Nurses and midwives represent a vast majority of the health workforce in Kenya. They are trusted by their communities and are often the first and only health professionals with whom patients interact when needing care. Despite its critical role, nursing and midwifery practice in Kenya continues to face systemic challenges that hamper professional development and the delivery of quality healthcare services to the community.
These include industrial strikes driven by frustration with poor working conditions and remuneration, inadequate quality of nurse and midwifery education and training, and challenges in workforce supply and demand. With the high needs-based shortage of nurses and midwives, the situation is expected to deteriorate even further if mitigating actions are not set in motion.
The development and recent launch of a comprehensive National Policy for Nursing and Midwifery, Revised Scheme of Service and Scope of Practice in Kenya puts the profession on course to manage these various challenges.
Co-creation: The first step to a formalized policy for nurses and midwives in Kenya
Given the country’s vast requirements, at the Johnson & Johnson Center for Health Worker Innovation (the Center) we recognized early in our journey that a concerted, multi-stakeholder approach would be necessary to achieve any success. We needed to create an enabling environment that brought everyone around the table and potentially crowded in resources to achieve a common goal. The role of government here was central, and we needed to ensure strong engagement and alignment to government policies from the outset.
Therefore in 2019, with support from Johnson & Johnson Foundation, we joined forces with the Aga Khan University School of Nursing and Midwifery to convene a co-creation workshop attended by the Nursing and Midwifery Associations, the Nursing Council, the Directorate of Nursing, Liverpool School of Tropical Medicine, M-Health Kenya and other stakeholders. Together, we explored ways to alleviate the challenges facing the profession in Kenya using innovative techniques such as storyboarding, rapid prototyping and mental benchmarking and ideated potential solutions for several priority thematic areas.
Outputs from the discussion centered on ways in which we might: lobby a policy that governs, regulates, and progresses the nursing and midwifery profession in Kenya to operate within a well-resourced health system; comprehensively review and update the scope of practice for all nursing and midwifery cadres; improve nurses’ and midwives’ self-image, raise the profile of clinical nursing, increase public perception of the profession, and give nurses and midwives a voice; and ensure nurses and midwives feel adequately connected to the health system and their peers by developing a centralized, integrated digital platform that captures, stores and transmits data.
An alliance and national policy that supports nurses and midwives—a first for Kenya
The launch of the Nurse and Midwife Alliance in Kenya in August 2021 following the co-creation workshop represented a turning point for the profession, establishing a platform to convene all nurses and midwives in the country and facilitate professional growth. The alliance has proved a formidable force in successfully and regularly bringing together health professionals, health sector stakeholders, donors and other partners who are working to improve education, professional development, standards, regulation, and terms of service for nurses and midwives.
The culmination of this work has been the development and launch of a robust National Policy for Nursing and Midwifery. The policy is a first for Kenya and serves as a guideline for improving regulation and education frameworks, workforce planning and management, increasing nurses’ and midwives’ participation in decision-making, and sustainable financing for nursing and midwifery services. It speaks to the current and future state of nursing and, implemented correctly, will be critical in guiding execution of all health programs in the country and increasing sustainability of these programs.
"The launch of the policy documents has made a significant difference in the way the profession is held, and how we interact and collaborate with each other. Nurses and midwives have a direct line to the Ministry, facilitating more open channels of communication. Conversations are more constructive, and engagements are focused on how we can work together to find solutions and improve the current and future state of nursing and midwifery in Kenya. The new policy is helping to change the view of healthcare from something that people see as a problem to something that is seen as the solution that it is."
Now ministry-approved and recognized, the new policy seeks to ensure that nurses and midwives benefit from continuous professional development, fair pay and fulfilling working conditions. It will also aid in increasing recruitment, deployment, retention, and motivation for nurses and midwives, thereby improving access to quality health services across the country, particularly in remote and underserved areas.
Additionally, a Revised Scope of Practice will articulate duties and evaluate all levels of the professions’ functions, and the ongoing development of the Scheme of Service will define a clear career pathway for nurses and midwives in Kenya. This will reinforce health professionals’ understanding of the critical role they play towards primary healthcare and its overall contribution to universal health coverage in Kenya.
The policy was launched in May this year to coincide with Nurses and Midwives Week. The event offered the ideal platform to rally a host of stakeholders behind the policy and renewed efforts to professionalize and enhance the public image of nursing and midwifery in Kenya. It also provided an opportunity to demonstrate the value of the alliance and the ways in which it can strengthen and coordinate future interventions among stakeholders for the benefit of health professionals.
A sustainable future for Kenya’s nursing and midwifery profession
The launch of a new alliance and policy to champion nurses and midwives in Kenya signals strong progress against the Center’s priority challenge areas. Together with dedicated partners, we have come a far way in laying a solid foundation for nurses and midwives to succeed in their profession and deliver health for all. But we also recognize that we need to be deliberate in our efforts to create a sustainable future for the profession.
We continue to build on our commitment to nurses and midwives through, for example, scholarship support for specialist training and education (particularly in areas such as oncology and mental health), championing the development of mHealth technologies to better connect and integrate nurses and midwives, and resilience studies to promote self-care so that nurses and midwives can consistently deliver on the services needed in the healthcare system.
Nurses and midwives are often the first line of defense for patients seeking care, and need to be adequately supported, recognized and celebrated for the critical work that they do, every day. At the Center, we will be relentless in helping them achieve this, and urge you to join us.