of the burden of the disease and its link with HIV and
AIDS although the problem is not prioritized in the Millennium Development Goals (MDGs).
Health facility managers confirmed that there was an increase in numbers of cervical cancer
cases and health workers were not skillful in diagnosing cervical cancer at an early stage, thus a
major training priority.
Other priority training areas highlighted by all respondents include training in PMTCT, Newborn
care, management of childhood disease and focused antenatal care. Once disaggregated by
type of respondents however, priorities differed; among those from the MOH technical divisions,
M&E was selected as the highest training area of need with (50%) of the respondents indicating
it as such while among Health Facility Managers, Cervical Cancer Screening was selected the
most important training area of need with (46%) of the respondents indicating it as the highest
priority need. Other training priorities identified by MOH divisions included Commodity
Management (38%), HIV-PMTCT (38%), FANC (25%), HIV-Pediatric Care (25%), IMAI (25%), and
IMCI (25%). Other top training priorities according to health facility managers included AMSTL
(35%), newborn care (35%), and FANC, PMTCT, IMCI, and pediatric HIV, which were all prioritized
by 33% of respondents.

Figure 1 shows a breakdown of the total of 28,347 health workers represented by the Health
Facility Managers who participated in the assessment.
TABLE 2 - PRIORITY TRAINING NEEDS IDENTIFIED BY MOH DIVISIONS AND HEALTH FACILITY
MANAGERS
Priority Training Area
MOH Technical
Division (n=8)
Health Facility
Managers
(n=46)
% of Total
Respondents
(n=54)
Active Management of 3rd
Stage Labor (AMSTL) 0% (0) 34.8% (16) 29.6%(16)
Cervical Cancer Screening (CaCx) 25% (2) 45.7% (21) 42.6 % (23)
Commodity Management 37.5% (3) 26.1% (12) 27.7% (15)
Drug and Substance Abuse 12.5% (1) 15.2% (7) 14.8% (8)
Family Planning (FP) 12.5% (1) 10.9% (5) 11.1% (6)
Focused Antenatal Care (FANC) 25%(2) 32.6% (15) 31.5% (17)
HIV - Nutrition 0%(0) 8.7% (4) 7.4% (4)
HIV - Adult ART 12.5% (1) 13% (6) 12.9% (7)
HIV - Pediatric Care 25% (2) 28.3% (13) 27.7%15)
HIV – PMTCT 37.5% (3) 32.6% (15) 33.3% (18)
Infant and Young Child Feeding (IYCF) 0% (0) 15.2% (7) 12.9% (7)
Int. Management of Adult Illnesses (IMAI) 25% (2) 21.7% (10) 22.2% (12)
Int. Management of Childhood Illnesses (IMCI) 25% (2) 32.6% (15) 31.5% (17)
Integration of Services 12.5% (1) 17.4% (8) 16.6% (9)
M&E - MOH Tools 50% (4) 21.7% (10) 25.9% (14)
Malaria - Case Management 12.5% (1) 15.2% (7) 14.8% (8)
Newborn Care 12.5% (1) 34.8% (16) 31.5% (17)
Psychology – Pediatric 0% (0) 2.2% (1) 1.8% (1)
Supportive Supervision 25% (2) 21.7% (10) 22.2% (12)
TB - MDR Mgmt. 12.5% (1) 19.6% (9) 18.5% (10)
TB - Mgmt. (Microscopy) 12.5% (1) 8.7% (4) 9.2% (5)
TB – Nutrition 0% (0) 4.3% (2) 3.7% (2)
TB/HIV Counseling and Testing (C&T) 12.5%(1) 15.2% (7) 14.8% (8)
Trauma Counseling 0% (0) 4.3% (2) 3.7% (2)
Tables listing subtopics for each priority area suggested by MOH divisions and health facility
managers are included as Appendix A.
Training Priorities According to Health Facility Manager
Health facility managers were asked to identify priority training areas of need for their province.
In total, 46 facility managers represented all 8 Kenyan provinces. Table 3 shows the number of
respondents in each province that prioritized each subject area. Managers from Central
Province selected AMSTL and FANC as top priorities. The Coast also selected FANC as a top
training priority. The Rift Valley highlighted PMTCT as top training priority while Western
Province selected both Cervical Cancer Screening and Newborn Care as their top priority.
Training priorities were more evenly dispersed among the Eastern, North Eastern Province (NEP),

Nyanza and Nairobi. Nonetheless, all provinces selected multiple training priorities, indicating a
widespread need for training providers and training resources and highlighting a shortage of
health providers with training in key areas. Training priorities varied across provinces, as such,
remedial actions should be tailored to address the specific knowledge gaps of each province.
TABLE 3 - BREAKDOWN OF PRIORITY AREAS BY PROVINCE FOR HEALTH FACILITIES
Training Priority Area
Central
Coast
Eastern
NEP
Nyanza
RiftValley
Western
Nairobi
Total
Active Management of 3rd
Stage Labor (AMSTL) 4 2 1 2 2 1 3 1 16
Cervical Cancer Screening (CaCx) 3 3 3 2 3 2 4 1 21
Commodity Management 2 1 3 3 1 1 1 0 12
Drug and Substance Abuse 0 1 2 0 1 1 2 0 7
Family Planning (FP) 0 0 2 1 0 1 1 0 5
Focused Antenatal Care (FANC) 4 4 1 2 1 0 2 1 15
HIV – Nutrition 0 1 1 0 0 0 2 0 4
HIV – Adult ART 0 2 1 0 0 0 1 2 6
HIV – PMTCT 2 3 2 1 0 4 1 2 15
HIV – Pediatric Care 2 3 1 0 2 2 2 1 13
Infant and Young Child Feeding (IYCF) 0 1 0 3 1 1 0 1 7
Int. Management of Adult Illnesses (IMAI) 3 1 1 3 0 2 0 0 10
Int. Management of Childhood Illnesses (IMCI) 3 2 2 3 1 1 2 1 15
Integration of Services 0 2 0 2 1 0 2 1 8
M&E - MOH Tools 2 1 1 3 1 0 0 2 10
Malaria – Case Management 0 3 1 1 0 0 2 0 7
Newborn Care 3 2 2 2 2 1 4 0 16
Psychology – Pediatric 0 0 0 0 0 1 0 0 1
Supportive Supervision 1 1 1 2 3 1 1 0 10
TB – MDR Mgmt. 2 1 1 1 1 1 1 1 9
TB – Mgmt. (Microscopy) 1 1 1 0 0 0 1 0 4
TB – Nutrition 0 1 1 0 0 0 0 0 2
TB/HIV Counseling and Testing (C&T) 3 2 0 0 0 2 0 0 7
Trauma Counseling 1 0 0 0 0 1 0 0 2
Health Workers Trained and to be Trained
Health facility managers represented 46 different public, private and faith based health facilities
across Kenya. These facilities employ a total of 28, 347 health workforce which represents a
total of 41.5 % of health workforce in public service (68,185-total numbers of health workers in
GOK facilities; (KHSSP; 2012-2018). Figure 1 below represents the distribution of workforce per
cadre and nurses represented the largest cadre with over 16,000 nursing staff across the 46
facilities. Respondents were asked to identify workers within their facility who had been trained
in the top priority areas (AMSTL, CaCx, Pediatric HIV, PMTCT) as well as those who still needed
to be trained. Findings in fig.1 below show the training areas identified by health administrative

