June 30, 2022

Pediatric care outside the capital is hard to come by in Kenya, but a new fellowship program brings training home

Group of people posing together outside

School of Nursing and Midwifery KPFP scholarship recipients in Aga Khan University

Baby Anne has been diagnosed with pneumonia and admitted to a pediatric ward in a public hospital for close management. However, there is no pediatric nurse in sight – only general nurses. The hospital has been trying to hire a pediatric nurse for several months without success. The few trained pediatric nurses in the county work in the private sector.

The general nurses in Anne’s ward struggle to manage her condition. When her symptoms worsen, she is moved to the newly established intensive care unit (ICU), but still, there is no pediatric critical care doctor or nurse to monitor her.

Anne becomes critically ill and put on a ventilator. She is later referred to a private hospital. She doesn’t arrive in time and dies on the way.

Anne’s story is not unique in Kenya. Many children and mothers struggle to get specialized care. There is a critical shortage of pediatric subspecialists, including nurses, neonatologists, neurologists, emergency and critical care specialists, as well as nurse midwives, particularly in publicly run county hospitals. According to the Kenya Demographic Health Survey (2014), about 52 out of every 1,000 children under five die each year from preventable and treatable conditions. Maternal mortality rates are similarly high, with many women dying of birth complications such as post-partum hemorrhage, eclampsia, and puerperal sepsis because they cannot access a skilled nurse-midwife.

The acute shortage of the pediatric workforce is compounded by the shortage of pediatric sub-specialty training programs in Kenya. The few existing ones are centered in the capital, Nairobi. Even then, they can only admit so many students. The result is most trained pediatric nurses stay in or near Nairobi as opposed to the counties where they are needed most.

To circumvent the shortage of training opportunities in Kenya, several pediatricians have attended the African Pediatric Fellowship Program (APFP) in South Africa to get more specialized training. However, in the decade before the pandemic, only 26 pediatric subspecialists from Kenya had graduated from the program. Given the growing need for trained pediatric providers in Kenya, sending health workers to South Africa with limited training positions available was not a sustainable solution.

Inspired by the South African institute, the Kenya Pediatric Fellowship Program (KPFP) was established in 2019 with support from The ELMA Foundation. The goal of the fellowship is to increase the number of pediatric subspecialists in Kenya by setting up new subspecialty training programs, strengthening existing but underused programs, and training and deploying more pediatric nurses and medical subspecialists, as well as nurse-midwives for the public sector. Through KPFP, Kenya will become a regional training hub for pediatric care in East and Central Africa and beyond.

The KPFP program offers 148 scholarships for higher diplomas, nursing midwifery degrees, and fellowships for pediatric specialties. CHAI works with the Ministry of Health at both national and county levels, the Kenya Paediatric Association, and four training institutions—University of Nairobi, Aga Khan University, Moi University, and Gertrude’s Institute of Child Health & Research—to select beneficiaries, track training and completion, and ensure rational deployment across counties post-training.

By June 2022, KPFP had enrolled 128 trainees in school with students from all 47 counties benefitting from the scholarships. This is a steppingstone towards addressing the inequitable distribution of subspecialists in the country. Once the graduates go back to work, they are expected to serve in their respective counties for two to three years as per the public service commission requirements of the scholarships and help reduce maternal mortality and disease rates in their communities.

The KPFP program is already demonstrating how the gaps in the health workforce can be addressed through investments in domestic and regional training capacity and has modeled an approach that can be used across the continent to a wide range of specialties and provider types.

“CHAI has been working with the national and county governments to ensure that the graduates have everything they need to practice once redeployed back to their counties and will help measure the impact the graduates will be making.”
Gerald Macharia, Vice President East and Southern Africa & Country Director CHAI Kenya

“Looking at the Kenya Pediatric Fellowship program at Aga Khan University (AKU) since its inception in 2019, I am amazed at the growth and the milestones achieved. The past year has been phenomenal in terms of achievements and challenges. At AKU, we have managed to admit 30 sponsored Bachelor of Science in Nursing Midwifery students. Despite the COVID-19 pandemic challenges and restrictions, our programs have remained within the projected timelines. Midwifery students had a smooth transition to online learning for their theory classes, while the clinical rotations have continued seamlessly. Having been trained through a similar program —Africa Paediatric Fellowship Program (APFP)—over a decade ago, I desire to see the fellowship program within Aga Khan University equip the trainees with much-needed subspecialty skills and then go on to positively contribute to improvements in health outcomes for children in the East African region in a lasting way. We are confident graduates from our programs shall be well prepared to lead desired change in healthcare delivery in their immediate contexts.”
Professor Pauline Samia, Aga Khan University Project Principal Investigator

“My interest in neurology has developed over time and I was especially motivated to pursue the program since it is being offered locally and fully sponsored. I have a passion in childhood disability and most children with neurological disorders fall under this category.”
Dr. Dorcas Supa, Pediatric Neurology Fellow, Machakos County

“I have sharpened and gained more skills in neonatal resuscitation, feeding of the newborn which includes total and partial parenteral nutrition; ventilatory support of the newborn -including choice of ventilation and different modes, follow up on progress and weaning off to other non-invasive forms of ventilation. I have learned how to minimize complications associated with different ventilatory modes and how to manage the complications if they do happen. I am more conversant with managing the preterm neonate including the extreme preterm. I have learned and sharpened my knowledge and skills in managing different neonatal conditions in different systems. This knowledge is invaluable upon re-deployment to my county.”
Dr. Edith Mwasi, Neonatology Fellow, Kwale County

“My motivation to join the program was to build my capacity to provide care for children with neurological problems and train other doctors/clinicians in pediatric neurology. So far, I have acquired knowledge on diagnosis and management of pediatric neurological  problems; improved clinical skills in neurology and ability to perform and interpret neuro-diagnostic tests such as EEG; improved neuroradiology knowledge and as well as research skills.”
Dr. Nicholas Odero, Pediatric Neurology Fellow, Nyamira County
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Written by Rosemary Kihoto, Senior Deputy Country Director Kenya, Antony Mukui, Senior Associate, Kenya Paediatric Fellow Program
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