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Suggested citation: Kenya Ministry of Health (MOH) and IntraHealth International, 2012. Report
of the Rapid Baseline Survey of the National Trainining Mechanism in Kenya. Nairobi, Kenya:
MOH.
Rapid Baseline Survey of the National Training Mechanism in Kenya iii

Table of Contents
LIST OF ACRONYMS.....................................................................................................viii
EXECUTIVE SUMMARY.................................................................................................. 10
INTRODUCTION ............................................................................................................ 12
PURPOSE OF THE ASSESSMENT .................................................................................... 12
METHODOLOGY........................................................................................................... 13
Assessment questions ......................................................................................................................... 13
Assessment design and overview by result area ........................................................................... 13
IR 1: Supporting increased number of new health workers.........................................................13
IR 2: Training Needs Assessment......................................................................................................13
IR 3: Strengthening the capacity of training institutions...............................................................14
IR 4: Strengthening regulatory bodies to enhance training demand........................................14
Assessment sites................................................................................................................................... 14
Target population and assessment sample.................................................................................... 15
Data collection methods................................................................................................................... 15
Data collection.................................................................................................................................... 16
Data quality assurance...................................................................................................................... 16
Data Analysis........................................................................................................................................ 16
Survey Limitations ................................................................................................................................ 17
Sample Size........................................................................................................................................17
No Response .....................................................................................................................................17
Unavailability of data.......................................................................................................................17
Ethical considerations and human subject protection................................................................. 17
Privacy for research participants...................................................................................................... 17
Confidentiality ..................................................................................................................................... 17
Compensation..................................................................................................................................... 18
RESULTS ......................................................................................................................... 18
Demographic information about study sample ............................................................................ 18
Intermediate Result 1.................................................................................................. 18
Forecasting training needs ................................................................................................................ 18
Creating an enabling environment for training fees access....................................................... 19
Funding of student fees ...................................................................................................................19
Average total annual fees for in-service training .........................................................................19
Increasing capacity of training institutions...................................................................................... 19
Number of health workers graduating by region.........................................................................21
Number of student allowed to enrol by regulatory bodies.........................................................21
Training institutions’ output performance......................................................................................22
Barriers to increasing training capacity .........................................................................................23
The survey collected data from the training institutions on existing provision of in-service training,
coordination of training in the regions, database processes used to track in-service training for health
workers in the institution and linkages to MOH and regulatory bodies.................................................23
Facilitating training.............................................................................................................................. 23
In-service training for health workers..............................................................................................23
Coordination of in-service training at surveyed institutions.........................................................23
Tracking training through training database and data linkages ...............................................24
Recommendations for linking database to MOH and Regulatory bodies ...............................24
Capacity of training institutions to offer continuous professional development (CPD) training
............................................................................................................................................................25
Rapid Baseline Survey of the National Training Mechanism in Kenya iv

CPD/CME Courses ............................................................................................................................................25
CPD/CME policy, guidelines and calendar...................................................................................................26
Documentation of in-service training, CPD/CME..........................................................................................26
Business management tool..............................................................................................................................27
Funds for in-service CPD/CME training ...........................................................................................................27
Learning approaches and CPD/CME Calendar...........................................................................................27
Acceptance of learning approaches for CPD/CME....................................................................................27
Evaluating performance.................................................................................................................... 28
Barriers to meeting and increasing training demand..................................................................28
Developing content and courses to support curricula................................................................. 28
Improving the capacity of faculty and clinical mentorship ........................................................ 29
Induction training for preceptors/mentors ....................................................................................29
Pooling mentorship programs and resources ...............................................................................32
Framework for assessing preceptor/clinical instructors................................................................32
Capacity to deliver training through innovative approaches ...................................................33
Upgrading training facility management systems and infrastructure ........................................ 34
Clinical placement sites...................................................................................................................34
Existing infrastructure for adopting new technologies to train health workers for CPD and
accreditation ....................................................................................................................................35
Guidelines for curriculum development and implementation...................................................35
Capacity existing in the regulatory bodies to coordinate and regulate licensure and
accreditation of training institutions and CPD..............................................................................36
CPD/CME accreditation, review and curriculum guidelines .......................................................................36
Linkages to MOH and training institutions......................................................................................36
Lessons learned from training accreditation programs...............................................................37
Training regulatory framework ........................................................................................................37
Discussion .................................................................................................................... 38
Current state of forecasting for new health workers..................................................................... 38
Current state in addressing health workers training demands.................................................... 38
................................................................................................................................................................ 39
Existing models and gaps in models used to assess and update training needs in the training
institutions ............................................................................................................................................. 39
Conclusion and Recommendations ......................................................................... 41
Current state of forecasting for the health workers....................................................................... 41
................................................................................................................................................................ 42
Existing models and gaps in models used to assess and update training needs in the training
institutions ............................................................................................................................................. 42
Existing infrastructure for adopting new methodologies to train health workers for CPD and
accreditation....................................................................................................................................... 42
accreditation of training institutions and CPD. .............................................................................. 42
APPENDIX A: List of Participating Institutions............................................................. 44
APPENDIX B: Introduction and Consent.................................................................... 45
APPENDIX B: Approval Letter from MOH ................................................................... 57
Rapid Baseline Survey of the National Training Mechanism in Kenya v

List of Tables and Figures
Table 1: Target Survey Respondents by Region...................................................................................... 15
Table 2: Target Survey Respondents......................................................................................................... 15
Table 3: Numbers of Health Workers Graduating by Type of Institution ............................................. 21
Table 4 : Perceived rates for acceptance of e-learning, mobile and distance learning ............... 28
Table 5: Existence of joint meetings by type of training institutions..................................................... 29
Figure 1 - Respondents by Ownership of Institution................................................................................ 18
Figure 2 - Funding Sources for Student Fees at Surveyed Institutions .................................................. 19
Figure 3 - Comparison of Pre-service Enrollment and Graduation by Number of Health Workers
and Cadre........................................................................................................................................... 20
Figure 4 - Actual Enrollment Compared to That Allowed by Regulatory Bodies .............................. 22
Figure 5 - Training Institutions' Performance against Maximum Output Capacity............................ 22
Figure 6 - Barriers to increasing training capacity .................................................................................. 23
Figure 7 – Training Institutions’ Performance on Tracking Training through Databases ................... 24
Figure 8 - Training Institutions' Suggestions for Improving Stakeholder Linkages ............................... 25
Figure 9 - Existence of CPD/CME calendar............................................................................................. 26
Figure 10 –Barriers to meeting current demand ..................................................................................... 28
Figure 11 - Preceptors/mentors completed induction training............................................................ 30
Figure 12 - Channels used for sharing clinical knowledge.................................................................... 31
Figure 13 - Frequency of Preceptor/Mentor Engagement in Self-Directed Learning as Reported
by Training Institutions......................................................................................................................... 32
Figure 14 - Recommended Areas to Pool Mentorship Programs with Other Training Institutions... 32
Figure 15- Resource Support Available for Mentorship by Number of Training Institutions.............. 33
Figure 16 – Capacity of competency for the mentors to Convert Curricula to Distance, e-
Learning and m-Learning Formats................................................................................................... 34
Figure 17 - Number of Clinical Placement Sites by Region................................................................... 34
Figure 18 - Capacity Gaps for Implementing Alternative Training Approaches by Number of
Training Institutions.............................................................................................................................. 35
Figure 19 - Frequency of Evaluating CPD/CME Programs by Regulatory Bodies ............................. 36
Figure 20- Strength of Regulatory Bodies’ Linkages with MOH and Training Institutions .................. 37
Rapid Baseline Survey of the National Training Mechanism in Kenya vi

ACKNOWLEDGEMENTS
This baseline survey involved a wide variety of stakeholders. We wish to acknowledge and thank
the Permanent Secretaries of both Ministry of Medical Services (Ms Mary W. Ngari, CBS) and
Public Health and Sanitation (Mr. Mark K. Bor , CBS) for giving us an opportunity to carry out this
important assessment. Special thanks to the Heads of Departments of Human Resource and
Development of the two ministries, Mr. David Njoroge and M/s Grace Odwako who facilitated
the approval processes and guiding the survey.
We also acknowledge United States Agency for International Development (USAID) and
IntraHealth-Chapel Hill for financing and giving technical advice. The survey could not have
been successful without training institutions, regulatory bodies and professional associations.
We are grateful to Dr. Perle Combary, Dr. Leigh Shamblin, Dr. James Mwanzia, Dr. Norbert
Rakiro, Prof. Steve Okeyo, Peter Milo, David Maingi, Martin Kinyua, Nobert Boruett, Allan
Oginga, Isaac Munene, Mohamed Ibrahim, Emily Mungai and Joelle Mumley for the role they
played for the success of this survey such as development and review of the questionnaire, data
collection, data analysis. Special thanks to Wanjiru Kangara and Dr. Hazel Mumbo for the
editorial role. We acknowledge the authors; Joyce Kinaro, Assistant Director – Monitoring and
Evaluation (M & E) and Joseph Murage, M&E Officer both of FUNZOKenya Project, IntraHealth
International.
Rapid Baseline Survey of the National Training Mechanism in Kenya vii