officers (
human r
who did
FIGURE 1
From the
all cadre
significan
Among m
trained i
been trai
been tra
area, whe
in the pa
they are
1811
6%
2670
10%
896
3%
aining Need
HAOs) and
esource reco
not.
provincial hu
ords to see
uman resou
those who
rce officers i
attended tr
in the health
raining in th
h facilities by
he last 12 m
y referring t
months and t
o the
those
- TOTAL NUM
e above scen
es. The per
nt, elucidatin
medical doc
n at least o
ined in at lea
ined. Figu
ere the deno
articular area
believed to
3356
12%
503
2%
6
2
Numbe
s Assessmen
MBER OF HEA
nario, there
rcentage of
ng a potent
ctors for exa
ne of the to
ast one of th
res 2 below
ominator is a
a. Medical do
be in most n
1521
5%
16919
60%
671
2%
er of Pro
nt of the Hea
ALTH WORKERS
was need fo
workers tra
tial gap in s
ample, betw
op training
he top prior
w highlights
all members
octors, nurse
need of train
oviders b
alth Workfor
S AT HEALTH FFACILITIES SAAMPLED
or training in
ained comp
skills and kn
ween 2% an
priorities wh
ities as betw
the percent
s in each cad
es and clinic
ning among
by Cadre
Medical o
Nurses
Medical
Clinical O
Pharmac
Techs.
Public/En
al Health
e
officer
Lab Tech.
Officer
cists/Pharm
nvironment
h Officers
n the top pr
ared to tho
nowledge a
nd 5% who
hile between
ween 1.4% an
tage of wor
dre who requ
cal officers a
all the cadre
riority areas
ose in need
mong the h
required tra
n 1% and 6
nd 3% of cli
rkers trained
uire the skill
re emphasiz
es.
identified a
of training
health workf
aining had
% of nurses
nical officers
d in each pr
s and knowl
zed here bec
cross
g was
force.
been
s had
s had
riority
edge
cause
Rapid Tra rce in Kenya 20

FIGURE 2
The surv
workers a
1.4% of s
repeated
trained in
and Integ
for healt
trained in
T
MOH div
and in w
in this a
nutrition
require c
Public H
much pri
aining Need
- PERCENTA
ey establish
at surveyed
selected hea
dly been iden
n PMTCT or
grated Mana
h facility ma
n pediatric H
Training P
visions respo
which courses
rea. For th
ists and pha
critical trainin
ealth Office
ority training
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
Train
AM
4.1%
2.2
s Assessmen
AGE OF KEY P
ed that, acc
facilities had
alth workers
ntified as a c
Pediatric HIV
agement of
anagers, has
HIV.
Priorities
ondents also
s. Table 4 be
he top 7 sel
armacy techn
ng in PMTCT
rs and Com
gs as the oth
ned in
MSTL
Trai
Ca
%
1.14%
27%
2
3%
nt of the Hea
PROVIDERS TR
cording to h
d received tr
have been t
critical priorit
V and other
Childhood I
s been taugh
by Cadre
o prioritized
elow summa
lected priori
nologists we
T, Cervical Ca
mmunity Hea
hers.
ined
aCx
Train
Ped.
%
6%
2%
3
1.4%
alth Workfor
RAINED IN PR
health facility
raining in an
trained in ce
ty issue. A lit
topics such
Illnesses. AM
ht to 4.1% o
e Accordin
d which cadr
arizes the Tr
ity training
ere the most
ancer Screen
alth Workers
ned in
. HIV
Train
PMT
2%
3%
1.91.4%
rce in Kenya
RIORITY AREA
y managers
ny of the top
ervical cance
ttle over 2%
as newborn
MSTL, anoth
of health wo
ng to the
res most cri
raining Need
areas, medi
t in need of
ning and inf
s, on the ot
ed in
TCT
94%
2.8%
AS
, less than 3
p five training
er screening
of health wo
n care, focuse
her top prior
orkers, while
e MOH Di
tically need
ds Assessme
ical doctors,
critical train
ant and you
ther hand d
Nurses
Doctors
Clinical Officeers
3% of the h
g priorities.
, a topic tha
orkers have
ed antenata
rity training
4.8% have
health
Only
at has
been
l care
topic
been
ivisions
ed to be tra
ent data repo
, clinical off
ing. Nurses
ung child fee
o not requi
ained
orted
ficers,
s only
eding.
ire as
Rapid Tra 21

TABLE 4 - STAFF CRITICAL TO TRAINING BY CADRE PER MOH DIVISIONS
Training area
MedicalDoctor
Nurse
LabTechnician
ClinicalOfficer
PharmacyTech
PubHealth
Officer
Nutritionists
HealthInfo
Officer
Community
HealthWorker
Cervical Cancer Screening Yes Yes Yes Yes Yes
Drug and substance abuse Yes Yes Yes Yes Yes Yes Yes
Infant and young child feeding Yes Yes Yes Yes Yes Yes Yes
Int. Management Childhood Illness Yes
Malaria case management Yes Yes Yes Yes Yes Yes Yes
PMTCT Yes Yes Yes Yes Yes
TB/HIV counseling and testing Yes Yes Yes Yes Yes
CAPACITY TO TRAIN
The TNA also captured data on the capacity of the ministries of health and health training
institutions to deliver trainings that equip health workers with the appropriate competencies to
respond to health demands that include responsive, integrated comprehensive services. The
data also indicated that the capacity to provide in service courses primarily exists in the form of
MOH facilitators and lecturers from training institutions and consulting firms. This section
provides survey findings on the number of and sources of training providers as well as
highlights gaps in training human resources for health.
Availability of trainers/lecturers
The MOH divisions of health have historically trained trainers in priority areas of need across
Kenya. The trainings have been in such areas as HIV/AIDs, tuberculosis, child and adolescent
health, nutrition and reproductive health among others in in-service training. These are often
conducted in provinces that are traditionally the workers duty location. The numbers of trainers
however is not sufficient to meet the current needs of the training backlog. According to table 5
below, in the 12 months preceding the assessment, a total of 255 trainers were trained by the
MOH divisions in the 8 regions, with an average of 32 trainers per region in their core mandate
disease areas. However, data on trainers at the division’s level could not be easily disaggregated
into training priority areas or their precise duty station. This was attributed to the fact that the
divisions do not necessarily conduct training as a core mandate and lack of a robust database of
tracking trainees.

TABLE 5 - NUMBER OF TRAINERS TRAINED BY REGION FOR ALL PRIORITY AREAS BY MOH DIVISIONS
Training area
Central Coast Eastern
North
Eastern
Nyanza
Rift
Valley
Western Nairobi
Total
Cumulative for
all priority areas
31 29 31 32 31 35 31 35 255
Capacity for training also exists at the various training institutions surveyed. Training institutions
besides training pre-service where found to have the potential to conduct in-service trainings to
health workers. However, the training needs assessment established that training institutions
had less than 10% of the human resource capacity of lecturers to address the training priority
areas identified by the survey. Training institutions indicated that they had 6% of lecturers in
adult ART, TB/HIV counseling and testing and PMTCT, bearing in mind the same pool of trainers
are used for pre-service training as well.
Table 6 below represents the number of trainers/lecturers available in training institutions by
priority areas. A total of 17 training institutions were surveyed. Most of the training institutions
assessed have human resource capacity for training in priority areas such as HIV/AIDS, malaria,
family planning, maternal and child health and nutrition. The number of trainers in a particular
training area range from 1 trainer/lecturer in the institution to 57 trainer/lecturers.
TABLE 6 - NUMBER OF TRAINERS/LECTURERS AVAILABLE BY TRAINING PRIORITY AREAS (N=17)
Training priority area
Number of
training
institutions Number of trainers/lecturers
HIV - Adult ART 15 180
TB/HIV C&T 15 163
HIV - PMTCT 14 152
Malaria - Case Mgmt. 13 141
FANC 13 117
Newborn Care 14 105
HIV – Nutrition 15 106
FP 13 99
IMCI 14 98
AMTSL 12 95
TB - MDR Mgmt. 13 93
Supportive Supervision 13 85
IYCF 11 73
Integration of Services 12 70
TB – Nutrition 13 69
Trauma Counseling 13 69
CaCx 9 66
M&E - MOH Tools 11 56
Others 8 126

