Does Kenya Owe Her Nurses a Job?

Photo Courtesy of Nursing Workforce Report

Does Kenya owe her nurses a job? Or do we just fail to absorb and place them? According to the Health Workforce Status Report (released on 5th May 2017), the ratio of nurses per 10,000 Kenyans varied from as high as 9.7:10,000 in Nairobi to as low as 0.1:10,000 in Mandera. Another comprehensive Kenya Nursing Workforce Report in 2012 spoke out loudly about the dire need for placements of nurses. The supply side was not that bad, the demand side was real, but the gap had persisted.

Certainly, no one owes nurses a job or so it seems, yet Kenyans were entitled to quality, accessible, affordable health care. This was in line with the constitution and universal health coverage Big Four Agenda. Perhaps Kenya was ill-prepared for this challenge. Nurses, on the other hand, must ensure they got paid what they’re worth.

“Nursing is a profession for which you can never be out of work because there is always a demand for health care in Africa”,  a nurse who had outmigrated in the early 2000s to the US said. “But people are not willing to employ because there is no money.” Nursing is without dispute an international career, was highly regarded and well paying one for that matter.  Back in 2005, the U.S. Bureau of Labor Statistics projected that nursing would create the largest number of new jobs growing much faster than average for all occupations through 2014. The Bureau of Labor Statistics projects 1.2 million additional registered nurses will be needed in the healthcare workforce by 2020.

This is not to say that it is an easy job and its not for everyone. Even where it appears like there could be a scramble for nurses a good number of nurses were leaving nursing altogether. Some quit nursing and move on to other sectors that require a nurses expertise. In 2016, sources from NHS Trust of the UK indicated that 40,000 nurses quit their job that year.

According to American Association of Colleges of Nursing (AACN), nursing schools in US turned away 79,659 qualified applicants in 2012 for lack of faculty, clinical preceptors, classroom space, and clinical placements. This progressive nursing shortage cannot be addressed if nursing students leave school or newly graduated nurses change career for whatever reason.

In mid-2017 Nursing and Midwifery Council of the UK (NMC-UK) indicated that more nurses were leaving the national register than those joining it. The Netherlands indicated that there were 200,000 nurse shortages by August 2017. Sources from US Bureau of Statistics by mid-2017 predicted that there would be 100,000 vacant registered nurses jobs by the year 2022.

The United Kingdom, the United States, Norway, Australia and Ireland among others were currently in dire need of nurses due to the huge demand for healthcare. Changing consumer demands in developed countries will continue to increase demand for more health workers above the “indigenous supply”. The other reason being low enrollment in nursing schools and the retiring ‘baby boomers’ generation of nurses.

Evidence showed that nurses often leave because of low compensation, lack of educational or other opportunities, poor working and living environments, and inadequate social amenities. These poor conditions push workers away from areas where they are most needed.

Simultaneously, better conditions pull them toward better work opportunities and a better life, resulting in the migration of health workers, both internally (e.g., rural to urban) and internationally. Unfortunately actively contributing to the brain drain from the developing world to the West. “… sometimes the best and the brightest leave,” said Dilip Ratha, a World Bank senior economist and expert on the brain drain phenomenon.

Currently, the Kenya government plays a limited role in overseas employment for its citizens. Individual Kenyans exercise their right to seek better returns for their labour wherever they can get it. However, Kenya needs to develop a structured labour export model. Many Kenyans nurses were unsure what the hiring process was like in foreign countries and there was the ever-present fear of exploitation by middlemen, agents.

Nurses needed to ask country-specific questions even as they endeavor to venture into the global community. They need an expert negotiator (who is on their side) before signing that job offer. It is not unusual to take up a contract only to find out later that your duties seem to be expanding far and wide. You need to have an outstanding memory to sign all those papers.

The transitioning itself could be a big blow to many of the things one always liked. Though inadequate one could always check on some online self-help links. Probably the most important thing to ask yourself is – how much you actually want this? Getting really excited about the American dream can lead one to have a hazy mind.

This is not to say we have enough nurses ourselves or do we just fail to absorb and place them? Mr. Rakuom a former Chief Nursing Officer with the Ministry of Kenya did a case study in 2010. Section five of the report covered nurses outmigration as a real area of concern. Earlier reports dating 2008 predicted this phenomenon.

The Nursing Council of Kenya (NCK) receives hundreds of clearance request every year for nurses wishing to outmigrate.  Nearly 600 nurses leave the country annually to seek greener pastures overseas. The Nursing Council of Kenya says a majority of them were aged between 21-35. Most go through referrals, green card lottery and, recruitment agencies e.g Avant.

But then no one should be looking into Africa to get nurses eti…‘because they are cheaper’. If our counties continue hiring them on contracts for a paltry sum they will be driving the rest of the world to believe nurses were cheap!

I believe Kenya can export nurses. If we are unable to absorb our own nurses then let’s give them that chance elsewhere. It is a feasible, viable development strategy, at least so observed Patsy Lewis in Social and Economic Studies.

One needs the necessary knowledge and competencies that on the minimum can allow them to practice as an entry level staff nurse out there. We could enhance this in some areas touching on skills mismatches and how to pass licensing exams during the nursing training and we would be good to go:

  • Home-based care
  • Geriatrics
  • Professionalism
  • Standards
  • Quality improvements
  • Patient safety
  • Treatment adherence
  • Palliative care
  • Evidence-based practice
  • Case study for each patient
  • Case conference/specialty boards
  • Care givers support groups
  • Nursing informatics
  •  etc

Indeed it is about the high time we developed a deliberate policy on training nurses for an export model like Philippines, India, Zimbabwe, Ghana, Ethiopia etc. Almost all Caribbean countries do,  they were rated the highest contributors of skilled nationals to developed countries. Within the African continent, a majority of the nurses prefer working in Botswana and South Africa

At some point in  Dr. Da Costa Aboagye urged the Ghanaian government to develop a strategic arrangement to export nurses officially to countries where their services are needed. He cited that this was a viable foreign exchange, the nurses would improve the economic fortunes of their families through remittances. This would ease the unemployment among the youth. Many nurses had continued to remain unemployed after the completion of their academic studies and mandatory rotation.

Dr. Costa added “The Philippine government has a formal arrangement with the United Kingdom to export nurses. Other countries like Cuba have similar arrangements with some governments of developed and developing countries to export nurses…” Why not Kenya? What is so hard about coming up with a policy document. Nurses themselves can spearhead this. Come up with a key piece of legislation that can institutionalize nursing labor migration and put in place an overseas employment strategy.

Certainly, it will raise the bar in terms of quality of training, terms of hiring as well as remittances of foreign exchange. Therefore overseas employment for nurses should not be seen as an end in itself but a means to a higher end. We need a strong development policy at home to retain most of what we got as well as attract back those who had left.

This is not to mean that we do not have the dark side of migrant work. The fact is that once out of Kenya the country really has less control over what happens to the worker out there.  Nevertheless, the government can have a strategy to manage nursing outmigration flow. We can learn lessons from Cuba and Philippines on nurse exporting. The international centre for nurse migration is another resource.

You can check out other developing insights concerning Cuban Docs. For instance, why not embrace Cuban docs and export Kenyan nurses here

Feel welcome to sample another article -Which should we do first? Universal health care or universal health cover or both? Look out for my article on Shallom Hospital.

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