Rapid Baseline Survey of the National Training Mechanism in Kenya viii
LIST OF ACRONYMS
CPD Continuing Professional Development
CME Continuous Medication Education
FBO Faith Based Organization
HRD Human Resources for Health
ICT Information Communication Technology
IR Intermediate Result
IT Information Technology
KII Key informant interview
KMTC Kenya Medical Training College
MCH Maternal Child Health
M & E Monitoring and Evaluation
MOH Ministry of Health
NEP North Eastern Province
PHO Public Health Officers
PNA Performance Needs Assessment
TNA Training Needs Assessment
USG United States Government
USAID United States Agency for International Development

FOREWORD
The Ministry of Medical Services and the Ministry of Public Health and Sanitation are committed
to improving access to affordable health care services in order to accelerate the achievement of
national health targets, Millennium Development Goals and Vision 2030. To provide quality
health care to all Kenyans, there is a need to have adequate qualified health workforce that can
address current and emerging health needs in the country. This can be achieved through
training of new health workers, addressing current in-service training needs, strengthening
training institutions to increase their admission capacity and lastly to support the regulatory
bodies to improve professionalism among the health worker force.
The Ministries of Health are undertaking reforms that have the potential to promote greater
efficiency, accountability and decentralization of health training mechanism in the health sector.
In this rapidly changing environment, the Government of Kenya supported by FUNZOKenya
carried out a rapid survey to identify the areas of needs of the health workforce to ensure that
adequate numbers of well-trained health workers are available to provide quality services
throughout the country.
This report identifies key issues in the training institutions that can be used for forecasting of the
health force. It addresses health workers training demands and their capacity to offer
Continuous Professional Development (CPD) training. In addition, the survey gives useful
insights on the gaps in the existing models used to assess and update training needs in the
training institutions. Further, the survey indicates strengths and weakness of the existing
infrastructure in adopting new methodologies to train health workers for CPD as well as the
capacity of the regulatory bodies to regulate licensure and accreditation of training institutions.
We are pleased that the recommendations in this study provide the Ministries of Health and
training institutions with an opportunity to make evidence based decisions in their bid to
strengthen training mechanisms for the health workers. Together with the Faith Based
Organisations, private sector and development partners, the Ministries are ready to support
interventions that can transform health workforce training.
Dr. Francis M. Kimani, MB.ChB, MMed Dr. S.K Sharif, MBS, MBChB, MMed., MSc.
DIRECTOR OF MEDICAL SERVICES DIRECTOR OF PUBLIC HEALTH AND SANITATION
Rapid Baseline Survey of the National Training Mechanism in Kenya 9

EXECUTIVE SUMMARY
Introduction
The Government of Kenya (GOK) is determined to improve access and equity of essential health
care services to accelerate the achievement of national health targets, Millennium Development
Goals and Vision 2030. To achieve this, a well-managed heath workforce with appropriate skills
equitably distributed across the country is essential. This survey set out to identify gaps that can
be addressed by the Ministries of Health (MOH) in collaboration with FUNZOKenya project to
streamline training mechanism. The respondents were selected training institutions, regulatory
bodies and professional associations. Gaps identified in the survey include inadequate
mechanism to coordinate training data, weak linkages between training institutions, Ministries of
Health and Regulatory bodies. The survey shows that there are opportunities for the training
institutions to expand their admission capacity through improvement of infrastructure, adapting
delivery of courses through innovations and diversification of funding resources. Existing gaps in
Continuous Professional Development (CPD) can be addressed by strengthening policy and
guidelines. There is also need to improve mentorship program, through strengthening clinical
placement and skills development of the preceptors. Establishing a mechanism in regulatory
bodies to evaluate accreditation is critical, development of training regulatory framework and
development of a CPD database linked to training institutions, regulatory bodies and Ministries
of Health (MOH).
Findings
Finding of this survey show that about 57% of the training institutions do not have a mechanism
to forecast training needs and only 21% indicated they had a follow-up committee for updating
the forecast. Although majority of training institutions (71%) run in-service training courses, less
than half (43%) of them had in-service database of staff who had undertaken training. In
addition, half of the training institutions have documentation for CPD/CME (Continuous Medical
education), with only 21% having their database linked to MOH and regulatory bodies.
The results also show that majority of the students accessing training were either fully self or
self/partly public funded, a negative implication for access to health training for students from
poor and marginalized areas who cannot afford the high fee charged for training but also
training institutions could capitalize on this opportunity by increasing admission capacity for
paying students.
In relation to CPD/CME, only 29% of institutions indicated they run regularized courses for in-
service (CPD/CME) and half of them do not have a training calendar. The findings show that
traditional face-to-face remains as the most used method of training delivery with distance
learning being more preferred alternative method than mobile learning.
Lastly, that most training institutions lack Information Technology (IT) infrastructure and faculty
lack skills to convert curriculum content for new training delivery approaches. About 67% of the
regulatory bodies indicated that they did not have a mechanism to regularize accreditation. In
addition, half of the regulatory bodies do not have written guidelines for curriculum review.

Conclusion
The Government of Kenya is persuaded that the identified gaps in this survey are critical to the
health sector and need to be addressed in order to achieve national health targets, Millennium
Development Goals and Vision 2030. With the support of our development partners, the
Government of Kenya is confident that strategies to seal these gaps are in place and should be
properly implemented to enable us move towards achieving our overall objective to improve
access and equity of essential health care services.
David Njoroge, Ms. Grace Odwako
Assistant Director Director,
Human Resource Development- MOPHS Human Resource Development-MOMS

INTRODUCTION
Training is one of the key inputs into the performance of health workers and delivery of health
services in any country. A Performance Needs Assessment (PNA) of the Kenya national health
training systems that which was conducted in 2010/2011 revealed several areas of concerns and
opportunities to include:
• Linkages between stakeholders in the system are weak, which affects system efficiencies
as well as the quality of training and service delivery.
• Resources currently provided to support health care and health care training systems are
insufficient, especially in the areas of staff, health care facilities, supplies and ICT. This
affects both the quantity and quality of health care provision and health care training.
• Curricula for health care training, while strong in many aspects, are not optimized and
are not necessarily structured or standardized to deliver on national priorities.
• Clinical placements need to be strengthened in order to provide more practical and
relevant experience for students.
• Faculty and clinical preceptors need more support in terms of supervision and training in
order to perform their roles more effectively.
• Gender inequalities exist in the health training system. This has been observed to impact
on system effectiveness and need to be addressed.
The PNA recommended the establishment of a national health training policy and advisory
board to create a mechanism to coordinate the health care training mechanism in order to
strengthen linkages, increase standardization and efficiency as well as other interventions
designed to close performance gaps in the health training system.
In view of the foregoing, the Government of Kenya in collaboration with the United States
Agency for International Development (USAID) came up with a strategy to address these key
issues. This bore a USAID funded project FUNZOKenya, a 5-yr (2012-2017) initiative designed to
improve health training in Kenya. FUNZOKenya is working closely with Kenya’s Ministries of
Health, USG-funded health programs, leading health training institutions in Kenya, the National
Health HRD Working Group, and at least eight regional training hubs to strengthen training
capacity, address the quality and accessibility of training for current health workers, and support
training facilities and regulatory bodies.
PURPOSE OF THE ASSESSMENT
The purpose of this assessment was to establish baseline data and information against which the
effect of Ministries of health interventions could be assessed, specifically identifying:
• The current state of forecasting for health workers
• The current state in addressing health workers training demands
• The capacity of training institutions to offer continuous professional development (CPD)
training
• Existing models and gaps in models used to assess and update training needs in the
training institutions