Training Providers
The assessment established that 76.1% of surveyed health facilities used MOH facilitators for
training purposes, 71.7% used their own staff for training and 34.8% of the health facilities used
training institutions for training purposes (figure 3). Other providers of training included
APHIAPlus partners, USG (USAID) funded projects such as CDC, JHPIEGO, MSH, and ICAP,
medical associations such as the Nursing Council of Kenya, UNICEF, Liverpool VCT, updates from
MOH, NGOs, KEMSA, MEDS, AMREF and Health Right International. Since facilities can select
different trainers from several locations for various trainings, percentages will not add up to
100%.
This therefore providers’ vital resource that is readily available for training of in-service health
workers in a cost effective manner since providers are within reach. It also provides an
opportunity for on- The- Job training (OJT) and other learning methodologies such as
mentorship that minimizes health worker being away from duty to be enhanced since trainers
are within health facilities. The presence of other providers of training lend’s itself as an
opportunity for collaboration of GOK and partners in provision of in-service training in Kenya.
FIGURE 3 - TRAINING PROVIDERS ACCORDING TO HEALTH FACILITY MANAGERS
35 33
16
12
31
19
76.1%
71.7%
34.8%
26.1%
67.4%
41.3%
MOH trainers Trainers
from staff
Training
institutions
Consulting
firms
National.
Organ's(e.g
NASCOP)
Others
Providers of training
Frequency (n=46) %
Clinical Preceptors
Clinical preceptors are trainers who are based in health facilities with teaching collaboration with
training colleges and are charged with the responsibility of demonstrating clinical skills during
practicum. The recommended clinical preceptor to student ratio is 1: 10 to 1:15.Training
institutions counted a total of 1336 preceptors trained to provide clinical training. The majority
of preceptors are able to provide training and clinical supervision in Adult ART (172), PMTCT
(136), Newborn Care (133) and pediatric HIV (120) giving a preceptor ratio per institution in the
priority areas as follows 1:13,1:11,1:11 and 1:9 for Adult ART, PMCT, newborn care and pediatric
HIV respectively. Thus a great potential for in-service training. It is important to note that there

is likelihood that one preceptor could demonstrate one or more skill area since the survey did
not establish the total number of skill areas they could facilitate. The chart (figure 4) gives a
summary of number of preceptors and the corresponding training priority areas.
FIGURE 4 - TOTAL NUMBERS OF PRECEPTORS BY TRAINING PRIORITY AREAS FOR INTERVIEWED
INSTITUTIONS
136
120
172
124
71 68
99
133
62
120
44
79
51 57
0
20
40
60
80
100
120
140
160
180
200
Clinical preceptors
Area of Training Experience
Representatives from training institutions were asked to report the cadres for which they have
experience in providing training in the key training areas. The cadres of health workers who the
training institions had the most experience in providing in-service training were: nurses (19%),
clinical officers (16%) and medical doctors (15%) as compared to other cadres. This is attributed
to the fact that the 3 cadres form the bulk of the health workforce in Kenya by membership.
Encouragingly, all training insituitions have experience in providing training to all types of
health workers in all key training areas,hence an opportunity for scaling up in-service training to
all cadres of health workforce in Kenya The chart(figure 5) below illustrates training experience
by cadre by training area.

FIGURE 5 - AREAS OF
Approve
The TNA
who are
institutio
training
curricula,
faculty/le
Figure 6
Practition
to the re
the follow
appears
providers
at the mo
areas.
It should
record ke
numbers
caution.
other are
Public
health
officers
9%
Nutrit
10
aining Need
ed Continui
A also consid
able to tra
n or organ
in accredite
, adequate
ecturers in th
6 represents
ners and De
esults, there
wing priority
that there a
s in other ar
ost, 2 regula
d be noted t
eeping syste
of regulato
It is critical
eas is in urge
Pharm. Te
10%
ionists
0%
s Assessmen
TRAINING EX
ing Professi
dered the nu
ain in priorit
nization man
ed CPD pro
teaching eq
he subject ar
s the num
ntists Board
is no regula
y areas: PMT
are no CPD
reas are also
atory boards
that regulat
em, with ele
ory institutio
to note tha
ent need.
Clini
chs
HRIO
8%
Others
3%
nt of the Hea
XPERIENCE BY
onal Devel
umber of Co
ty training a
ndated by
ograms. CPD
quipment an
reas/program
ber of Reg
that have e
atory board t
TCT, Adult A
providers in
o not known
s that have a
tory authorit
ectronic reco
ons that hav
at an efficie
Medica
Doctors
15%
cal officers
16%
O
alth Workfor
Y CADRE FORR TRAINING INNSTITUTIONS
opment Pro
ontinuing Pro
areas. A CP
health prof
D providers
nd materials
m/course are
gulatory au
ever approve
that has eve
ART, pediatr
n these key
. In the rem
approved at
ties in Keny
ords that ca
ve approved
nt database
l
s
Med lab t
10%
Nurses
19%
techs.
%
oviders
ofessional D
PD provider
fessional reg
s must mee
, training re
eas for defin
Development
is defined
gulatory bo
et set criter
esources, ad
ned CPD acti
t (CPD) prov
as an indiv
odies to pro
ria; have cu
dequately tra
vities.
viders
idual,
ovide
urrent
ained
rce in Kenya
thorities su
ed at least o
er approved
ic ART, and
training area
maining trai
least one C
uch as the
one CPD prov
CPD provid
cervical can
as; the total
ning priority
PD provider
Kenya Me
vider. Acco
ers to traini
ncer. As su
l number of
y areas, ther
r to train in t
edical
rding
ng in
uch, it
f CPD
re are
these
ya have been
an easily be
d CPD provi
e for mainta
n observed
e retrieved. A
ders should
aining CPD p
to lack a ro
As such, the
d be viewed
providers am
obust
e low
with
mong
Rapid Tra 26

Figure 6
priority a
- Number o
areas
of Regulatoory Boards tthat have appproved CPD Providerss in key training
0
1
2
3
4
5
AMSTL
Number
Table 7 h
the numb
be the m
opportun
Pediatric
aining Need
r of Health W
highlights in
ber of health
most commo
nity, regardl
HIV Care an
AMSTL
CaCx
Commodity Mgmt
Drug & Substance Abuse
FP
FANC
HIV ‐Nutrition
HIV ‐Adult ART
s Assessmen
Workers Tra
n – service t
h providers,
on training a
ess of form
nd PMTCT.
nt of the Hea
ined in the
raining activ
per cadre, tr
area with m
at. Other c
HIV ‐PMTCT
HIV ‐Pediatric Care
IYFC
IMAI
alth Workfor
Last 12 Mo
vities in the
rained in eac
embers of a
common tra
IMAI
IMCI
Integration of Services
M&E ‐MOH tools
rce in Kenya
onths
last 12 mon
ch technical
all cadres re
ining areas
Malaria ‐Case Mgmt.
Newborn Care
Psychology ‐Pediatric
Supportive Supervision
TB ‐MDR Mgmt
TB ‐Mgmt (Microscopy)
TB ‐Nutrition
TB
nths. Specific
area. TB dia
eceiving at le
included HI
/HIV C&T
Trauma Counseling
AMSTL
/
cally, it desc
agnosis seem
east one tra
IV and Nutr
cribes
ms to
aining
rition,
Rapid Tra 27

