Does Kenya need advanced nurse practitioners?

Does Kenya need advanced nurse practitioners in view of shortage of primary care physicians? That is a mega dollar question considering that someone somewhere will oppose the entry of nurses into ‘their docket’.  This article explores a Kenyan perspective.

Availability of skilled and motivated physicians and nurses in sufficient numbers is critical in attaining better primary healthcare outcomes. Primary care is the foundation of an evolving health care system. There is need for more focus on primary care and realigning the health system to meet our country’s basic care and equality through redistribution ( if this were possible). It had been variously argued that to meet future demand for primary care in US, NPs could be increasingly utilized to meet the needs. Nicole Fishers (2013) was reluctant that NPs were the panacea to PCP shortage http://thehealthcareblog.com/blog/2013/09/04/why-nurse-practitioners-will-not-solve-the-primary-care-crisis/ (Links to an external site.

I start by looking at the situation of physicians (it is a luxury in Kenya context to begin talking about primary care physicians but for the purpose of this discussion let’s call them so).

It has emerged that the doctor-patient ratio in Kenya has widened in the past four years, an indication that the number of doctors entering and staying in the public health sector has been outpaced by population growth. By end of 2011, Kenya had a doctor-population ratio of one doctor to 17,000, for a population of 40million dhsprogram.com/pubs/pdf/spa8/02chapter2.pdf.

A report by the Ministry of Health report suggested that the country had one medical officer for every 20,000 people. According to: Kenya Service Availability and Readiness Assessment Mapping (SARAM, 2013) also showed that there was only one registered clinical officer (physician Assistant) for every 10,000 people and a nurse for every 3,333 people  www.who.int/healthinfo/systems/sara…/en/

According to chairman Kenya Medical Practioners, Pharmacists and Dentists union (KMPPDU) Dr Samuel Oroko, in 2014 alone 1800 doctors left public service to join private practice. The main reason cited during this season was the bumpy take of the revolutionized health care services; there was reported harassment of health care providers by local leaders including Members of County Assemblies (MCAs) who forcefully wanted to run facilities in their various county wards. The Union also attributed the low retention of doctors in the public sector to poor remunerations and poor working conditions. The Kenya government itself in 2011 admitted that up to three quarters of doctors joining public hospitals after graduation would have left these hospitals in three years’ time.

The commitment of a few pioneer private nurse midwives in Kenya had increased access to community-level reproductive health /family planning services and child welfare activities but they generally provided curative health services and very few preventive services. If anything Advanced Nursing Practice (ANP) or Nurse practitioners (NP) as defined in the US are most likely to be in nursing education than as practitioners. Doctorate of Nursing Practice (DNP) degree is not available in Kenya yet. Personally I only know one DNP and she trained at Indiana US.

So in my approach NP is the same as nurse in private practice, in other words self- employed, and likely to be operating a standalone clinic as opposed to one who is employed. Nurses in this category do not work under physicians. Private maternity homes fall under the governance of the Kenya Registered Midwives Association (KRMA). Some maternity and nursing homes are run by other health care professionals, such as doctors and clinical officers.

According to Private Nurse Practitioners’ (PNP) Chapter, the association ‘encompasses nursing experts with at least 5 years post registration certificates who have advanced to operate their own facilities countrywide thereby contributing remarkably to increasing access to quality healthcare’.  Sources from National Nurses association of Kenya (NNAK, 2014) indicate that there wre over 1600 registered nurses who were  in private practice http://www.nnak.or.ke/privatenur.php. Therewere high chances a good number do not have degrees or advanced nursing education for that matter and these are not a requirement to practice but they must be licensed by Nursing Council of Kenya. The clinic or the outfit they run must comply with the (multidisciplinary) statutory checklist nckenya.com/wp-content/…/Guidelines-for-Private-Practice-Nurses.pdf.

As much as it took sometime (late 90s) for nurses to be allowed a license to practice privately, nurses are not essentially in competition with doctors in this aspect though one cannot rule out that from a business point of view. Nurses in Kenya usually opt for rurals, the estates while physicians practice in plazas in large towns. Every doctor looks forward to specialization and they have incentives to do them. A few general practitioners (those with one degree MBChB) perhaps may be referred to as primary care physicians (PCP), but certainly I am not too sure if there is any PCP’s as such in our context. Medicine and disciplined forces are about the only careers that guarantees one a job in the government after graduation in Kenya. Nurses have to hassle for placements, in recent years  they have managed to secure stipends during internship after BSN but after that they have to look for a job.

I agree that in Kenya too nurse practitioners will not solve the primary care crisis. But again we also have clinical officers. But expanding this discussion that way would bring in many other issues that are beyond the scope of this article. But my reader is free to add a voice in that direction. But do we have nurse practitioners (NPs) in Kenya? Yes to some extent as explained above.

[Compleat Nurse has a MS in Nursing Leadership and Health Systems Administration from University of Colorado Denver].

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