Characterising hospitals’ suitability for medical officer internship training in Kenya: analysis of the Kenya Harmonized Health Facility Assessment

Background Kenya has significantly expanded its medical school numbers and internship training hospital numbers to address its workforce gap. The majority of newly accredited internship hospitals are first-level referral/district hospitals, which are considered to have shortage of staff, medications, have limited service capacity and are described as “not organized for training purpose”. Using data from the Kenya Harmonized Health Facility Assessment (KHFA) 2018, we characterise the readiness and capacity of 61 internship hospitals to understand whether they are suitable to provide internship training for medical doctors. Methods We used secondary data from KHFA 2018, which sampled 61 out of all 74 internship hospitals in Kenya. Comparing against the minimum requirement outlined in the national guidelines for medical officer interns, we filtered and identified 166 indicators from the KHFA survey questionnaire and grouped them into 12 domains. An overall readiness and capacity index was calculated as the mean of 12 domain-specific scores for each facility. We compared the readiness and capacity of each domain and overall between Level 4 small hospitals, Level 4 large hospitals and Level 5 & 6 hospitals. Results The average overall capacity and readiness index is 69% for all internship training centres. Hospitals have moderate capacity and readiness (over 60%) for most of the general domains, though there is huge variation between hospitals and only 29 out of 61 hospitals have five or more specialists assigned, employed, seconded or part-time - as required by the national guideline. Quality and safety score was low across all hospitals with an average score of 40%. As for major specialties, all hospitals have good readiness and capacity for surgery and obstetrics-gynaecology, while mental health was poorest in comparison. Level 5 & 6 facilities have higher capacity scores in all domains when compared with Level 4 hospitals. Conclusion Major gaps exist in staffing, equipment and service availability of Kenya internship hospitals. Level 4 hospitals are more likely to have a lower readiness and capacity index, and should be reviewed and improved to provide appropriate and well-resourced training for interns and to utilise appropriate resources to avoid improvising .