Table 7 - Total Number of Health Workers Trained in Last 12 Months
Training Area MD Nurse Lab CO Pharm PHO Nutri HIO Other TOTAL
PMTCT 37 255 17 104 20 5 43 7 178 666
Ped. HIV Care 21 146 20 158 8 0 5 0 360 718
Adult ART 40 171 47 200 23 0 39 5 164 689
MDR TB 11 36 5 27 5 0 0 0 0 84
TB Diagnosis 33 413 46 313 27 17 55 14 472 1390
Mcm 11 36 5 27 5 0 0 0 0 84
FANC 23 311 13 53 13 5 30 5 151 604
AMSTL 20 350 0 44 25 0 0 0 108 547
FP 5 225 0 19 5 0 0 2 123 379
Newborn Care 27 333 6 55 8 0 34 0 67 530
CCS 30 229 16 45 8 5 30 5 141 509
IMCI 37 322 8 89 8 5 36 5 102 612
Pediatric Psychology 12 54 0 28 1 0 0 0 0 95
Drugs and substance abuse 6 193 0 13 10 10 0 0 163 395
Trauma 22 305 44 83 7 5 9 5 120 600
IYCF 5 176 0 12 5 0 34 0 58 290
TB – Nutrition 38 210 5 48 8 10 64 0 0 383
HIV - Nutrition 142 215 6 218 9 24 110 0 0 724
M&E 26 54 11 50 9 0 6 79 5 240
Integration 27 177 10 38 24 1 27 0 0 304
Supervision 27 112 9 40 13 0 5 0 0 206
Others 32 258 54 103 13 16 5 10 0 491
Training Resources
Ministries of Health divisional heads, training institutions, health facility managers and
regulatory bodies were asked to list the physical spaces, equipment and materials available to
them for training purposes. This section highlights the gaps in resources and the opportunities
for cost-saving and bringing in-service training closer to the health worker.

FIGURE 7 - TRAINING VENUES AVAILABLE TO MOH DIVISIONS, TRAINING INSTITUTIONS AND HEALTH
FACILITIES
23
25
41
76 5
7
2
7
12
9 9
MOH facility In‐house Hotel Other
Available training venues by respondents
Health facilities MOH Training institutions
Forty-one health facility managers reported that trainings for their in-service health workers
were usually conducted in hotels. 23 facility managers interviewed also cited use of a nearby
MOH facility, while 25 reported using their own spaces as venues for training. Nearby MOH
facilities and other training venues included hospital boardrooms, farmers training colleges and
centers (such as Mabanga and Busia in Western Kenya), provincial general hospitals halls, CME
halls, government training institutes which include the Kenya School of Government, Embu,
hospitals such as Kapenguria, Kenya Medical Training Colleges campuses (KMTC) in Mombasa,
Port Reitz, Nyeri, Mathare Hospital, local dispensaries, provincial general hospital conference
halls in Nyanza and Kakamega, KENAFYA, and Tigoni District hospitals.
Most MOH divisional heads reported using a fairly equal combination of hotels (7), nearby MOH
facilities (6) and their own facilities (in-house) as training venues (5). Other training facilities
included government training institutes, like the Kenya Institute of Administration, hospitals such
as Kenyatta National Hospital and Mbagathi, the Kenya Polytechnic, Tom Mboya Labour
Colleges and missionary sites.
Twelve training institution respondents reported using their own facilities for training. However
trainings were also held in hotels (9) and MOH facilities (9). Other training venues included:
community social halls, district and sub-district hospitals (Burnt Forest, Webuye, Turbo, Teso,
Busia, Amukura, Port Victoria, Khunyangu, Pumwani Maternity Hospital, Kiambu, Thika, Mathare,
Ruiru, and Busia), provincial general hospitals, universities, skills laboratories, lecture halls,
nearby research institutions (e.g. Kenya Medical Research Institute-Kilifi), resource centers, the
Liverpool VCT Training Institute, pastoral centres, universities (Great Lakes University of Kisumu

and Masinde Muliro University of Science and Technology-MMUST), government and private
institutions, and Kenya Medical Training Colleges - Kakamega.
Number of training facilities and capacities
The survey established that the 17 training institutions sampled had a total of 68 training
locations which included satellite campuses or training collaborations with hospitals distributed
across Kenya, (Appendix B)
FIGURE 8 - AVAILABLE TRAINING FACILITIES BY REGION
Rift Valley Province had the highest numbers of training facilities owned and or supported by
divisions of MOH as compared to other provinces. Such divisions include, Division of
Reproductive Health; Division of Leprosy, Tuberculosis and lung Diseases and the Division of
Nutrition. In total Nyanza and Nairobi provinces have the highest number of training facilities
(27) as compared to other provinces. Table 8 below illustrates the total number of training
facilities in each province and their total capacities. In relation to the number of training facilities
in each province as illustrated in figure 8 above, Nairobi and Nyanza provinces have
corresponding higher capacities to enroll in- service health workers for training.
It’s interesting to note whereas you would expect higher numbers of trainers to be available in
provinces with higher numbers of facilities and capacities, North Eastern has a higher number of
trainers with very few number of facilities and capacities, likewise, Central Province has
seemingly higher number of trainers compared to the number of facilities and their capacities
(Table 8). This is a clear indication of a disproportionate distribution of trainers of priority areas.
TABLE 8 - TRAINING FACILITY TOTAL CAPACITIES BY REGION
Capacity Central Coast Eastern Northeast Nyanza Rift Valley Western Nairobi
Training
Institutions
300 575 630 190 800 560 490 1000
MOH
Divisions
20 20 20 20 20 60 20 20
Total 320 595 650 210 820 620 510 1020
11
17 15
6
24
20 21
17
2
1 5
2
3
3 1 10
Central Coast Eastern Northeastern Nyanza Rift Valley Western Nairobi
Training facilities available, by region
Training Institutions MOH

Access to training services and status of condition
The survey was also interested in establishing access to Internet and skill laboratories by MOH
divisions of health, health facilities and training institutions for purposes of training of in-service
health workers by introducing and scaling up use of innovative learning approaches such as e-
learning, distance, and on the job training (OJT) among many others.
FIGURE 9 – MOH DIVISIONS, HEALTH FACILITIES AND TRAINING INSTITUTIONS WITH ACCESS TO
TRAINING SERVICES
14.30%
36.40% 36.40%
50.0%
43.5%
28.2%
87.50% 86.70%
81.30%
Wired internet Wireless internet Skills labs
% of Respondents Answered "YES" to Having Access to Training Tools
MOH Divisions Health Facilities Training Institutions
Less than 40% of the MOH Divisions had access to Internet or skills labs at their facilities. There
was inconclusive data to make an assessment of the quality of service according to respondents.
Half of the health facility managers had access to wired internet in their facilities for training
purposes, while 43.5% of them had access to wireless internet and 28.2 % had access to skills
labs for training. A little over 15% (n=7) of health facility managers believed the wired internet
was “excellent” as compared to the wireless internet (at 11%; n=5). Additionally, 6, or 13% of
the skills labs were rated as “good”.
Over 80% (n=44) of the training institutions had access to training services in regard to wired
internet, wireless internet and skills labs. All were found to have access to other resources that
included clinical research laboratories, libraries and e-libraries, projectors, training venues and
catering services, resource centers, teaching laboratories, classrooms, computer laboratories
among many others and video conference facilities. 55% (n=6) of the training institutions
indicated good wired internet quality and 42% (n=5) rated their wireless connection as “good”,
which results in a great opportunity for e-learning.
Teaching materials
The MOH divisions had a wide range of resources for trainings at their facilities. They reported
that laptop computers (25), DVDs (42) and overhead projectors(7) were available and could be
borrowed for use for training in other locations with prior arrangements with the divisions. Table
18 in the appendices summarizes resources within the division and their availability for training.

