Health systems are often discussed in terms of policies, statistics, and targets, and yet, behind these decontextualised numbers and charts are health workers carrying the weight of care and service delivery. 

The importance of effective governance and the strategic management of human resources for health (HRH) is well recognised as central to achieving Kenya’s health system goals. Still, difficult questions persist. Why are there chronic shortages of health workers? What causes the persistent inequitable distribution of health personnel across the country? How do these challenges affect the well-being of those at the forefront of delivering care? 

These questions have become even more compelling in the wake of donor transitions and shifts in global health financing approaches. Nonetheless, despite widespread concern, the full extent and lived realities of these upheavals in the Kenyan context remain insufficiently understood. 

Against this background, this project – “Towards a Unified Health Workforce Information System: Examining the Kenyan Health Workforce Landscape, and Policy and Institutional Frameworks Governing Health Providers and Information” – was conceived. 

A People-Centred Fieldwork Approach Across Diverse Counties

Our goal was to generate evidence on Kenya’s current HRH landscape, examine the implications of donor transition on the health workforce, and contribute to the co-creation of a national health workforce master registry. At its heart, however, this project focuses on people: listening to those who hold the health system together every day, often quietly and against immeasurable odds.

Fieldwork took us to seven purposively-selected counties – Kajiado, Trans Nzoia, Homa Bay, Garissa, Tharaka Nithi, Murang’a, and Nairobi – representing the diversity of Kenya’s health system. The counties were chosen to reflect the varying regional blocs, rural and urban contexts, and disease burdens. From busy urban facilities to remote communities, each county revealed a different face of healthcare delivery, and yet they shared remarkably similar challenges and aspirations.

What We Heard in the Field: Voices, Realities, and System Pressures

Throughout our journey in the field, we engaged with individuals across all levels of the health system. We held focus group discussions with community health workers, frontline healthcare providers, and facility managers to better understand the realities of service delivery since the devolution of health services, and more recently, donor withdrawal shocks. 

These conversations offered more than data; they revealed resilience, frustration, innovation, and hope. Health workers spoke candidly about the pressures they face, the gaps that hinder effective service delivery, and practical solutions that they believe could bolster the health system going forward.

We also conducted interviews with county leaders and managers responsible for overseeing healthcare delivery. These discussions provided important governance and policy perspectives that shed light on the complexities of managing health systems amid financial constraints and evolving health demands. In addition, national-level stakeholders from government and non-governmental institutions shared insights on broader policy directions and emerging priorities for workforce planning and sustainability.

Key Reflections: Challenges, Resilience, and the Need to Be Heard

After two months of immersion in counties collecting data, and as we now begin the data analysis phase, several observations stand out from our field experiences. 

First, healthcare workers are eager to be heard. Across counties and healthcare worker cadres, many showed appreciation for simply being asked about their experiences. The recurring sentiment was that the people closest to service delivery are often the least consulted in decisions that affect their work and wellbeing.

Second, the challenges facing the health workforce require urgent and sustained attention. Staffing shortages, resource limitations, and concerns about worker welfare and burnout continue to shape the realities of care delivery. However, despite these difficulties, we encountered inspiring examples of local innovation and adaptive leadership practices that could inform learning across counties.

Third, and perhaps most striking, was the optimism we encountered. Despite the constraints, many health workers remain deeply committed to serving their communities. There is an unmistakable belief that meaningful change is possible if health workers are listened to and more actively involved in shaping the systems they sustain.

Moving Forward: We are Willing, But We Need Support

As we move into the phase of data synthesis and analysis, one reflection stands out clearly: healthcare workers throughout the country are willing to do their best for communities that they serve. What they ask in return is equally clear: better support, meaningful engagement, and systems that listen. 

To us, listening to these voices is not simply part of research; it is part of building stronger and more responsive health systems.