• Existing infrastructure for adopting new methodologies to train health workers for CPD
and accreditation
• The capacity existing in the regulatory bodies to coordinate and regulate licensure and
accreditation of training institutions and CPD.
METHODOLOGY
This rapid assessment was a cross sectional descriptive survey using quantitative and qualitative
methods.
Assessment questions
Assessment questions identified included:
• What is the current capacity of the health worker training system to admit, graduate, and
train pre-service and in-service health workers?
• What is the current state of institutional resources available for training pre-service and in-
service health workers in Kenya?
• To what extent do regulatory bodies meet their mandates to:
o Coordinate licensure and accreditation of training institutions and CPD?
o Assess performance gaps and determine needs for continuing professional development
for health workers?
o Enforce current standards for re licensure of health workers?
o Assess current status of data generation and sharing as it relates to training information?
Assessment design and overview by result area
IR 1: Supporting increased number of new health workers
The assessment sought to understand training institutions’ capacity to train more new health
workers, especially in specialty areas; the availability and adequacy of clinical placement sites;
methods used to forecast the number of new trainees to meet established forecasting targets;
plans to increase number of health workers by cadre; and existing opportunities for health
workers to access financial support for their training. Data was also collected on the number of
trained faculty, including their qualifications, computer skills, and e-learning skills; existing
faculty/student ratios and requirements for extra space should institutions wish to expand
classroom space for new students or include new technology (computers); and respondent
recommendations for areas of the curriculum content to review and update. The assessment was
also designed to help document existing local and international linkages with other training
institutions and benefits accrued from those linkages.
IR 2: Training Needs Assessment
In conjunction with the Training Needs Assessment (TNA) that the Ministries of health in
collaboration with FUNZOKenya conducted in the summer 2012, this assessment sought
information from faculty and health service providers of different professions and cadres (public
health officers, clinical officers, nurses, pharmacists, lab technicians) on: existing provision of in-
service training, database processes used to track in-service training for health workers in the

institution, levels of staff retention; existing opportunities for professional development, felt
needs for update training, existing staff members’ computer skills, processes used to validate
health professional skills, challenges faced when seeking in-service training, opportunities and
felt knowledge gaps that hinder provision of quality health care services. The assessment also
reviewed existing mentorship methods used in the training institution and challenges existing in
the mentorship process.
IR 3: Strengthening the capacity of training institutions
In relation to capacity of the institutions, the baseline assessment sought information to
document opportunities for integrating e-Learning, m-Learning, d-Learning and offering
evening/weekend classes for both pre-service and in-service training as well as to understand
opportunities for health workforce and faculty to use self-learning via Internet and mobile
phones. Questions were also asked about current curricula used and their adequacy to meet
expected quality of services and national health priorities, challenges experienced, opportunities
for curriculum reviews and content areas recommended for improvement for each cadre as well
as opportunities for innovations in delivery of training outside the current traditional
approaches, and necessary infrastructure/technology needed to successfully implement the new
approaches. Finally, the assessment also sought to documented tools used to track performance
of learners as well as existing mentorship methods used in the training institution and
challenges and recommendations for improved mentorship and preceptorship in clinical
instruction.
An inventory of available clinical placement sites and existing staff skills of faculty in relation to
adult learning methodologies within the regional catchment areas would be documented.
IR 4: Strengthening regulatory bodies to enhance training demand
Under strengthening of regulatory bodies to enhance training, the assessment focused on
training standards, practice standards, functional databases, registration and licensing and
effective management systems. This was in order to improve their abilities to optimize training
and practice regulation.
Assessment sites
The study was carried out in a select number of training institutions throughout Kenya. Public,
Faith Based Organizations (FBOs) and private institutions accredited to train health workers were
included in the sample. Regulatory and professional bodies were also assessed. Table 1 below
shows the distribution of institutions by regions.

Table 1: Target Survey Respondents by Region
Nairobi Central South Rift North Rift Western Coast NEP Total
Public 2 2 1 2 2 2 1 12
Private 1 1 2
FBO 1 1 2
Regulatory Body 6 6
Professional Association 6 6
Total 14 2 1 3 4 2 2 28
Target population and assessment sample
The survey used a purposive convenience sample of training institutions and regulatory bodies.
The target group of training institutions identified included institutions with a national focus,
institutions in marginalized areas, public, private and FBOs and training regulatory bodies (see
APPENDIX A: List of Participating Institutions). The survey planned to interview representatives
from 15 health training institutions (including nine tertiary institutions, three mid-level
institutions from marginalized areas, Kenya Medical training Institute (KMTC) headquarter, one
private institutions and two mid-level FBOs), 6 regulatory bodies and 6 health professional
associations participated. Professional associations conduct in-service training/CMEs and
therefore an important group to participate. Respondents from each institution included
training faculty, clinical instructors/preceptors and secretaries or Chairmen of regulatory bodies
and professional associations.
Table 2: Target Survey Respondents
Respondent category Faculty Preceptors Total
KMTC Headquarter 1 1 2
MTC in marginalized areas 3 3 6
FBOs 2 2 4
Private midlevel training institution 1 1 2
Tertiary 9 9 18
Regulatory bodies 6 (Chairman/Secretary) 6
Professional associations 6 (Chairman/Secretary) 6
Total 28 16 44
Data collection methods
Data collection methods employed to generate information were key informant interviews (KII)
of stakeholders, self-assessment questionnaires (see APPENDIX B: Introduction and Consent)
and use of secondary data. Documents reviewed were identified purposively to generate
maximum data and information needs. Specifically, the project used information from the Report
on the Performance Needs Assessment of the Kenya Health Training System1
and the Rapid
Training Needs Assessment Report2
to generate tools and identify issues for probing during KIIs.
Data was collected from targeted public, private and faith-based organization (FBOs) training
institutions together with regulatory bodies and professional associations.
1
Kenya Ministry of Health (MOH) and IntraHealth International, 2011. Report of the Performance Needs
Assessment of the Kenya Health Training System. Nairobi, Kenya: MOH.
2
FUNZOKenya Project Report, October 2011.

Data collection
Qualitative and quantitative data collection was carried out from July 16th
– July 27th
2012. Open
ended questions generated qualitative data.Ten surveyors collected data under the supervision
of the M&E Team lead. Training was conducted for the surveyors before data collection, where
the tool was discussed to clarify any issues regarding the question. The questionnaire was
further reviewed by the M&E team to include all the comments during training and pre-testing
and forwarded to Chapel Hill for final approval. Surveyors were divided into five teams to cover
Nairobi, Mombasa region and NEP and Western region and Rift Valley. A supervisor was
selected to lead each assessment team.
Data quality assurance
Pre-testing was conducted by the research team members who were also involved in
development of the questionnaire and understood the data collection goals in all the result
areas. Each questionnaire was given a reference number to avoid double entries and to enhance
accuracy. During data collection, each questionnaire was systematically checked by the
supervisor, to ensure data was correctly recorded and that the information received was
plausible. Where necessary, the supervisor discussed with the surveyor to clarify information on
individual questionnaires. All supervisors regularly reported on data collection progress (number
and type of targets reached compared to the plan and type of questionnaires collected, major
events and constraints).
After completion of data collection, the survey principal team leader checked whether the
questionnaires were correctly filled out. Where data was missing or not accurate, a repeat of
data collection from the particular respondent either face-to-face, e-mail or by telephone was
carried out. After the principal team leader was satisfied with data quality, questionnaires were
handed over to the M&E officer for data entry and analysis. Data entry and analysis was
conducted using SPSS. SPSS screens were developed with the principal team leader rechecking
coding of all variables. To ensure data quality, the M&E team proceeded as follows:
• Each questionnaire was adapted as case in SPSS format.
• Entry of all data, by questionnaire, was done by maintaining quality check criteria on
labelling and coding. After the initial entry was completed, the M&E team lead checked
data quality by entering over 13% of the same questionnaires data to check for errors
and ensure accuracy.
• After analysis, results were checked for coding errors, completeness and uniformity.
Data Analysis
Quantitative analysis involved creation of dummy tables. Dummy tables indicated how
information would be analysed and presented during report writing. The dummy tables had
columns with variables while the rows contained results by their percentages and total number
of cases. Descriptive statistical analysis was used to compute frequencies, recoding of variables
and running of cross tabulations. Basic descriptive statistics on frequencies were computed to
assess the quality of data and to assist with recoding of categorical variables or grouping
variables. Frequencies were used to identify missing cases or few cases. After running

frequencies and recoding, cross tabulation was carried out. Cross tabulation was used to
compare for example, variables/responses on number of students graduating by region and
cadre. Cross tabulation would therefore help to identify and assess disparities in training needs
and capacities to conduct training across the regional hubs. Data output was organized
according to each question and by each category of respondents. This facilitated the M& E
Team to write the survey report. During the process of writing the report, further analysis was
carried out as needed. Tables, graphs and pie charts were used to present results. Qualitative
analysis was undertaken by coding open ended questions with common themes or issues
grouped together for analysis quantitatively. Responses with suggested recommendations were
also analyzed and presented in the report.
Survey Limitations
Sample Size
This was a rapid assessment that used a purposive sample of 15 health training institutions, 6
regulatory bodies and 6 professional associations. This is not a representative sample for the
entire training system; hence the conclusions may not be generalized for the entire system.
However the study identified gaps that can be used by the project as baseline indicators.
No Response
Participants were asked to provide information on a voluntary basis. As a result, responses to
some questions on some questionnaires were left blank and some questionnaires were not
returned at all. The effect of this was to reduce the size of the sample.
Unavailability of data
Some data was unavailable from respondents especially with questions that requested data for
cadre disaggregated into sex and regions.
Ethical considerations and human subject protection
The survey was approved by the Ministry of Health (MOH) under whose mandate the program is
anchored. The survey was also approved by IntraHealth Ethical committee. Written consent was
obtained from all respondents before conducting interviews. The consent form described the
respondent rights and confidentiality of the information given. During the preparation of the
survey, M&E Team and staff who were supervising for data collection undertook online human
subjects and protection training.
Privacy for research participants
Respondents who participated in the survey were assured that data collected from their
institutions will be private without access to unauthorized people.
Confidentiality
The respondents were explained about the survey and how the results would be used and about
their rights to give information or refuse. The respondents were assured that their names would
not be used in the report and all responses will be aggregated in one report.