According to health facility managers, desktop computers (208), laptop computers (61), DVD
players (27) and overhead projectors (30) were resources found most available in health facilities
for training. Table 18 in Appendix C shows the number of respondents with resources and total
number of resources.
Laptop/ computers (68), overhead projector (51) DVDS (44), demonstration equipment,
reference books/manuals and VCR (21) were resources training institutions were willing to lend
and be moved for training purposes. As was the case with MOH divisions, health facilities were
willing to lend Laptop computers, overhead projectors, and DVDs with prior arrangements.
Financing training
The Survey was also interested in identifying sources of financing for in-service training by
health facilities. Health facility managers were asked to respond to the question “How do you
usually pay for training for your staff? ” and they were to respond by selecting five options and
not limited to one choice but to as many as applied.
87% (40 of 46) of health facilities relied on some sort of donor funding to support the training of
health workers in their hospitals and clinics (see figure 10 below). The health facility managers
also reported that 46% of health workers participants had financed their own trainings. This
provides an excellent opportunity for loans and scholarship to be made available to health
workers so that they may have access to health training. Other sources of financing training for
in-service health workers included Government of Kenya scholarships, APHIAPlus support,
KEC/CHAK subsidies in their hospitals, support from pharmaceutical companies, and training
through the decentralized training centers (DTC) in reproductive health and hospitals that met
training costs for their staff.
FIGURE 10 - FINANCING TRAINING - HEALTH FACILITY MANAGER PERSPECTIVE
17
12
21
40
9
Ministry training
budget
Organization
training budget
Staff pay for
training
Donor funding Other
How health facilities finance trainings

PERSPECTIVE OF REGULATORY BODIES
Six regulatory authorities representing approximately 62,500 health workers were also
interviewed for this training needs assessment. A breakdown showing the number of members
reported by each regulatory body is shown in the pie chart below. With the exception of the
Clinical officers council(COC) which reported to having 1000 plaster technicians registered
under them as clinical technicians – none of the other regulatory bodies reported having
substantial membership outside of the primary cadres they represented.
FIGURE 11 - MEMBERSHIP OF SAMPLED REGULATORY BODIES
8651
30000
7280
6824
8000
1683
Kenya Medical Practioners and
Dentists Board (KMPDB)
Nursing Council of Kenya (NCK)
Pharmacy and Poisons Board
(KPPB)
Kenya Medical Laboratory
Technologist and Technicians
Board (KMLTTB)
Clinical Officers Council (COC)
Kenya Nutritionist and Dietician
Council (KNDC)
Availability of training guidelines
One of the functions of a regulatory body is to provide guidelines for training the cadres it
represents. All regulatory bodies were asked if they had training guidelines for in-service
training. They were asked if they would share training content or syllabus for the priority training
areas. The Clinical Officers Council and the Kenya Medical Practitioners and Dentists Board
indicated that they had more guidelines for priority training areas to share than other regulatory
bodies; however, none of the regulatory bodies participating in the assessment could provide
training guidelines in all key training areas. Five of the six regulatory bodies indicated that they
had training guidelines to share on supportive supervision, suggesting that supportive
supervision training has been institutionalized within the regulatory bodies. Interestingly,
although the Nursing Council of Kenya has the most members, the national Council Kenya (NCK)
indicated that it had no guidelines for the training priority areas, however it could share

guidelines for training in other training areas such as; mental health, operational research,
leadership and management, nursing processes and teaching methodologies. Table 9 presents
results in this area. Based on responses presented, it is clear that there are significant gaps in
training guidance available from regulatory bodies in Kenya.
TABLE 9 - AVAILABILITY OF GUIDELINES FOR TRAINING IN KEY TRAINING AREAS
Key Training Area COC KMLTTB KMPDB KNDC KPPB NCK
AMTSL # N/A No No # Yes*
CaCx No N/A Yes No N/A No
Commodity Mgmt. No N/A No No Yes No
Drug & Substance Abuse No N/A No No Yes No
FANC Yes N/A Yes No N/A No
FP No N/A Yes No N/A No
HIV - Adult ART N/A No No No N/A No
HIV – Nutrition No N/A No Yes N/A No
HIV – Pediatric N/A No No No N/A No
HIV – PMTCT N/A No No No N/A No
IMAI Yes N/A Yes No N/A No
IMCI Yes N/A Yes No N/A No
Integration of Services No N/A No No N/A No
IYCF No N/A Yes Yes N/A No
M&E – MOH tools No No No Yes No No
Malaria - Case Mgmt. Yes No # No # No
Newborn Care Yes N/A Yes No N/A No
Psychology – Pediatric N/A # No No N/A #
Supportive Supervision Yes Yes Yes Yes Yes No
TB - MDR Mgmt. Yes No No No N/A No
TB – Nutrition No N/A No Yes N/A No
TB Management (Microscopy) N/A No No No N/A No
TB/HIV C&T N/A No No No N/A No
Trauma Counseling No N/A No No N/A No
*-(for mid-level and tertiary institutions)
#- No response provided- Regulatory bodies are in the process of developing guidelines for Continuous
Professional Development (CPD). This will provide for general guidelines for providing CPD in specific
thematic areas. From the results It is apparent that standardization of these courses needs to be
addressed by regulatory bodies.
Each of the Regulatory bodies also listed other areas for which they had training guidelines to
offer as follows:
COC: Kenya quality model for health (KQAMH) checklist
KMLTTB: Good clinical laboratory practice
KMPDB: Medical legal issues and medical malpractice
KNDC: Corporate management and training on governance
PPB: Rational drug use

NCK: Mental health, operational research, leadership/management, nursing process, teaching
methodology
Availability of training curricula
Regulatory authorities were asked to list approved curricula that they could share for the
provision of HIV/AIDs related and other training in priority areas. The following table
summarizes responses from regulatory bodies in this area.
TABLE 10 - AVAILABILITY OF CURRICULA FROM REGULATORY BODIES
AMTSL Yes N/A Yes No N/A Yes*
CaCx No N/A Yes No N/A Yes
Commodity Mgmt. No N/A No No Yes Yes
Drug & Substance Abuse No N/A No No Yes Yes
FANC Yes N/A Yes No N/A Yes
FP No N/A Yes No N/A Yes
HIV - Adult ART N/A No No No N/A Yes
HIV – Nutrition No N/A No Yes N/A Yes
HIV – Pediatric N/A No No No N/A Yes
HIV – PMTCT N/A No No No N/A Yes
IMAI Yes N/A Yes No N/A Yes
IMCI Yes N/A Yes No N/A Yes
Integration of Services No N/A No No N/A Yes
IYCF No N/A Yes Yes N/A Yes
M&E – MOH tools No No No Yes No Yes
Malaria - Case Mgmt. Yes No # No # Yes
Newborn Care Yes N/A Yes No N/A Yes
Psychology – Pediatric Yes # No No N/A Yes
Supportive Supervision Yes Yes No Yes No Yes
TB - MDR Mgmt. Yes No No No N/A Yes
TB – Nutrition No N/A No Yes N/A Yes
TB Management (Microscopy) N/A No No No N/A Yes
TB/HIV C&T N/A No No No N/A Yes
Trauma Counseling No N/A No No N/A Yes
#- No response provided
In sharp contrast to its responses on availability of training guidelines, the NCK indicated in the
TNA that it could provide approved curricula for all of the priority training areas listed. This
presents an excellent opportunity to have the NCK share curricula for adaptation/customization
by other regulatory bodies. There were no independent curricula for the training in priority areas
identified for most of the regulatory bodies interviewed. However the course content in the
identified courses are integrated in larger thematic areas like reproductive health, community
health, HIV AIDS care, medicine and surgery
Training institutions were also asked if they could supply curricula for priority training areas.
Table 11 provides a summary of the responses from 17 training institutions. As indicated below,

