Factors influencing the retention of medical specialists working in public Level 4 and Level 5 rural health facilities in Kenya

Abstract

The unequal distribution of healthcare workers, particularly medical specialists, remains a significant global challenge, especially in underdeveloped and rural regions. These areas often experience acute shortages across nearly all cadres of healthcare workers, with medical specialists being among the scarcest. Their scarcity contributes to elevated patient morbidity and mortality rates in rural settings. This study aimed to determine the factors influencing the retention of medical specialists in rural Kenya among Level 4 and 5 hospitals, to mitigate turnover and enhance access to specialized care. A descriptive cross-sectional study was conducted among 323 randomly selected medical specialists working in rural health facilities. Regression analysis was used to analyze the association between retention and various factors including working conditions, financial incentives, career development, and professional responsibilities. Findings revealed that only 32.5% of respondents were willing to remain at their current facilities. Key positive predictors of retention included the presence of quality equipment and infrastructure satisfaction with salary and availability of career development opportunities. However, limited availability of essential drugs and supplies significantly reduced retention. The study concluded that improving working conditions, providing professional development, and ensuring adequate resources are critical to enhancing specialist retention in rural Kenya, thereby improving healthcare service delivery in underserved regions. The study recommends that rural health facilities should strengthen working conditions, ensure consistent medical supplies, upgrade equipment, and maintain supportive infrastructure, while also improving salary competitiveness and expanding funding for professional development.

Keywords: Medical specialists, Retention, Rural healthcare, Kenya, Healthcare workforce, Working conditions, Career development, Health equity.