Compensation
Respondents were to give information voluntarily and no nature of compensation was provided
as inducement to respond.
RESULTS
Demographic information about study sample
A total of 35 questionnaires out of 44 in the sample size were received which included 14 from
faculties (11 public, two private and one FBO), 13 from preceptors (10 public, one private and
two FBOs), eight regulatory/professional bodies (6 regulatory and two professional associations).
There were fewer respondents because in some areas like Western and NEP regions some
institutions were sharing the same placement clinical preceptors while there were some
regulatory bodies that have same role of professional body.
Figure 1 - Respondents by Ownership of Institution
11
2
1
14
10
1
2
13
6
2
0
2
4
6
8
10
12
14
16
Public Private FBO Total
Faculty Preceptors Regulatory bodies Professional associations
The results below are organized by objectives of the study.
Intermediate Result 1
The survey collected data from training institutions on their capacity to train more new health
workers, mechanisms or guidelines to forecast training needs and establishment of targets,
access to training by students and barriers that hinder increased admission capacity for the
training institutions.
Forecasting training needs
The survey results showed that eight out of 14 (57%) training institutions had no mechanism or
guideline to forecast training needs compared to 6 (43%) institutions with a mechanism. This

data is supported by other on- going health workforce forecasting which indicates that that
health worker forecasting models have gaps that need to be addressed in Kenya.
On updating of forecasting training needs, five institutions with a mechanism responded to this
question and three of them updated their forecast within one to two years while two had a
forecast after more than two years. On existence of a committee or a mechanism to follow-up or
update forecasting training needs in the institutions, three out of 14 institutions have such a
committee or mechanism, 4 had no such a mechanism while the remaining seven institutions
did not respond.
Creating an enabling environment for training fees access
Funding of student fees
Figure 2 below shows that training institutions utilized several options to fund student fees.
Through a multiple response question, majority of the institutions have students that pay for
pre-service training through fully self/family support and partly self & partly public.
Figure 2 - Funding Sources for Student Fees at Surveyed Institutions
5
6
8
10
12
Partly Self &
Partly Privately
Fully Private Fully Public Partly Self &
Partly Public
Fully
Self/Family
0
2
4
6
8
10
12
14
Average total annual fees for in-service training
The average annual fee for in-service course is in the range of Ksh 100,000 to Ksh 200,000. It
should be noted that the high in-service cost in universities is when health workers are
upgrading into degree courses. Other data collected by the project through a desk review of
training institutions has also established that the average annual cost to disburse for pre-service
students is as follows: Public = 101; 148; FBO = 154,271; Private = 130,588. These costs are
inclusive of the Ksh 30,000 to cover costs such as book allowance, personal effects and
transport.
Increasing capacity of training institutions
Data collected from 14 institutions (11 public, two private and one FBO) show that in the last
academic year, there were 8,561 health workers who enrolled in surveyed institutions and 5,597
health workers who graduated in the same period. Figure 3 below presents a comparison of

total students enrolled and those graduating by cadre. As shown below, surveyed institutions
are enrolling more nurses than any other cadre, followed by laboratory
technologists/technicians and clinical officers. The highest number of health workers who
graduated from pre-service training in the last academic year was in the nurse cadre, followed
by clinical officers, public health officers (PHOs), and nutritionists. Results also indicate that all
the institutions surveyed except two train nurses, six institutions train nutritionists, and four
institutions train clinical officers. There are considerably more nurses, laboratory technologists,
medical records officers, PHOs, pharmacists, and medical doctors enrolling than graduating. This
suggests that either the capacity to train in these cadres has recently increased or the attrition
rates among these cadres while in pre-service training are high.
Figure 3 - Comparison of Pre-service Enrollment and Graduation by Number of Health Workers and Cadre
15
239
511 586 608
933
1232 1278
3159
0 108 244 252 535 252
1322
405
2188
0
500
1000
1500
2000
2500
3000
3500
Entered pre‐service education in last year Graduated pre‐service education in last year
Public training institutions remain the key trainers of health workers in all cadres. Table 3 below
shows that common courses offered by private institutions and FBOs include Nursing, Clinical
Officers, Public Health Officers and Nutritionists.

Table 3: Numbers of Health Workers Graduating by Type of Institution
Number of Health Worker
Medical
doctors
Dentists
Labtech.
Nurses
Clinical
officers
Pharmacists
PHOs
Nutritionists
Medical
recordsOff.
Total
Public 108 405 2,157 1,295 244 395 519 252 5,375
Private 31 148 16 195
FBO 27 27
Total 108 405 2,188 1,322 244 543 534 252 5,596
Number of health workers graduating by region
The survey sought information on the number of health workers who graduated distributed by
regions. Only two institutions responded to this question, an indication that there are gaps in
student management information system in training institutions. One private institution had
had all the graduates from the same region while the other FBO institution had 22 out of 27
(81%) graduates from the same region, as the institution.
Number of student allowed to enrol by regulatory bodies
Figure 4 below shows a comparison between the numbers of health workers enrolled in the
pre-service training institutions surveyed and the number of students that the institutions are
allowed to enroll per the regulatory bodies associated with each cadre. Results indicate that,
with the exception of clinical officers, training institutions are enrolling more new students than
they are technically allowed to enroll by regulatory bodies. One institution did not respond to
this question. This data, when combined with comparison data on enrollment vs. graduation,
suggests that training institutions may be increasing their capacity to train new health workers
faster than regulatory bodies are expanding enrollment restrictions. This is a potential area of
intervention for the Ministry through the FUNZOKenya project.

Figure 4 - Actual Enrollment Comppared to Thatt Allowed by Regulatory Bodies
Training
Training
students
Figure 5
the rang
performa
Performa
data from
0
500
1000
1500
2000
2500
3000
3500
seline Surve
institutions’
institutions
who gradua
shows that
e of <80%,
ance in the
ance ratings
m training in
Figure 5 - T
239
205
Medical
doctors
#
0
1
2
3
4
5
6
ey of the Nat
’ output per
can rate th
ate as comp
out of 13 in
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are self-rep
stitutions.
raining Instit
15
127
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of students en
2
< 80%
tional Trainin
rformance
eir effective
pared to thei
nstitutions re
ated their pe
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78
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239
tech. Nurses
ntering Pre‐ser
4
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s Clinical
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rformance b
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s
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actual
Rapid Ba