at least 50% of the training institutions surveyed can provide curricula in AMSTL, CaCx, FANC,
FP, HIV services (Adult ART, Nutrition, Pediatric), IMAI, IMCI, Newborn Care, and TB (Diagnosis,
MDR management, Nutrition).
TABLE 11 - AVAILABILITY OF CURRICULA FROM TRAINING INSTITUTIONS
Training area Yes % (N=17)
AMTSL 11 65%
CaCx 9 53%
Drug & Substance Abuse 8 47%
FANC 10 59%
FP 11 65%
HIV - Adult ARV 12 71%
HIV – Nutrition 13 76%
HIV – Pediatric 12 71%
HIV – PMTCT 13 76%
IMAI 9 53%
IMCI 10 59%
IYCF 9 53%
M&E 8 47%
Malaria - Case Mgmt. 10 59%
Newborn Care 9 53%
Psychology – Pediatric 4 24%
TB – Diagnosis 9 53%
TB - MDR Mgmt. 9 53%
TB – Nutrition 10 59%
Trauma Counseling 7 41%
Others 7 41%
When combined, these data indicate that there is an opportunity for regulatory bodies and
training institutions to collaborate by sharing curricula.
Length of training using approved curricula
Both training institutions and regulatory bodies were asked about the length of their training
programs in priority training areas using the curricula they reported having. Training institutions
reported that, on average, in-service (CPD) training programs take on average less than 2 weeks
(See Table 12 ). This is consistent with a need to minimize health workers’ time away from duty
stations. Comparative data on this question from regulatory bodies is sparse. Only five of the six
regulatory bodies provided data on this question. The regulatory body that indicated it has
approved curricula in each priority area, the NCK, responded by indicating that the training
priority areas are integrated into the available pre-service curriculum that takes 3 to 4 years. The
data suggest that there are opportunities to investigate this issue further and perhaps more
closely harmonize curricula and training schedules between regulatory bodies and training
institutions.

TABLE 12 - COMPARING AVERAGE TRAINING LENGTHS BY PRIORITY AREAS
Training area
Average training length (in days)
Average length
of training in
days as reported
by training
institutions
Length of training in days as reported by
regulatory authorities
COC KMLTTB KMPD
B
KNDC KPPB
AMTSL 4.8 7
CaCx 6.4
Drug & Substance
Abuse
8.7
FANC 6.5 7 5
FP 17
HIV - Adult ART 4
HIV - Nutrition - 5
HIV - PMTCT 8.7
HIV - Pediatric Care 7.7
IMAI 11 7
IMCI 11.5 8
Integration of
Services
6.6
IYCF 7.3 5
M&E - MOH Tools 8.5 3 30
Malaria - Case
Mgmt.
7.3
7
7
Newborn Care 7.5 14
Psychology -
Pediatric
9.7
Supportive
Supervision
-
7
3
TB - Diagnosis 8.5
TB - MDR Mgmt. 6.5 14 14
TB - Nutrition 8.5 5
Trauma Counseling 9.2
From these figures above it is clear for the need to standardize the courses and CPD credits
provided for similar courses. This can be achieved through regulatory authorities holding forums
for determining what qualifies for cross cadre CPD.

Approved CPD providers for training in priority areas
Regulatory bodies were asked if they had approved CPD providers to train in each of the priority
areas. Data revealed that there are few approved CPD providers for training in the broad
thematic areas where priority areas fall: PMTCT, Adult ART, pediatric ART, CaCx and others
illustrated in the table 13 below. This points a critical gap in the CPD accreditation system that
needs to be urgently addressed. Whereas the regulatory authorities may have accredited certain
institutions and CPD providers in broad thematic areas like reproductive health, midwifery, HIV
AIDS Care and Counseling, nutrition, family planning among others, priority may not have been
apportioned to identified areas. Therefore Identification, recognition and accreditation of
trainers in the priority areas need to be an ongoing process.
TABLE 13 - AVAILABILITY OF APPROVED CPD PROVIDERS BY TRAINING PRIORITY AREAS
AMTSL Yes N/A # No N/A N/A
CaCx No N/A # No N/A N/A
Commodity Mgmt. No N/A # No Yes N/A
Drug & Substance Abuse No N/A # No Yes N/A
FANC Yes N/A # No N/A N/A
FP No N/A # No N/A N/A
HIV - Adult ART N/A No # # N/A N/A
HIV – Nutrition N/A N/A # Yes # N/A
HIV – Pediatric N/A No # # N/A N/A
HIV – PMTCT N/A No No No N/A N/A
IMAI Yes N/A # No N/A N/A
IMCI Yes N/A # No N/A N/A
Integration of Services No N/A # No N/A N/A
IYCF No N/A # Yes N/A N/A
M&E – MOH tools No N/A # Yes Yes N/A
Malaria - Case Mgmt. Yes No # # # N/A
Newborn Care Yes N/A # No N/A N/A
Psychology – Pediatric No # # # N/A N/A
Supportive Supervision Yes # # # No N/A
TB - MDR Mgmt. Yes No # # N/A N/A
TB – Nutrition No N/A # Yes N/A N/A
TB Management (Microscopy) # No # # N/A N/A
TB/HIV C&T N/A No # # N/A N/A
Trauma Counseling No N/A # # N/A N/A
#- No response provided-Notably the KMPDB indicated they had no approved CPD providers and it is
likely the respondents interpreted the question to mean any knowledge of training institutions and other
providers that are accredited to provide training.
Accredited/approved trainers, training institutions and consulting firms
For each of the areas in which they have accredited training, regulatory authorities were asked
to name trainers, training institutions, and consulting firms that are accredited to provide
training. Regulatory authorities identified MOH facilitators and Professional Associations such as

the Pediatric Association, Kenya Obstetrics and Gynecologist Society (KOGS), Kenya Association
of people with TB and lung diseases as trainers that can be used for training. Mid-level and
tertiary training institutions were mentioned to have the capacity to train in the priority areas.
Regulatory bodies provided no information about consulting firms that have been accredited to
provide trainings in the identified priority areas. This points at an urgent need by regulatory
bodies to make public the priority training needs for the trainers, CPD providers, consulting
firms to prepare curricula and apply for accreditation to provide the same.
Regulatory authorities recommended that MOH facilitators and associations such as pediatric
association, KOGS, Kenya association of people with TB and lung diseases as trainers that can be
used for training. Mid and high level training institutions were mentioned to have the capacity
to train in the priority areas as indicated in the matrix (Appendix D). Regulatory bodies provided
no information about consulting firms. A full list of approved trainers is included in APPENDIX D:
Accredited/Approved Trainers and Institutions.
Professional members attained training standards for re-licensure
Only three (50%) of the six regulators reported data on re-licensure. Data revealed that less than
half (43.9%) of the Medical Officers and only 37.5% of pharmacists qualified for re-licensure in
the last year. The NCK reported the highest re-licensure rate with 65.8% of nurses meeting re-
licensure standards. These data point to significant training gaps for health workers as well as
gaps in the capacity of regulatory bodies to monitor health workers’ attainment of training
requirement for re-licensure. The Clinical Officers Council, KMLTTB and KNDI are in the process
of developing their databases. Development of such regulatory databases may significantly
enhance tracking of CPD and re-licensure compliance. The survey identified an enforcement
mechanism by the Nursing Council, where an advertisement had been made in the local dailies
requesting compliance to this professional requirement. This is reported to have increased the
number of persons re-licensing. This may be adopted for all other regulatory bodies.
The other explanations that were provided by the respondents regarding the low level of
compliance to re-licensure requirement was the un-availability of CPD courses in the locality of
the health care providers and the cost of trainings sought far from the health care providers
workplace. The annual symposia provided by Pharmaceutical Society as a source of CPD, was for
example termed as an expensive source of CPD. This therefore calls for investment in technology
options that enhance training access for health workers in remote locations. There is need also
to accredit more CPD providers and variety of courses and activities, conferences that count for
CPD. In this case, the re-licensure is likely to improve.
TABLE 14 - PROFESSIONAL MEMBERS ATTAINING STANDARDS FOR RE-LICENSURE
Cadre Total membership
# of members attaining
standards for re-licensure Percentage
Medical Officers 8651 3800 43.9%
Nurses 30000 19743 65.8%
Pharmacists/
PharmTechs 7280 2733 37.5%

