title: Kenya's emergency-hire nursing programme: a pilot evaluation of health service delivery in two districts.
abstract: OBJECTIVE
  To assess the feasibility of utilizing a small-scale, low-cost, pilot evaluation in assessing the short-term impact of Kenya's emergency-hire nursing programme (EHP) on the delivery of health services (outpatient visits and maternal-child health indicators) in two underserved health districts with high HIV/AIDS prevalence.
  
  
  METHODS
  Six primary outcomes were assessed through the collection of data from facility-level health management forms-total general outpatient visits, vaginal deliveries, caesarean sections, antenatal care (ANC) attendance, ANC clients tested for HIV, and deliveries to HIV-positive women. Data on outcome measures were assessed both pre-and post-emergency-hire nurse placement. Informal discussions were also conducted to obtain supporting qualitative data.
  
  
  RESULTS
  The majority of EHP nurses were placed in Suba (15.5%) and Siaya (13%) districts. At the time of the intervention, we describe an increase in total general outpatient visits, vaginal deliveries and caesarean sections within both districts. Similar significant increases were seen with ANC attendance and deliveries to HIV-positive women. Despite increases in the quantity of health services immediately following nurse placement, these levels were often not sustained. We identify several factors that challenge the long-term sustainability of these staffing enhancements.
  
  
  CONCLUSIONS
  There are multiple factors beyond increasing the supply of nurses that affect the delivery of health services. We believe this pilot evaluation sets the foundation for future, larger and more comprehensive studies further elaborating on the interface between interventions to alleviate nursing shortages and promote enhanced health service delivery. We also stress the importance of strong national and local relationships in conducting future studies.
authors.affiliation: University of Washington School of Medicine, 1959 NE Pacific Street, Box 356421, Seattle, WA 98195-6421, USA. stephen.vindigni@gmail.com.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Vindigni
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Riley
authors.forename: Francis
authors.initials: F
authors.lastname: Kimani
authors.forename: Rankesh
authors.initials: R
authors.lastname: Willy
authors.forename: Patrick
authors.initials: P
authors.lastname: Warutere
authors.forename: Jennifer F
authors.initials: JF
authors.lastname: Sabatier
authors.forename: Rose
authors.initials: R
authors.lastname: Kiriinya
authors.forename: Michael
authors.initials: M
authors.lastname: Friedman
authors.forename: Martin
authors.initials: M
authors.lastname: Osumba
authors.forename: Agnes N
authors.initials: AN
authors.lastname: Waudo
authors.forename: Chris
authors.initials: C
authors.lastname: Rakuom
authors.forename: Martha
authors.initials: M
authors.lastname: Rogers
mesh_terms: D000328:Adult; D002648:Child; D003695:Delivery of Health Care; D036861:Delivery, Obstetric / Q000451:nursing; D016529:Emergency Nursing; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007630:Kenya; D009726:Nurses / Q000600:supply & distribution; D010560:Personnel Selection; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D011295:Prenatal Care; D015397:Program Evaluation; D000078329:Workforce