Off the smooth Nairobi-Meru highway, at the busy Karaba Trading Centre and Market, begins the rough and dusty road to Mbonzuki Dispensary.

Fifty-five kilometers later you’ll find Pauline Wangari, one of the two health workers who run the facility and provide health care for Mbonzuki Village, a very remote part of Kenya’s Embu County.

The temperatures are high here and the wind is gusty. But come the rainy season, the road out—and to any other health facility—becomes impassable except by foot or heavily levied motorbike (drivers always charge more in the rain). 

Pauline is a registered community health nurse. She provides family planning services and immunizations and prescribes and dispenses medications. She even delivers babies.

She also oversees the facility’s comprehensive care center, helping HIV-positive clients and counseling them on the importance of taking their antiretroviral drugs on time. If they don’t, their viral loads increase and they are more apt to get sick or infect others.

Before Pauline came to Mbonzuki three years ago, the dispensary just had one employee. Paul Munami, now her supervisor, used to care for a population of about 10,000 by himself.

Kenya Needs More Paulines

Kenya has a serious shortage of health workers. There is only 1 doctor, nurse, or midwife for every 1,000 people, less than half the minimum recommended by the World Health Organization. The deficit is even worse in hard-to-reach areas like Mbonzuki Village—health workers tend to prefer to live and work in more urban areas where they have access to schools, social life, Internet, and other amenities.

Kenya’s urgent need to expand access to HIV prevention, care, and treatment services puts a further strain on its health workforce. Across Kenya, approximately 1,600,000 people live with HIV and only about 650,000 of them have access to antiretroviral treatment. Although new HIV infections and related deaths have dramatically decreased, 101,560 new HIV infections still occur each year and 58,465 HIV-related deaths occurred in 2013.

The Ministry of Health has made tremendous efforts to address health worker shortages, but there are still not enough workers like Pauline to make high-quality services available to everyone.

For example, less than half of all births are attended by skilled health workers, a fact that contributes to many maternal and infant deaths. Kenyan women have a 1 in 53 lifetime risk of dying in childbirth and the infant mortality rate is 39 deaths per 1,000 live births. And only about 70% of HIV-positive women receive antiretroviral treatment to prevent mother-to-child transmission of HIV.

Faster Recruitment, Hiring, and Deployment

The Government of Kenya, as expressed in its Kenya Vision 2030, is committed to making faster progress toward combatting HIV and AIDS, reducing the country’s high maternal and child mortality rates, fighting other infectious and noncommunicable diseases; and expanding reproductive health and family planning services.

And the government’s Kenya HIV Prevention Revolution Roadmap aims to reduce new HIV infections to zero by 2030. Aligned with the Kenya Vision 2030 blueprint, the roadmap emphasizes effective health service delivery and specifically recommends the adequate staffing of health facilities.

Through USAID-funded projects, IntraHealth International has been helping Kenya meet these goals by strengthening the country’s systems to train, manage, recruit, post, and retain a high-quality and equitably distributed health workforce.

In 2006 IntraHealth and partners launched the Emergency Hiring Plan to rapidly hire and deploy additional health workers. At the time, staffing in rural areas was entirely inadequate—half of health centers had fewer than three staff members, and one in ten dispensaries like the one at Mbonzuki had no staff at all.

IntraHealth worked with the government to design a new hiring process and with health workforce management teams to pinpoint staffing gaps. All the 830 identified high-priority posts were filled and all new hires—including clinical officers, nurses, midwives, lab technicians, and pharmacists—were trained to provide HIV care.  

As needs evolved, IntraHealth also focused on improving the recruitment and onboarding of newly hired health worker through the Rapid Hiring Plan. The new processes have reduced the time it takes to recruit and fill new positions from over a year to just three-and-a-half months and improved access to HIV and other services. The ministry adopted this model and expanded its employed health workforce by over 10,000 to serve at the community level for three years under its Economic Stimulus Program.

Now IntraHealth’s Human Resources for Health Capacity Bridge project recruits, contracts, and deploys health workers to 219 health facilities in 44 of the 47 counties, concentrating on underserved and high HIV areas. Pauline is one of 837 health workers the project contracted to support HIV care and treatment in public health facilities. In all, IntraHealth’s projects have contracted over 3,000 health workers.

The project is also working to transition the health workers to county government payrolls in order to sustain HIV care and treatment interventions. As of April 2015, 400 of the project’s contracted health workers, including Pauline, had transitioned to county payrolls.

Meet Pauline and other contract workers in Kenya. 

It's Still Tough

Pauline was posted at Mbonzuki Dispensary in April 2012, and has worked and lived on the grounds ever since.

She puts in long hours, sometimes six days a week, and cares for up to 70 clients a day.

The facility lacks electricity (and probably won’t get it any time soon) and piped water. There’s a shortage of essential medicines and equipment. And she and Paul need more personnel to handle the heavy patient load.

“It’s tough here,” she says.

Pauline also has more personal concerns. Her four-year-old daughter is due to start school soon. “With no kindergarten school in the village, it’s a difficult situation,” Pauline says. ”My passion for community health nursing and my responsibility as a parent is a dilemma I’m struggling with.”

It’s a problem rural health workers face all over the world.

Nonetheless, Pauline strives to keep the villagers’ hope of better health care down the road alive. She remains upbeat about her work, and appreciates the employment opportunity.

For Paul, he’s grateful for Pauline’s presence. “Without Pauline, I would most likely be alone and this work would be impossible.”

Want to help health workers like Paul and Pauline? Consider donating to IntraHealth.

Photo above and slideshow photos by Wycliffe Omanya for IntraHealth International.

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Pauline Wangari is a Kenya Registered Community Health Nurse and one of 837 health workers deployed under the Sustainable Health Workforce model, which is funded by the US Agency for International Development and led by IntraHealth International’s Human Resources for Health Capacity Bridge project. The project partners with USAID implementing partners, faith-based organizations, and the public and private sectors to improve health workforce management, strengthen national health workforce policies, and roll out the country’s health workforce information system to enhance the quality and equity of health service delivery and, ultimately, to improve health outcomes for the people of Kenya.