Determining training needs for health workers
Regulatory bodies were asked to describe the types of performance assessments they conduct
to determine training needs for health workers. Respondents identified exit interviews,
satisfaction surveys, and stakeholder meetings as ways in which they engage their members to
identify training needs. The councils reported that supervision visits they conduct are informal
ways of carrying out performance assessments. Consultative meetings with provincial and
district hospital in charges were seen as opportunities for identification of training gaps for
members, resulting in performance assessment. Only PPB indicated that it had performance
assessment tools that could be shared, further suggesting that much of the current performance
assessment methods are unstructured and there is an opportunity to create more structured
support for training needs assessment in the system.
Post training support
Regulatory bodies were also asked to indicate what type of post-training support they provide
to in-service health workers. 2 of the 6 regulatory authorities used mentorship and coaching as
modes of post training support, a third used Internet/email to send updates to their members
and one sent updates and used manuals. Regulatory authorities identified the need for new
employees and new comers to be inducted on the identified priority areas as well as in other
areas critical to their practice. There is need to enhance post training support by regulatory
bodies and ensuring that trainings have an impact on practice. Diversified post training support
mechanisms including clinical mentorship, training materials and support supervision are in
urgent need for scale up.
Figure 12 illustrates post training support accorded to members by regulatory authorities.
FIGURE 12 - POST-TRAINING SUPPORT TO IN-SERVICE TRAINEES ACCORDING TO REGULATORY
AUTHORITIES
2
33.3
4
66.7
1
16.7
5
83.3
2
33.3
4
66.7
3
100
0 0
0
20
40
60
80
100
120
Yes‐n Yes‐% No‐n No‐%
Mentorship/coaching Sending updates/manuals
Sending websites Others

Training institutions also reported on their methods of post-training support. A total of 17
training institutions were surveyed and only 15 responded to the question on post training
feedback; eighty percent (12) of the training institutions used follow up as post training support
to in-service trainees whereas sending updates via websites was used by 84.6 % of the training
institutions. None of the training institutions interviewed used mentorship and coaching as a
form of post training support to trainees.
When asked about the effectiveness of post-training support provided to in-service workers,
none of the regulatory bodies reported that they provided “very effective” support. Two of the
six indicated that their support was “someswhat effective” while the remaining four suggested
that post-training support was “not at all effective.” This is an area where regulators could
require additional support. In contrast, more than half (53.3%) of the training institutions
indicated their post training support was very effective and less than 15% (n=2) indicated their
follow up to be ineffective. This suggests that training institutions are more confident in their
ability to provide effective post-training support for health workers than are regulatory bodies.
0
2
4
8
5
2
Very effective Somewhat effective Not at all effective
Effectiveness of Post Training Support for In‐service Trainees
Regulatory Authorities Training Institutions
FIGURE 13 - EFFECTIVENESS OF POST-TRAINING SUPPORT FOR HEALTH WORKERS
Post Training Support Provided To Training Institutions
Regulatory bodies were also asked to comment on the post-training support they provide to
training institutions. Responses included: approval of teaching and training curricula; supportive
supervision, especially to pre and in-service trainings; inspections for quality assurance and
compliance; reviews of curricula; participating in examinations; assessment of training facilities;
indexing of students; follow up meetings; sending of circulars and updates through
correspondence and the need for quality assurance every four (4) years.
Regulators’ self-assessments of the effectiveness of their post-training support for institutions
were somewhat more optimistic than that for individuals. Two 2 authorities, KMPDB and NCK,
rated the support they provided as “very effective” (see figure 14 below).

FIGURE 14 - EFFECTIVENESS OF POST-TRAINING SUPPORT PROVIDED TO TRAINING INSTITUTIONS BY
REGULATORY AUTHORITIES
Effectiveness of post‐training support of Regulatory bodies to training institutions Frequency(#)
Effectiveness of post‐training support of Regulatory bodies to training institutions Percent(%)
2 2 2
33% 33% 33%
0
0.5
1
1.5
2
2.5
Not at all effective Somewhat effective Very effective
Methods of evaluation
Regulatory authorities were asked, “What methods of evaluation do you utilize to determine the
effectiveness of training”. Responses included: council final examinations, which all are required
to pass; review and registration of final examinations; and issuance and renewal of clinical log
books for pre-service trainees. Respondents also reported use of a national minimum standards
document to evaluate new schools’ attainment of criteria required for training. However, they
indicated that they lacked a mechanism to evaluate the adherence of the school over time. On
the other hand training institutions were asked, “What methods of evaluation do you utilize to
determine the effectiveness of training”. Reponses included administrating pre and post test,
summative training evaluation; interviews post training and facilitators evaluation by students.

DISCUSSIONS AND CONCLUSIONS
Training priorities
This study established that while there were some differences between the training priorities of
the technical divisions of MOH and those of the health facility managers, all priorities noted
were in line with those previously identified by the USAID APHIAPlus supported projects in
Kenya.
The top 8 priorities according to both MOH Divisions and health facility managers were:
Cervical Cancer Screening Training, HIV –PMCT, Focused Antenatal Care, Integrated
Management of Childhood Illness, new born care, active management of third stage of labour,
commodity management and HIV pediatric care. The study established there were regional
training differences and therefore it was prudent to have regional specific trainings; table 2
shows regional training priorities.
Recommendations
The ministries of health with the support of FUNZOKenya, in addressing the backlog training,
should focus on the top national training priorities and the unique needs of each province as
well. According to this report, most of the training priorities are topics or sessions within broader
training areas and therefore there may be need to consider training the entire course. For
example active management of third stage of labour is a component within essential obstetric
care which would be a comprehensive course to deliver.
Number of health workers to be trained
The study established that less than 12% of the health workforce had been trained in the
priorities areas. This is evidence that training backlog is real and the ministries should identify
ways in which the vast majority of the health workforce can access high quality training.
Recommendations
Innovative learning methods such as distance learning, e-learning, evening, weekend and other
methods can be introduced to increase access to training by health workforce in cost effective
approaches. There is greater need to involve training institutions at the regional level for wider
reach since they are widely spread in the country.
Trainers in priority areas
The MOH facilitators were engaged in the training of in-service health workers more than any
other category of trainers. In addition, training institutions were found with the capacity to train
in-service health workers. However, they had less than 10% of lecturers to train in the priority
areas despite having facilities country wide with the potential to use for in-service training.
Recommendations
Training institutions to collaborate with the MOH technical departments to build their capacity
for in-service training to reach the standards required and use of MOH trainers and professional
associations for in-service training.