Barriers to increasing training capacity
Training institutions were also asked to identify barriers to increasing training capacity. As shown
in figure 6 below, expert teaching faculty and accommodation are the most common current
barriers to increased training capacity in the institutions surveyed followed by content
development and clinical instruction.
Figure 6 - Barriers to increasing training capacity
2
4
6
6
8
8
0 1 2 3 4 5 6 7 8 9
Infrastructure
Funding
Content Development
Clinical instruction
Teaching faculty
Accommondation
The survey collected data from the training institutions on existing provision of in-service
training, coordination of training in the regions, database processes used to track in-service
training for health workers in the institution and linkages to MOH and regulatory bodies.
Facilitating training
In-service training for health workers
The results show that the majority of training institutions (10 out of the 14, 71%: 9 Public and 1
Private) conduct in-service training courses while the rest (29%) do not have such courses. In
addition, on existence of in-service database 12 institutions responded, with 6 (43%) institutions
indicated they have database of health workers who have undertaken in-service training, 6 (43%)
institutions had no database while two (14%) institutions did not respond. Further, for the
training institutions that have in-service training database undertaken by health workers, five
institutions had updated the database within less than one year while one institution had their
database updated between one to two years. For the 6 institutions with in-service database, five
institutions had a linked database while remaining one institution was not linked. Two
institutions were linked to professional association, two institutions linked to Nairobi KMTC, one
institution linked to MOH while another one was linked to regulatory body.
Coordination of in-service training at surveyed institutions
The assessment showed that in three training institutions in Nairobi, North Eastern province
(NEP) and Coast regions, there is a committee that coordinates in-service training while the rest

of the institutions in Central, South Rift, Western and North Rift regions have no such
committee. The committee coordinates training on part time basis in the region giving guidance
to students and liaises with KMTC for information.
Tracking training through training database and data linkages
Training institutions were asked to rate how well they tracked training through databases. The
results as indicated in figure 7 below show that only one out of 14 (7%) institutions rated their
performance on training database and data linkages by institution as excellent, five out of 14
(36%) institutions rated good performance, two out of 14 (14%) institutions rated fair, four out
of 14 (29%) institutions rated poor while the remaining 2, (15%) institutions did not respond to
the question.
Figure 7 – Training Institutions’ Performance on Tracking Training through Databases
Excellent
7%
Good
36%
Fair
14%
Poor
29%
No Response
14%
Recommendations for linking database to MOH and Regulatory bodies
As indicated in figure 8 below, areas recommended by training institutions for improving
linkages with MOH and regulatory bodies were holding stakeholders meetings, developing
linkages, establishing training institutions as CPD/CME providers and having a standardized
database in training institutions with harmonized curriculum.

Figure 8 - Trraining Instittutions' Sugggestions for IImproving Stakeholder LLinkages
Capacit
training
The surv
through
registrati
courses
trainings
CPD/CME
The resu
in-service
course si
workers a
Only two
while the
institutio
the rest o
Training
medical/
Malaria,
Teaching
Dietetics,
Managem
Research
Managem
seline Surve
ty of trainin
vey collecte
regularize
on/accredita
offered, doc
and source
E Courses
lts show tha
e, CPD/CME
nce only 1 i
are medical
o institutions
e remaining
ns indicated
of the institu
institutions
health cadre
Reproductiv
g methods, L
, Monitorin
ment. The m
h, Teaching
ment.
0
2
4
6
Stake
mee
ey of the Nat
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ed informati
ed training
ation that
cumentation
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t four out of
E training. H
nstitution re
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most popular
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6
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for the traini
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owever the
esponded. Fr
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tutions did n
bility of offe
ot respond to
ended cour
ses were gro
esearch Met
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5
ng Mechanis
er continuo
acity of trai
ce of p
o in-service
ME courses,
ings.
nstitutions in
survey did
rom the inst
hnologists, C
D/CME cours
not respond
ring core cr
o the questio
rses/topics
ouped into
hodologies,
ent, MCH C
neral medic
entioned wer
/AIDS, Rep
Training
institutions
CPD/CM
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3
sm in Kenya
ous professi
ning institu
olicy for
training/CM
learning ap
ndicated the
not establis
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ourse, Comm
cal conditio
re also grou
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E
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S
in
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ME/CPD, cr
pproaches in
ey run regula
h the target
responded,
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itutions had
stion. Seven
courses acr
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ucation, Hea
munity Heal
ons and In
ped into the
Health and
Standardized
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training
stitutions with
harmonized
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3
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elopment (C
fer CPD tra
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arized course
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ross cadres
across se
HIV/AIDS, TB
alth promoti
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fectious Dis
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25
CPD)
aining
on
CPD
of the
es for
or the
health
urses
(50%)
while
everal
B and
on &
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areas:
p &
Rapid Ba

CPD/CME policy, guidelines and calendar
Results show that six out of 14 (43%) institutions had a policy for practice guidelines on
registration/accreditation that is linked to in-service training/CME/CPD compared to eight out of
14 (57%) institutions without such a policy. In addition six out of 14 (43%) of the training
institutions rated their level of compliance on accreditation regulations as satisfactory, one (7%)
institution rated their level of compliance as unsatisfactory, while the remaining seven (50%) of
the institutions did not respond to the question.
As shown in figure 9 below regarding the training/teaching calendar for CPD/CME, 9 out of 14
(64%) institutions do not have a calendar for CPD/CME, two out of 14 (14%) have a calendar
while the remaining three out of 14 (22%) institutions did not respond to the question.
Figure 9 - Existence of CPD/CME calendar
Yes
14%
No
64%
None Response
22%
The results further show that the two institutions with such calendar for CPD/CME had a good
compliance to CPD. On existence of guidelines for CPD/CME four out 14 (29%) institutions
indicated existence of guidelines for CPD/CME while the rest (71%) of the institutions did not
respond to the question.
Documentation of in-service training, CPD/CME
The results from the survey show that half (7 out of 14) institutions have a documented in-
service training CPD/CME compared to the rest of the institutions who do not have
documentation or did not respond to the question. In addition for the seven training institutions
with a documented in-service CPD/CME training, all had a regularized/systematic process except
one institution. Furthermore, for the seven training institutions with a documented in-service
CME/CPD training three had their in-service CPD/CME linked to MOH/regulatory bodies while
the rest of the institutions had not linked their database.

Business management tool
Regarding business management tool, results show that seven out of 14 (50%) of institutions
had tools while the rest of the institutions did not have such tools. In addition 8 out of 14 (57%)
institutions indicated the need for additional management tools, one out of 14 (7%) of
institutions did not need additional tool while the remaining five out of 14 (43%) institutions did
not respond to the question.
Funds for in-service CPD/CME training
The survey on funds for in-service CPD/CME training showed that 6 out of 14 (43%) institutions
received their support through donor support while 3 out of 14 (21%) indicated government as
another source. In addition, ten out 14 (71%) of the training institutions indicated that there are
opportunities to raise alternative funding for in-service CME/CPD compared to 29% of the
institutions without alternative funding. Further, training institutions indicated donors and fees
as other alternative funding for in-service/CME/CPD.
6 institutions responded to the question about making profit after raising resources for in-
service/CPD/CME with 2 institutions indicating they make profit while the remaining four did not
make profit. One institution indicated that they use the profits to improve training
resources/materials/supplies.
Existing models and their gaps used to assess and update training needs in the training
institutions
Learning approaches and CPD/CME Calendar
Most institutions indicated they use classroom/face-to-face as learning approaches to deliver
courses, two used e-learning while three used distance learning approach. The results show that
seven out of 14 (50%) institutions had appropriate rate for the acceptance on e-learning, two
out of 14 (14%) institutions had fairly appropriate rate on e-learning while the rest (36%)
institutions did not respond to the question. For mobile learning, four out of 14 (29%)
institutions had appropriate rate for acceptance, three out of 14 (21%) institutions had fairly
appropriate rate, and two out of 14 (14%) institutions indicated it was unacceptable while the
rest of the institutions did not respond to the question. For distance learning, eight out of 14
(57%) institutions had appropriate rate for acceptance, 1 (7%) institution had fairly appropriate
rate for acceptance while the rest of the institutions did not respond to the question. This is
illustrated in table 4 M-learning appears to be the learning approach which received the lowest
rating among the three approaches.
Acceptance of learning approaches for CPD/CME
Training institutions were asked to rate e-learning, m-learning, and distance learning
approaches as being appropriate for learners, fairly appropriate, or unacceptable for learners.
Table 4 shows responses.

Table 4: Perceived rates for acceptance of e-learning, mobile and distance learning
Appropriate Fairly appropriate Unacceptable No Response Total
e-Learning 7 2 5 14
M-learning 4 3 2 5 14
D-learning 8 1 5 14
Evaluating performance
Training institutions were asked to evaluate their performance by addressing health training
demands to increasing training capacity.
Barriers to meeting and increasing training demand
Training institutions were asked through a multiple response question to identify barriers to
meet training demand. As Figure 10 below shows the multiple responses, lack of expert teaching
faculty and sufficient equipment and materials were most frequently mentioned as barriers.
Figure 10 –Barriers to meeting current demand
14
13
8
4
1
Teaching Faculty
Equipment/Materials
Infrastructure
Management
Clinical sites
The baseline survey collected data from the training institutions on joint technical/curriculum
meetings, capacity of clinical mentorship, sharing of clinical experiences and their capacity to
deliver training through innovative approaches.
Developing content and courses to support curricula
The results show that 6 out of 14 (43%) institutions have a training needs assessment tool to
guide curriculum reviews as compared to eight out of 14 (57%) institutions without such a tool.
Joint technical/curriculum meetings

The results show that 9 out of 14 (64%) training institutions hold joint technical/curriculum
meetings between classroom, teachers and clinical placement site instructors to support quality
instruction, compared to 36% who do not have such meetings. Table five shows that 3 out of 14
(21%) institutions without joint curriculum meetings were universities.
Table 5: Existence of joint meetings by type of training institutions
Existence of joint meetings
YES NO Total
Universities 4 3 7
Middle Level 3 1 4
Private 2 2
FBO 1 1
Total 9 5 14
Of the training institutions that have joint meetings, 36% meet on quarterly basis, 21% meet bi-
annually, Forty-three percent of training institutions were not sure or did not respond on this
question.
Improving the capacity of faculty and clinical mentorship
Training institutions were surveyed regarding a regularized system of mentorship program for
preceptors/mentors, how they rated their mentorship program, recommended areas that need
strengthening and if preceptors/mentors have undergone induction training. The survey also
requested information on how regular the mentors spend time on self-directed learning,
opportunities to pool mentorship program with other training institutions and recommended
areas to pool mentorship.
Induction training for preceptors/mentors
The results in figure 11 show that preceptors/mentors in six out of 14 (43%) training institutions
surveyed had undergone induction training to prepare them for a preceptor/mentor role, while
four out of 14 (28.5%) institutions had not conducted training for their preceptors/mentors. The
remaining four (28.5%) institutions did not respond to the question.

