The Impact of an Emergency Hiring Plan on the Shortage and Distribution of Nurses in Kenya: The Importance of Information Systems/ L'impact D'un Plan De Recrutement D'urgence Sur le Manque et la Repartition Des Infirmiers et Infirmieres Au Kenya: L'importance Des Systemes D'information/ El Efecto De Un Programa De Urgencia Para la Contratacion Sobre la

Introduction The inequitable level of health-care provision in low- to middle-income countries compared with high-income countries has been well documented. (1-5) A variety of reports, including The world health report 2005 from the World Health Organization (WHO), Human resources for health: overcoming the crisis from the Joint Learning Initiative and the proceedings of the 2004 High-Level Forum on the United Nations Health Millennium Development Goals have described the correlation between the size of the health-care workforce and the health of a country's population. (2,6-8) With more than 24% of the global burden of disease and only 3% of the world's health-care providers, sub-Saharan Africa is facing an especially acute health worker shortage. (2,5) Hence, there is some concern about whether this region can even come close to the Millennium Development Goals for 2015) (1,7) The shortage of health-care workers in low-income countries is complicated by problems with motivation and retention and by unemployment among health-care providers who are professionally qualified but unable to find jobs. (9-12) Many low-income countries face fiscal restraints on hiring within the public sector (13) due to macroeconomic policies (2) that cap salaries, freeze hiring and neglect education and training. (6) Prolonged application of these policies has resulted in a severe erosion of the human infrastructure for health from which many countries are only now emerging. (6) In Kenya, the hiring freezes that began in 1994 eventually led to the unemployment of trained nurses. (14) Public-private partnerships, such as those described in this paper, can facilitate the hiring of trained but unemployed health-care workers while national governments create the budgetary space necessary to increase hiring in the public sector. The maldistribution of employed health-care workers between urban and rural areas exacerbates inequitable healthcare provision. (15,16) Like many countries in Africa, Kenya has a maldistribution of health-care workers that has a negative impact on achieving global health-care goals, including goals for rural primary health services and for the prevention and treatment of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS). (17-19) Whereas international migration and the "brain drain" have received considerable attention, (20-23) there is less awareness about the negative impact of internal health workforce migration from rural to urban areas. (12,24,25) Among the factors contributing to staff imbalances in the rural workforce are individual preferences for particular working and living conditions, the desire for professional opportunities not typically found in remote areas, financial incentives and weak deployment practices. (15,25) Recently, Kenya's National Health Sector Strategic Plan II noted disparities in health services among the country's eight provinces and stated an intention to rectify these disparities and "shift resources from relatively well-served areas to areas of extreme poverty". (25) One way the Government of Kenya is attempting to remediate acute nursing shortages in remote and underserved areas is through an emergency hiring programme. This programme, referred to as the Emergency Hiring Plan (EHP), focuses on speeding up hiring and deployment and upgrading training. It is supported by five donor organizations: the Clinton Foundation jointly with the Danish International Development Agency (DANIDA); the United States Agency for International Development (USAID)-funded Capacity Project; the Global Fund to Fight AIDS, Tuberculosis and Malaria; the International Center for AIDS Care and Treatment Programs (ICAP); and the United Nations Children's Fund (UNICEF). The aim of the EHP is to increase nursing staff in public health facilities through donor-supported l- to 3-year contracts. (26) Donors' support covers workforce recruitment, employment contracts, salary subsidies and staff deployment. …