Scale up through on-job mentorship programmes to increase in-house training for a wider
reach.
Training venues
The study established that much of the training happened in hotels. However, there was great
potential for moving towards MOH facilities nearby, in-house training and other facilities. Hotel
based training is unlikely to be effective, especially where clinical skills are to be demonstrated
and practiced. It is also expensive due to other related costs such as accommodation among
many others, thus reaching out to a small number.
Recommendations
There is need to use training institutions and alternative cost effective training venues and
locations which include faith based facilities such as pastoral centers, government facilities,
hospital facilities that include board rooms and clinical areas, thus making training simultaneous
and cost effective.
Access to services and equipment
The assessment established that half of the health facilities had access to internet, whereas more
than three thirds of the training institution had access to internet. This therefore presents a
unique opportunity for training through e-learning. Laptop computers, projectors and DVDs
were resources most available and could be moved from one location to another for training.
Recommendations
There exists a huge potential for distance and e-learning with the wider reach of internet access.
Financing of Training
More than 80% of health workforce training in health facilities were donor supported, thus
making it not sustainable in the long run and often not reliable beyond the sponsoring project
life period. The study established slightly more than 40% of the health workers financed their
own training.
Recommendations
There exists a big potential for the scale up of the health workforce training through access to
loan products that are reasonably priced for the vast majority of health workers who finance
their own training. With the current flexible loaning policies and competitive loan products
among the financial institutions, Training institutions have an opportunity to expand their
capacities to meet demand, as they have access to loan facilities.
The need for training institutions and health facilities to increase their training budgets and also
seeking alternative sources of funds for training cannot be under scored.

Areas of training experience by training institutions
Training institutions were found to have experience in training nurses mostly. This was expected
as nurses formed the bulk of the health workforce by membership.
Recommendations
Training institutions need to build capacities to expand their expertise to other cadres for
effective service delivery.
Average Training days and ability to supply curriculum by training institutions
Most of the training curriculums were found to be of less than 2 week training as confirmed by
the regulatory authorities’ as well. This seemed to be because the health workers cannot afford
to be out of duty for long in training as they are required to be providing health care services.
Recommendations
Other modes of learning such as distance learning, e-learning and training shortened to allow
for shorter periods of face-to-face interaction and longer period of self-directed learning.
Half of the training institutions where able to supply curriculum for in-service training in
identified training priority areas and hence were able to address the training backlog.
Post training support to trainees by training institutions and its effectiveness
The study established that follow ups by trainers and sending of updates were the most
commonly used methods of post training support by training institutions. None had used
mentorship or coaching as methods of support. These demonstrate lack of capacity in post
training support. Slightly more than half of the training institutions noted their support was
effective.
Recommendations
Training institutions strengthening was required through faculty development in post training
support and performance assessment.
Exposure to performance management tools was a priority for training institutions to improve
effectiveness of their trainings.
Availability of guidelines, curricula and CPD providers
A quarter of the regulatory authorities had guidelines to share in training priority areas for in-
service health workers. In HIV/AIDs related courses they had no approved CPD providers.
Recommendations
Training priority identified passed to regulators for award of CPD points.
Need for capacity building for the regulators to develop guidelines for areas of in-service
training with no guidelines. Encourage regulatory bodies to have cross cadre CPD
activities/programs with same number of CPD points across cadres.

Professional members attaining re-licensure
With the exception of nurses, less than half of the professional members were attaining
standards for re-license and other regulators lacked data on the same. This is a reflection of the
following likely scenarios: weak enforcement, guidelines lacking, unclear or manual recording
and ineffective databases for maintenance of records.
Recommendation
Need for capacity building of regulators and need for development of database for accurate
recording of member data.
Post training support to trainees and training institutions
Post training support to in-service trainees was found to be ineffective and the same was true
for training institutions
Recommendations
There is need to build the capacity of regulators to provide on-going support to members and
training institutions.

APPENDIX A: PRIORITY AREAS AND SUBTOPICS TO BE COVERED
MOH technical divisions reported that they required training priority areas to be covered as per
the national guidelines and emphasized the following subtopics to be covered under the priority
area mentioned below:
TABLE 15 - MOH TRAINING PRIORITY AREAS AND SUBTOPICS
Training Area Sub Topics
Adult ART Use of ARVs Managing treatments and
patients
Commodity
Management
Food safety and
commodity
management
Principle of commodity
management
Quantification and
procurement of commodities.
Distribution and storage.
Pharmaco-vigilance
(monitoring of drugs)
management and rationale
use of drugs
Drug and substance
abuse
Harms of drugs Drug management Prevention of drug abuse
Infant and young child
feeding (IYCF)
MIYCN Policy, strategy
and guidelines
Infant feeding IYCF and WHO Growth
Standards
M&E – use of MOH tools Guidelines and
information education
and communication (IEC)
materials
Data for decision
making(the practical
aspects )
Data quality assurance
Data collection and analysis
Use of data for decision
making.
Reporting data.
Malaria case
management
Management of
uncomplicated malaria
Parasitology and
diagnosis of malaria
Malaria in pregnancy,
management, prevention and
treatment of malaria in adults
Newborn Care Newborn resuscitation Detection of signs before
birth and after birth
Infection prevention
Nutrition and HIV High impact nutrition
interventions
Nutrient supplementation Food fortification
Nutrition and TB Nutritional elements in
DHIS
Others: Intervention sites,
Integrated management
of adult illnesses (IMAM)
Post training follow-ups,
full long acting and
permanent methods of
family planning
(LAPM)curriculum
Management of non-
communicable diseases,
Essential maternal obstetric
care(EMOC), Maternal
newborn care (MNC ) package,
full cervical cancer package
Pediatric Psychology Psycho-social support Assessment and referral
of children with
disabilities
Psychotherapy for parents,
guardians and care givers.
Management of child abuse
PMTCT The four prongs of
PMTCT
Full PMTCT package
Supportive Supervision Follow-up of supportive
supervision
Setting of objectives for
supportive supervision
Development of supportive
supervision tools.
TB/HIV counseling and
testing (C&T)
Use of HIV tools

TABLE 16 - TRAINING PRIORITY AREAS AND SUB-TOPICS TO BE COVERED ACCORDING TO HEALTH
FACILITY MANAGERS
Training Area Sub topics emphasized
PMTCT Care for PMTCT,
dissemination of
information
Pediatric HIV care Clinical presentation
of HIV in children
Early infant diagnosis
prophylaxis for the
newborn of HIV positive
mother
Pediatric Resuscitation
Primary management of HIV in
children
Follow up of infected children
Adult ART ART management As required by guidelines Side effects of ART and their
management
ART monitoring, referrals,
dispensing of ART
HIV staging and testing
TB/HIV counseling and testing
(C&T)
Attitude of health
workers towards TB
patients
Rapid HIV testing,
couple counseling and
testing
Relation of TB and HIV
PRE and POST TEST
MDR TB Management Assessment and
referral of MDR cases
Good management and
prevention of MDR
Overview of MDR TB management
Malaria case management New malaria
guidelines
Focused Antenatal Care (FANC) Antenatal care,
The whole of FANC
package
Counseling of pregnant
mothers and anemia in
pregnancy
Complications that can affect
normal delivery
investigation/follow up in
trimesters
AMSTL (Active Management of
3rd Stage of Labor
Precautions to take
during labour and
delivery
Post-partum hemorrhage
Newborn Care Birth preparedness Care of underweight and
pre-mature babies
How to give episiotomy
care and treatment of children
Cervical Cancer Screening Cervical Cancer
screening full
package
Integrated Management of
Childhood Illness (IMCI)
Mother child health
(MCH) Model
Neonatal resuscitation
Integrated management of adult
illness (IMAI)
emphasis on CD4
counts and staging
of HIV
Trauma counseling Abnormal and
normal behavior
Infant and young child feeding
(IYCF)
Feeding of newborn
and infection
prevention
Nutrition and HIV Epidemiology and
clinical presentation
of HIV in adults
Commodity Management Adherence
Commodity
Identification of
commodity
Others Partogram
advocacy at
community level
How to give episiotomy Cry therapy treatment
TB and HIV in pregnancy

Kenya Health Workforce Training Needs Assessment Report

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