Kenyas maternal mortality ratio is relatively high at 342/100000 live births. Confidential enquiry into maternal deaths showed that 90 of the maternal deaths received substandard care with health workforce related factors identified in 75 of 2015/2016 maternal deaths. Competent Skilled Health Personnel SHP providing emergency obstetric and newborn care EmONC in an enabling environment reduces the risk of adverse maternal and newborn outcomes. The study objective was to identify factors that determine the retention of SHP 1 5 years after EmONC training in Kenya.
A cross-sectional review of EmONC SHP in five counties Kilifi Taita Taveta Garissa Vihiga and Uasin Gishu was conducted between JanuaryFebruary 2020. Data was extracted from a training database. Verification of current health facilities where trained SHP were deployed and reasons for non-retention were collected. Descriptive data analysis transfer rate by county and logistic regression for SHP retention determinants was performed.
A total of 927 SHP were trained from 20142019. Most SHP trained were nurse/midwives 677 73 followed by clinical officers 151 16 and doctors 99 11. Half 500 54 of trained SHP were retained in the same facility. Average trained staff transfer rate was 43 with Uasin Gishu lowest at 24 and Garissa highest at 50. Considering a subset of trained staff from level 4/5 facilities with distinct hospital departments only a third 36 of them are still working in relevant maternity/newborn/gynaecology departments. There was a statistically significant difference in transfer rate by gender in Garissa Vihiga and the combined 5 counties p0.05. Interval from training in years 1 year AOR4.2 2.18.4 cadre nurse/midwives AOR2.5 1.44.5 and county Uasin Gishu AOR9.5 4.6- 19.5 Kilifi AOR4.0 2.17.7 and Taita Taveta AOR1.9 1.13.5 p0.05 were significant determinants of staff retention in the maternity departments.
Retention of EmONC trained SHP in the relevant maternity departments was low at 36 percent. SHP were more likely to be retained by 1-year after training compared to the subsequent years and this varied from county to county. County policies and guidelines on SHP deployment transfers and retention should be strengthened to optimise the benefits of EmONC training.