The Bottom Line:  In September 2024, the Kenyan coastal county of Mombasa made the decision to invest in 161 new frontline health workers, equivalent to a ~$1.1m investment, to better staff the facilities in the county. The decision was driven by data, specifically a series of in-depth data review meetings between Jacaranda and key county stakeholders to identify staffing gaps in a new Facility Quality Assessment. 

Staffing gaps stall progress on UHC

In Kenya, staffing challenges in facilities remain a challenge to Universal Health Coverage and quality of care: in 2021, Kenya had a needs-based shortage of nearly 60,000 health professionals (Asamani et al., 2025). From a patient perspective, short staffing means longer wait times, shorter contact time (ie. the time a patient spends with their provider), and compromised care quality. From a provider perspective, staffing shortfalls increase the risk of mistakes, and drive poor morale and burnout as providers struggle with increased workloads. In recent months, these staffing gaps have worsened with the ripple effect of the USAID Stop Work Order. We have documented these shortfalls (and their impact on patients and providers) in a widespread pulse survey of mothers and health care workers.

Data brings significant staffing issues into focus

Since May, Mombasa County has had access to a new data resource – Jacaranda’s Facility Quality Assessment. The assessment routinely monitors key quality indicators in public health facilities, including the availability of commodities, staffing, blood, infrastructure, equipment, training, and financial resources. County quality Improvement staff manage routine data collection in facilities, while Jacaranda compiles the resulting data on the back-end into traffic light-coded dashboards (red for significant gaps, orange for more minor gaps, and green where indicators meet the quality threshold).  

Data triggers rapid response from county health team

In July 2024, Mombasa’s Reproductive Health Coordinator, Mwanakarama, noticed a downward trend in the data. Hospitals and health centers across the county were showing up red for Human Resources for Health (HRH). Put simply, there weren’t enough staff on the wards to adequately manage their rising caseloads. Mwanakarama quickly took action, compiling a detailed, data-powered report on the shortfalls to share with the County Executive for Health. Within days, the recruitment process started

Caption: Nancy Gitonga, Jacaranda Health, presents FQA data to Mombasa Department of Health Executives, July 2024

Mombasa responds with historic HRH investment

In September, Mombasa’s County Health Management Team announced its plans to significantly increase county expenditure towards human resources for health. 161 staff, including nurses, clinical officers, pharmacists, and radiographers were recruited across primary and advanced health facilities between September and December 2024. Recruitment was accompanied by training refreshers for different cadres: for example, nurses recruited to specialized newborn units underwent a month of rigorous training in newborn-specific EmONC skills at the county’s main referral hospital. 

Quickly, the reds on the dashboard turned green. The investment – equivalent to 1.1m USD, or ~140m KSH – has had a catalytic impact on the ability of key facilities to cater for high patient volumes, and manage specialist cases on the ward. For example, in December, Mombasa was able to operationalize a new Newborn Intensive Care Unit at one of its largest hospitals, Port Reitz, which is anticipated to offer specialist support for ~120 newborns annually over the coming years. 

Beyond staffing, Mwanakarama has supported other improvements based on other gaps identified in the assessment: ‘Beyond recruiting healthcare workers, we’ve also supported facilities to procure essential equipment like fetal dopplers based on equipment gaps in the assessment. We’ve also been able to identify commodity gaps – we’ve recently re-stocked 1,500 doses of heat-stable carbetocin for managing postpartum hemorrhage within Level 4 hospitals and other health facilities.’

‘FQA data helps us know which facility, and by extension, which officer within that facility is performing better than others, enabling us to appreciate and recognise those who go an extra mile in improving performance. Secondly, considering scarcity of resources, gaps identified in FQA have really helped with prioritization, and directing funds towards addressing specific gaps. –Dr. Hanif Mohamed, Director Clinical Services