Figure 11 - Preceptors/mentors completed induction training
Yes
43%
No
28.5%
None
Response
28.5%
Sharing of clinical experiences
The results show that nine out 14 (64%) training institutions had mechanism for regular sharing
of clinical experiences; four out of 14 (29%) institution had no such mechanism while one (7%)
institution did not respond to the question. Further results show that of the training institutions
with a sharing mechanism, six institutions rated their mechanism as good while three institutions
rated their mechanism as poor.
On the channels used for sharing knowledge, as shown in figure 12 below, most common
channels used in the training institutions are meetings, presentations at clinical areas and
exchange visits.

Figure 12 - CChannels useed for sharingg clinical knoowledge
The resu
institutio
rest of th
their trai
remainin
On area
recomme
of mento
The 7 tra
on how
Figure 13
1
1
seline Surve
ults show th
ns have a re
he institution
ning institut
g four institu
as that nee
ended traini
ors.
ining institu
frequently t
3 below.
0
2
4
6
8
10
12
Mee
ey of the Nat
hat half (7
egularized/sy
ns do not ha
tions had a
utions have
ed strength
ng of mento
tions with a
their precep
10
etings
tional Trainin
out of 14)
ystem of me
ave such a sy
mentorship
a fair functio
hening on
ors while tw
regularized/
tors/mentor
8
Presentation
clinical are
ng Mechanis
of the res
entorship pr
ystem. In ad
p system; th
onal system.
mentorship
wo institution
/systematic
rs spent tim
ns at
eas
Exc
sm in Kenya
spondents i
ogram for p
dition, seven
hree have a
.
p program,
ns recomme
mentorship
e on self-di
4
change visits
ndicated th
preceptors/m
n responden
functional s
three train
nded increa
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rected learn
1
On‐l
hat their tra
mentors whil
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system while
ning institu
asing the nu
so gave feed
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1
ine
aining
e the
d that
e the
utions
mber
dback
wn in
Rapid Ba 31

Figure 13 - Frequency of Preceptor/Mentor Engagement in Self-Directed Learning as Reported by
Training Institutions
3
2
1 1
0
0.5
1
1.5
2
2.5
3
3.5
Very regularly
(daily)
Occassionally Irregularly Very limited
Number of Training Institutions Reporting
Pooling mentorship programs and resources
Results show that 11 out of 14 (79%) institutions had opportunities to collaborate on
mentorship programs with other training institutions while one institution had no opportunities
and two did not respond to the question. As shown in figure 14 below, most training institutions
suggested teaching and learning and clinical areas as areas of opportunity for collaboration.
Figure 14 - Recommended Areas to Pool Mentorship Programs with Other Training Institutions
1
2
2
2
5
9
0 1 2 3 4 5 6 7 8 9 10
MB. Chn & Bsc. Nursing
Public Hospitals
Public & Private Colleges
Research & Documentation
Clinical areas
Teaching & Learning
Framework for assessing preceptor/clinical instructors
Results indicate that 8 out of 14 (57%) institutions have a framework/policy for assessing
knowledge, skills and competencies of faculty and preceptor/clinical instructors while the rest
(43%) institutions do not have such a framework. On other preceptor tools in the institution,
three institutions indicated they have checklist and written exams, two institutions use staff
appraisals while one institution uses logbooks & checklist. For the training institutions with a

framework policy, seven indicated to have a policy implementation committee while 1 institution
did not have.
Capacity to deliver training through innovative approaches
The results indicate that in 10 out of 14 (71%) institutions faculty and mentors have
competencies to deliver training using the innovative training approaches as compared to 29%
institutions without competencies. Regarding access to resources, figure 15 shows that physical
library and anatomical models are the most available support for mentorship. Further the survey
established that only two out of 14 (14%) institutions had an excellent rate of access to
resources, nine out of 14 (64%) institutions had a fair rate of access while 22% institutions did
not respond to the question.
Figure 15- Resource Support Available for Mentorship by Number of Training Institutions
4
8
11
12
0
2
4
6
8
10
12
14
Internet for Mentors Electronic Database Anatomical Models Physical Library
As shown in figure 16, 8 out of 14 (57%) of the respondents indicated that their institutions had
a fair capacity of competency for the mentors to convert current curriculum to distant learning,
e-learning and mobile phone learning, five out of 14 (36%) of the institutions had no
competencies while 1 out 14 (7%) institutions had good competency.

Figure 16 – Capacity of competency for the mentors to Convert Curricula to Distance, e-Learning
and m-Learning Formats
Good
Competency
7%
Fair Competency
57%
No Competency
36%
Upgrading training facility management systems and infrastructure
The survey collected data on opportunities for innovations in delivery of training outside, the
current traditional approaches and necessary infrastructure/technology needed to successfully
implement the new approaches.
Clinical placement sites
The training institutions were asked to indicate the number of clinical placement sites they used
for their trainees across the regions in the country. Most training institutions who respondent to
the question indicated a fair distribution of sites by regions as indicated in figure 17. Coast
region had the highest, 25 clinical placement sites while NEP region had 8, as the lowest number
of sites.
Figure 17 - Number of Clinical Placement Sites by Region
8
10
16 17
19
21
23
25
0
5
10
15
20
25
NEP Eastern Nairobi Western Central Nyanza Rift Valley Coast
30

Existing infrastructure for adopting new technologies to train health workers for CPD and
accreditation
As shown in figure 18 most training institutions mentioned IT infrastructure and students &
lecturers computer skills as the capacity gaps for alternative approaches in delivery of training.
Figure 18 - Capacity Gaps for Implementing Alternative Training Approaches by Number of
Training Institutions
2
7
8
0
1
2
3
4
5
6
7
8
9
Curriculum Students & Lectures
Computer Skills
IT Infrastructure
Strengthening performance gaps identification
The survey collected data from the regulatory bodies and professional association on existence
of coordination mechanism for CME/CPD accreditation, existence guidelines for curriculum
development, existence of training standards and linkages with the training institutions and
Ministry of Health.
Strengthening regulation of curriculum review, development and implementation
Guidelines for curriculum development and implementation
On guidelines for curriculum development, implementation and review, results show that 6 out
of 8 regulatory/professional bodies had guidelines for curriculum development, while the rest
did not. In addition 4 out of 8 bodies had written guidelines for curriculum review while the rest
did not have. The results also showed that three out of eight regulator/professional bodies
reviewed their curriculum within three to five years while the remaining five did not respond to
the question or not sure when review was conducted. It was also observed that 6 out of eight
regulatory/professional bodies had application of guidelines to accreditation and licensure while
the rest did not have.

