Issues and Answers: Kenya’s Healthcare and Nursing Leadership

By April 25, 2019Uncategorized

Dr. Nandili, Director of Nursing Services for Kenya, Delivers Report

Connecting nurses with key experts and critical information is one of the primary roles of the Mary K Center for Global Nursing Development.  We do this virtually and in person.  To this end, we were honored to host Dr. Mary C. Ishepe Nandili, Director of Nursing Services, Ministry of Health, Republic of Kenya, as a speaker at the 2019 M3 (Mobile Medical Missions) conference held in Houston, Texas.  Her presentation on “Challenges Facing Quality of Healthcare Services in Kenya; A View of the Nurse Leader” was both eye-opening and inspiring.

Not only did Dr. Nandili share her insights with the M3 audience but we also took her to meet with nurses and nursing faculty at Memorial Hermann Texas Medical Center, Texas A & M College of Health Sciences and Texas Women’s-Houston College of Nursing while she was in Houston to facilitate shared learning.  It was humbling to observe and hear the direct impact Dr. Nandili had on the nurses she met with. Many shared openly how moved they were by the challenges and working conditions nurses in Kenya endure as they strive to deliver the best care possible for their patients.

Here are a few highlights from Dr. Nandili’s formal presentation.  We invite you to think about how they might apply to your own situation.

Kenya’s Healthcare Issues

In 2008, Kenya’s Vision 2030 was launched by the Government, with a section dealing strictly with healthcare.  Goals were defined for Kenya’s health sector and remain goals to this day.  The umbrella goal is to attain equitable, affordable, accessible and quality health care for all Kenyan citizens.

To achieve this, specific strategies have been developed, including:

  • Build a robust health infrastructure network
  • Improve the quality of health service deliver to the highest standards
  • Promote partnerships with the private sector
  • Provide access to healthcare for all citizens through the government

These are big goals, considering the challenges Kenya faces.  A complex disease burden– communicable and chronic conditions are considerable: malaria, upper respiratory tract infections, HIV/AIDS, hypertension, diabetes, malnutrition, and maternal – newborn-child mortality.

Taking a closer look at the mortality rates for mothers, newborns and children, the issues become more personalized:

  • Maternal mortality ratio is 510 maternal deaths per 100,000 live births
  • Neonatal mortality is 22 deaths per 1,000 live births
  • Infant mortality (before age one) is 35.1 per 1,000 live births
  • 15% of infant deaths occur during first month of life
  • Mortality of children under five is 49 deaths per 1,000 live births

Factors Impeding Improvement in Kenyan Healthcare

Nurses are essential to improving all these issues in Kenya, and yet they face their own set of challenges that can stop or slow down progress in improving patient care in the country.

First, Kenya needs more nurses.  The World Health Organization (WHO) recommends a ratio of 15 nurses for 10,000 people.   60,153 nurses and midwives serve Kenya’s population of 47 million.  This means a gap of 12,725 nurses.

What’s more, 8,200 nurses qualify annually to practice but they are challenged to find a job. This is especially true for BSN nurses.

Second, many healthcare facilities provide poor working conditions, with substandard patient rooms, labor wards, nurses’ offices , and nurses’ residences.  Inferior facilities work against progress, both physically and psychologically.

Third, nurses must have access to advanced tools and equipment.  Without the proper resources required to provide the highest level of patient care, all the knowledge alone will not help enough to accomplish the 2030 goals.

Fourth, since 2010, the Kenyan constitution has created 47 counties.  This shift has resulted in health devolving for everyone, and has diluted the impact and respect previously afforded to nurses.

What Is Working Now?

Despite these serious conditions, progress is being made.  It comes in a variety of forms, starting first with more education.   In just eight years, the number of nursing schools has grown from eight to 68. In addition, this May St. Paul’s University will launch its School of Nursing and BSN program at the Limuru campus.

Kenya has also emphasized nursing entrepreneurship and nursing informatics technology, which has translated into more sophisticated nursing practices and protocols.  Two additional efforts having a positive impact on patient outcomes and the nursing profession in Kenya are the Beyond Zero and Nursing Now Kenya campaigns.

The First Lady of Kenya launched Beyond Zero in 2014, when Kenya was one of the most dangerous countries in the world to deliver a baby. Its call to action is still in effect: improve the ratio of live births, prioritize policy and improve individual behaviors.

Nursing Now Kenya launched in August 2018 to join the international Nursing Now initiative, launched earlier in 2018 by the World Health Organization (WHO), International Council of Nurses (ICN) and the UK House of Lords. The goal of Nursing Now is to not only raise the status and profile of nursing worldwide but to empower nurses to play an active role in improving 21st Century health challenges worldwide.

What Is Needed Next?

There are clear opportunities for more progress.  Priorities and focus coming from the Nursing Services Office in Kenya’s Ministry of Health include:

  • Invest in nursing and midwifery as part of a multi-disciplinary, people-centered workforce.
  • Build capacity in nursing specialties
  • Develop national  nursing and midwifery policy for Kenya
  • Support nursing and midwifery research
  • Participate in global learning and sharing of best practices


We thank Dr. Nandili for being so open and informative with in her M3 presentation as well as in her multiple conversations with nurses and faculty in Houston. Our hope is by sharing some of those insights here, others can learn from and feel inspired too.  We are better together.

We have uploaded Dr. Nandili’s full PPT presentation in our Resources section.  CLICK HERE to view.

Lisa D. Cole, MA, RN

Director, Mary K Center for Global Nursing Development

MBF-Medical Benevolence Foundation

PS  I would welcome your response to Dr. Nandili’s presentation.  Have you tried anything that helped your work?  Do you share any of the same issues?  Please email us at [email protected]