Capacit
accredit
ty existing
tation of tra
in the regu
aining institu
ulatory bod
utions and C
dies to coo
CPD
ordinate annd regulatee licensure and
CPD/CMEE accreditatiion, review and curriculumm guideliness
Six regula
responde
mechanis
mechanis
regulariz
As show
CPD/CM
five years
respond
bodies e
bodies d
Strength
Linkages
As shown
level of li
out of eig
the rest
regulator
accredita
regulator
types of
seline Surve
atory bodies
ed. The re
sm to regu
sm. Furtherm
e accreditati
n in figure
E program a
s while four
to the ques
evaluated the
id not respo
Figure 19 -
hening the l
s to MOH a
n in figure 2
inkages betw
ght (37.5%)
t of the
ry/profession
ation while
ry/profession
elements fo
ey of the Nat
s and two pr
sults show
ularize accre
more, for th
ion only 1 ha
19, three ou
annually, 1 o
out of eight
stion. Furthe
eir CPD/CM
ond or had n
- Frequency o
link betwee
nd training
20, three out
ween regula
regulatory/p
bodies we
nal bodies h
the rest
nal bodies in
r linkages.
tional Trainin
rofessional a
that three
editation wh
he three reg
ad the regul
associations
out of eigh
hile the rest
gulatory/pro
arized mech
(out of 12 q
ht regulatory
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uestionnaire
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odies with
es that were
nal bodies h
not have su
a mechanis
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had a
uch a
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ut of eight
out of eight
t (50%) regu
er, the result
E program
ever reviewe
of Evaluating
en processio
institutions
t of eight (3
tory bodies,
professional
ere not s
have a strong
of the 6
ndicated tha
Not
Sure/No
Response
50%
ng Mechanis
(38%) regula
t (13%) regu
ulatory/profe
ts indicated
between ye
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Rapid Ba 36

Figure 20- Strength of Regulatory Bodies’ Linkages with MOH and Training Institutions
Excellent
37.5%
Fair
37.5%
Not
Sure, 25%
Lessons learned from training accreditation programs
Lessons learnt and challenges derived from the training accreditation program by
regulatory/professional bodies include awarding CPD points manually leading to delays of
updating health workers database and knowledge sharing among regulatory & professional
bodies and stakeholders.
Supporting a database system to capture training and regulatory information
Regulatory bodies were asked if they had a system in place to document in-service
training, CPD/CME. They were also asked to disclose whether or not any database they
had for tracking training was linked to the MOH and/or other regulatory bodies. The
results from the survey show that half of the training institutions, (50%) have a documented in-
service training CPD/CME compared to the rest of the institutions who do not have
documentation or did not respond to the question. Further, for the 7 training institutions with a
documented in-service CPD/CME training, all had a regularized/systematic process except one
institution. The results also showed that only 3 out 14 (21%) institutions had their in-service
CPD/CME database linked to MOH/regulatory bodies.
Supporting standardization and quality assurance of training and health worker
performance
The survey collected data from the regulatory bodies and professional associations on existence
of regulatory framework or standards and how often the framework/standards are updated. A
previous PNA report conducted through Capacity project indicates that one of the emerging
issues on standardization is harmonization of curriculum across training institutions.
Training regulatory framework
Regarding training regulatory framework or standard, results show that five out of eight
regulatory/professional bodies had a training regulatory framework while the rest of the bodies

did not have such a framework. Furthermore, the five regulatory/professional bodies with a
training framework, three bodies updated the framework regularly, one body rarely updated the
framework while the other body was not sure when the framework was updated.
Discussion
The survey has provided information on current capacity of the health worker training system to
admit, graduate and train pre-service and in-service health workers, status of data generation
and sharing as it relates to training information, state of institutional resources available for
training pre-service and in-service health workers, coordination licensure and accreditation of
training institutions and CPD.
Current state of forecasting for new health workers
The results of the baseline survey show major gaps in data base and linkages to regulatory
bodies and MOH. About 57% of the training institutions did not have a mechanism to forecast
training needs and only 21% indicated they had a follow-up committee for updating the
forecast. This result has implications on the management of resources required for training
health workers including required faculty, preceptors, placement sites, supplies and other
utilities.
Although majority of training institutions (71%) run in-service training courses, less than half
(43%) of them had in-service database of staff who had undertaken training. In addition, half of
the training institutions have documentation for CPD/CME, with only 21% having their database
linked to MOH and regulatory bodies. Lack of a database can contribute to none recognition or
missed opportunity for promotion of health workers which can affect their service delivery.
Less than half (43%) of the training institutions indicated that their rate of performance on
training database and data linkages was excellent and therefore acceptable. The results imply
that majority of training institutions have inadequate capacity to manage training data on health
workforce. This finding raises important issues related to forecasting and decision making when
institutions do not provide accurate information on the trained health workers.
It is therefore important to establish a mechanism to coordinate training data and to build
capacity of institutions to link data with the regulatory bodies and MOH for purposes of having
an updated database to guide decision making on the national health worker needs.
Current state in addressing health workers training demands
The results show that majority of the students accessing training were either fully self or
self/partly public funded. The annual cost for in-service was in the range of Ksh 100,000 to Ksh
200,000 with those upgrading to degree courses paying even higher. This finding has negative
implications for access to health training for students from poor and marginalized areas who
cannot afford the high fee charged for training. On the other hand, the finding provides an
indication that there are students willing to pay and therefore training institutions could
capitalize on this opportunity by increasing admission capacity for paying student. In addition,

financial intuitions could use this indication to develop products that attract loans for paying
student and faculty.
The results also show that only three regions out of seven existing regional hubs in the project
indicated having a committee that coordinates in-service training in the regions. This finding
brings to focus the need for organized in-service training to increase access to training that is
performance based for the regions and therefore enhancing identification of regions requiring
support.
Accommodation was found to be a critical bottleneck affecting capacity of training institutions
to address demand. There is therefore a need to explore strategies to address trainee
accommodation for example, through admitting more day scholars. However, there were
institutions found to admit more students than what the regulatory bodies allow. This
occurrence of admitting students could have negative implication of compromising quality of
training. However, it could be an opportunity for expansion of the training institutions to admit
more students. Supporting institutions with skills to forecast the student load could enhance the
same institutions to identify resources for the expanded capacity.
Capacity of training institutions to offer continuous professional development (CPD)
training
The results show that only 29% of institutions indicated they run regularized courses for in-
service (CPD/CME) and half of them do not have a training calendar. Further, half of the training
institutions indicated the possibility of offering core cutting courses across cadres. In addition,
majority (57%) of the training institutions did not have a CPD/CME policy and guidelines. This
finding has implication on the capacity of training institution to plan, coordinate and attract
health workers to improve their skills.
The respondents indicated that donors and government are the main sources of funds for
CPD/CME training although training institutions also indicated that they have opportunities to
raise alternative funding. Depending on donors and government alone for in-service training
brings up issues for sustaining the program hence the need for supporting capacity of training
institutions to diversify funding sources through use of market oriented management tools.
Existing models and gaps in models used to assess and update training needs in the
The findings show that traditional face-to-face remains as the most used method of training
delivery. The results also show that distance learning was the most preferred alternative method
and mobile learning was the least preferred. In addition, only 1 institution indicated that their
mentors have good competency to convert current curriculum to distant learning, e-learning
and mobile phone learning. To increase their admission capacity, training institutions could
adapt delivery of courses through innovations in training. This entails upgrading the knowledge
and skills of faculty to improve and develop curriculum content. Training institutions still use
traditional methods of sharing clinical experiences such as meetings and presentations that
need resources such as space and time while adopting methods such as online clinical sharing
can be more cost effective. However, alternative methods of training delivery require modern

information technology (IT) infrastructure. Consistent with other studies such as PNA, IT
infrastructure, students & lecturers computers skills remain capacity gaps for adopting
alternative approaches.
Consistent with the PNA report (2011), the survey showed gaps in clinical placement. Half of the
training institutions did not have a regularized system for mentorship program for preceptors
while less than half (43%) of the institutions had not inducted their preceptors. In addition, 57%
of those who responded to the question indicated that they had limited time spent on self-
directed learning. Majority (79%) of the institutions recommended opportunities to pool
mentorship program with other training institutions such as in teaching & learning, clinical areas
and research & documentation. The findings of this survey highlight gaps in clinical placement
models and inadequate capacities for providing quality clinical teaching and therefore the need
to build capacity of faculty and clinical preceptors. In addition, there is need to strengthen
clinical placement sites for health workers’ skills development. Further, there is need to identify
and update training needs in the institutions of learning.
Results show that 43% of training institutions did not have a framework for assessing skills of
preceptors/clinical instructors’ competencies while more than half (57%) of the institutions did
not have a training needs assessment tool to guide curriculum reviews, with only two public
universities, KMTC related campuses and 1 private college having a training assessment tool.
This may be an indication that clinical placement sites that have regularized system mentorship
program and trained preceptors are more likely to receive more requests than they can handle
thereby over stretching resources in the clinical sites as noted during one of the project
monitoring visits in Western Kenya.
Existing infrastructure for adopting new methodologies to train health workers for CPD
and accreditation
The results of the assessment show that most training institutions lack IT infrastructure. Both
faculty and trainees lack adequate skills and access to computer services and Internet. Faculty
lack skills to convert curriculum content for new training delivery approaches. The findings have
implication for adopting new methodologies for delivering training for health workers
effectively. There is need therefore to support IT infrastructure and skills for faculty to convert
curriculum for adoption of new methodologies.
The baseline survey conducted interviews from all six existing regulatory bodies and two
professional associations. About 67% of the regulatory bodies indicated that they did not have a
mechanism to regularize accreditation. In addition, half of the regulatory bodies do not have
written guidelines for curriculum review. This finding has implications on the capacity of the
regulatory bodies to guide and monitor activities of the training institutions in the development
and review of curriculums as well as monitoring of accredited and accreditation of health
training institutions. Inadequate monitoring of training institutions has the potential of having
mushrooming of training institutions offering low quality training.

About 67% of the regulatory bodies are not linked to a central database for CPD/CME
accreditation. It was also noted that CPD points are awarded manually leading to delays in
updating of health workers database.
Although CPD/CME is a legal requirement, some regulatory bodies are not aware. This finding
has implication on the seriousness of providing CPD/CME when the regulatory body is not
aware that it is a legal requirement thereby reducing opportunities for upgrading skills of health
workers.
About 33% of the regulatory bodies do not have training regulatory framework. A similar % of
regulatory bodies reviewed their curriculum within 3-5 years. However, there is no legal interval
indicated for the period to review the curriculums. Lack of guidelines on the curriculum review
has implications on using outdated content of training health workers with consequences of
producing health workers with inadequate skills to address emerging health challenges. There is
need therefore, to support the regulatory bodies to develop guidelines for curriculum review.
Conclusion and Recommendations
The survey identified gaps that can be addressed by the Ministries with support from
FUNZOKenya project to streamlining national training mechanism through the following
recommendations.
Current state of forecasting for the health workers
• Establish a mechanism to coordinate training data and to build capacity of institutions to
link data with the regulatory bodies and MOH for purposes of having an updated
database to guide decision making on the national health workers' needs.
Current state in addressing health workers training demands
• Work with MOH, regulatory bodies and stakeholders to identify cadres of health workers
that can be supported by project scholarship and loans
• Establish a loan mechanism to support more students on self/family support and partly
self and partly public for pre-service and in-service courses
• Need for organized in-service training to increase access to training that is performance
based for the regions and therefore enhance identification of regions requiring support.
• Explore strategies to address trainee accommodation for example, through admitting
more day scholars
• Work with regulatory bodies and training institution with expansion opportunities in
order to maximize their admission capacity without compromising the quality of training
• Support training institution to increase their admission capacity by adapting delivery of
courses through innovations in training by upgrading the knowledge and skills of faculty
to improve and develop curriculum content

Capacity of training institutions to offer continuous professional development (CPD)
training
• Support institutions with skills to forecast the student load through identification of
resources for the expanded capacity by using market oriented management tools
Existing models and gaps in models used to assess and update training needs in the
• Support training institution to strengthen clinical placement sites for health workers’
skills development
• Work with MOH and training institutions to regularize mentorship program and
strengthen selected clinical placement sites
• Support training institutions to develop a framework or policy for assessing knowledge,
skills and competencies of faculty & preceptor instructors
• Support training institutions to develop training needs assessment tool to guide
curriculum review
• Support training institutions to establish joint meetings on curriculum between
classroom, teachers and clinical placement site instructors
• Work with MOH, regulatory bodies, training institutions and other stakeholders to
establish a committee in the region that coordinates trainings. Through establishing
coordination at the region and County levels, a community of good practice could be
expected to emerge and be used to share knowledge, practices, models that are
working, synergies in the regions and providing feedback on the training mechanism
• Support training institutions to adopt cost effective sharing of clinical experience such as
on-line and tele-conferencing
• Support MOH, regulatory bodies, training institutions to review and adopt existing
CPD/CME policy and guidelines as standard policy in training institutions
Existing infrastructure for adopting new methodologies to train health workers for CPD
and accreditation
• Support training institution on IT infrastructure and skills for faculty to convert
curriculum for adoption of new methodologies
• Support selected training institutions to improve teaching faculty, equipment/materials,
content development and infrastructure to increase their capacity and meet training
demands which provides an opportunity for the institutions to work with the financial
agencies for loans
• Facilitate MOH, regulatory bodies and other stakeholders to establish training
institutions as CPD/CME providers and having a standardized database in training
institutions with harmonized curriculum
• Work with MOH, regulatory bodies and other stakeholders to establish a mechanism to
evaluate accreditation

• Support regulatory bodies to computerize the process of awarding CPD points in a
central database accessible to MOH, regulatory bodies and training institutions
• Support regulatory/professional bodies in developing training regulatory framework

APPENDIX A: List of Participating Institutions
Name of Institution Region
1 Maseno University Western
2 Great Lakes University of Kisumu Western
3 Masinde Muliro University of Science & Technology Western
4 St. Mary School of Clinical Medicine - Mumias Western
5 Moi University North Rift
6 Lodwar MTC College North Rift
7 North Eastern Province College of health Science North Eastern
8 Garissa MTC College North Eastern
9 Egerton University South Rift
10 Pwani University Coast
11 Kilifi Medical Training Centre Coast
12 Nairobi Medical Training Centre Nairobi
13 Kenyatta University Central
14 Jomo Kenyatta University of Agriculture Technology Central
Name of Regulatory Body
1 Nursing Council of Kenya Nairobi
2 Clinical Officers Council Nairobi
3 Kenya Medical Practitioners & Dentist Board Nairobi
4 Pharmacy & Poison Board Nairobi
5
Kenya Medical Laboratory Technician and Technologist
Board (KMLTTB) Nairobi
6 Kenya Nutritionists and Dietarian Institute (KNDI) Nairobi
Name of Professional Association
1 National Nurses Association of Kenya Nairobi
2 Pharmaceutical Society of Kenya Nairobi

APPENDIX B: Introduction and Consent
Hello, my name is ------------------and we are conducting this baseline survey from IntraHealth
FUNZOKenya project on behalf of the Ministries of Health (MOH)-MOMS and MOPHS. The goal
of the FUNZOKenya project is to improve access to and quality of health workforce training
by supporting an increased number of new health workers trained; supporting current health
worker training needs; strengthening the capacity of training institutions; and strengthening
Regulatory Bodies to enhance training demand. The baseline survey seeks to establish baseline
data and information against which the effect of interventions can be assessed. I would like to
ask you some questions about your/ institution/department/regulatory body in regard to
infrastructure capacity to provide pre-service/ in-service health workforce training/enhancing
training demand, documentation and accreditation. The interview will take about 20-25 minutes
to complete.
Your participation in giving us information is voluntary and there is no penalty for refusing to
take part. If you are uncomfortable during the interview you may stop the interview at any time
or refuse to answer any questions. The information you provide is confidential, and will not be
linked to you directly, and will be collated in a summary report without mention of your identity.
Whatever information you provide will be used solely to build capacity of training institutions
and to improve access to training opportunities. We will not record any identifying information
such as your name, age, and address on the questionnaire form on which your responses are
recorded or in publications. We hereby thus request your consent to continue with the interview
by signing or putting a mark below. Do you have any questions about the baseline survey?
Consent to participate in the baseline survey
I have read/listened and understood the information above describing the procedures, benefits
and risks of participating in this baseline survey. I agree to participate as an informant in this
survey.
_______________ ________________________________________________
Date Signature or Mark of Respondent
_______________ ________________________________________________
Date Signature of Person Obtaining Consent

BASELINE SURVEY: FACULTY, REGULATORY BODIES AND PROFESSIONAL ASSOCIATIONS
Name of Interviewer___________________________ Date______________________
Name of Institution__________________
Type of Institution_______________________Public_________Private__________
FBO______________________________
Regulatory Body_____________________
Professional Association______________________
(Circle your responses against the number indicated. If a response requires to give a
figure, indicate so against the dotted lines)
NB: Insert the responses on the right hand column of the questionnaire
NO SECTIONS: QUESTIONS
AND FILTER
CODING CATEGORIES
SECTION 1: TRAINING
INSTITUTIONS (Pre and
in-service)
101
a) How many students
enrolled for pre-service
training in the last
academic year?
b) How many health
workers graduated from
pre-service program in the
last full academic year?
a) Health workers who entered the training in the last
academic year
Medical Officers……………………………...........….….......1
Dentists.................................................................................2
Lab Technologists/technicians..................................3
Nurses...................................................................................4
Clinical Officers..................................................................5
Pharmacists.........................................................................6
Public Health Officers.....................................................7
Nutritionist and related cadre……..…………..……..8
Health records Information officers……….….…..9
b) health workers who graduated in last academic year
Medical Officers……………………………..........……....... 1
Dentists................................................................................2
Lab Technologists/technicians..................................3
Nurses...................................................................................4
Clinical Officers..................................................................5
Pharmacists..........................................................................6
Public Health Officers......................................................7

Rapid Baseline Survey of National Training Mechanism in Kenya

Rapid Baseline Survey of National Training Mechanism in Kenya

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