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Amref Institutional Repository
Welcome to the Amref Institutional Repository (IR) — a digital platform dedicated to collecting, preserving, and sharing Amref’s rich body of knowledge and research outputs. The Repository serves as a vital tool for safeguarding the organization’s intellectual legacy, ensuring long-term digital preservation, and promoting open access to scholarly communication across the public health and development community.
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Reconfiguring retention: a qualitative exploration of the lived experiences of female nurses in an arid rural setting in Turkana County, Kenya
(Global Health Action, 2026-12-21) Sif Sofie Vange; Mathilde Vraa-Jensen; Micah Matiang'i
Background: Retention is especially critical in rural and underserved areas of East Africa, such as Turkana County in Kenya, where resource limitations, harsh conditions, and a lack of professional development opportunities deter nurses from staying. In addition, female nurses face unique challenges shaped by systemic inequities and gendered expectations, influencing their retention.
Objective: The aim of this study was to explore factors influencing retention of female nurses in Turkana and to offer new perspectives on the concept of retention from underserved regions in East Africa.
Methods: This quasi-ethnographic study was conducted in an arid rural setting in Turkana, in 2024. Data were collected through semi-structured interviews with 21 female nurses and 8 local health administrators and through participant observations at 4 health facilities. We used thematic network analysis guided by an abductive approach.
Results: Female nurses in Turkana navigate a paradox of staff shortages alongside high unemployment, leaving many feeling stuck in occupational limbo or permanent liminality, hoping, and working toward better opportunities for themselves and their families. Although the motivation to work as nurses persists, challenging working conditions lead many to aspire to migrate abroad.
Conclusion: This study demonstrates the complex interplay of local and global dynamics driving retention of female nurses in Turkana. Perceived workforce stability is largely due to immobility caused by limited alternatives and systemic constraints. This immobility masks dissatisfaction, making the healthcare system in Turkana vulnerable to outmigration. Findings highlight the need for holistic, gender-sensitive policies that enhance rural career pathways for female nurses.
Youth employment in the primary health care ecosystem in Zambia: barriers and opportunities
(Frontiers in Health Services, 2026-10) Mwila,Gabriel; Banda, Lister; Lakati, Alice; Matiang’i , Micah; Masimbo, Peninah; Omogi , Jarim
Youth unemployment remains a critical challenge in Zambia despite increasing demand for health services and investments in primary health care (PHC). While PHC has the potential to generate both health and health adjacent employment opportunities, limited empirical evidence exists on the institutional and individual factors shaping youth employment readiness within this ecosystem. This study aimed to identify barriers and facilitators influencing youth employment readiness and opportunities in Zambia's PHC sector. A mixed-method, cross
sectional study was conducted in four districts (Lusaka, Kafue, Kitwe, and Ndola). Quantitative data were collected from 859 PHC trainees, interns, volunteers, and early-career professionals using a structured digital questionnaire. Qualitative data were gathered through 64 key informant interviews and 5 focus group discussions, including educators, employers, regulators, and PHC workers. Quantitative data were analyzed using descriptive statistics and multivariate logistic regression with Stata, while qualitative data were thematically analyzed on Atlas.ti. Employment readiness was significantly associated with age, education level, and early-career exposure. Youth aged 25–29 years (OR = 2.05), 30–34 years (OR = 4.31), and ≥35 years (OR = 3.28) were more likely to be employment-ready than those aged 18–24 years. Interns (OR = 2.97) and volunteers/early-career workers (OR = 17.55) had substantially higher odds of readiness compared to students, while respondents with undergraduate education or higher were nearly three times more likely to be employment-ready than diploma holders. No significant sex differences were observed. Qualitative findings identified gaps in training quality, limited clinical
exposure, weak regulation, poor working conditions, and constrained career progression, while internships,
mentorship, blended learning, and health-adjacent employment pathways emerged as facilitators. Youth
employment readiness within Zambia's PHC ecosystem is shaped by education quality, practical exposure, and
system-level workforce conditions rather than demographic characteristics alone. Strengthening training
regulation, expanding structured school-to-work transition pathways, improving working conditions, and
recognizing PHC as a broader employment ecosystem could enhance youth employability while supporting resilient primary health care systems.
“We cannot rely on foreign entities to take care of our health… we need to change our mindset”: immediate impacts of the 2025 U.S. government funding cuts on health in Kenya
(BMC Public Health, 2026-07-31) Laura, Ferguson; Lakati, Alice; Emoto, Sarah; Wanyonyi, Barasa Herbert; Rachman, Adji Fajar; Tompoi, Wilson; Anderson, Michelle Elizabeth; Masibo, Peninah Kinya
Background: In 2024, the United States Government (USG) distributed $730 million of development assistance for health to Kenya, much of which supported HIV care; in early 2025, almost all USG funding was abruptly halted. This study explores the impacts of the funding cuts on uptake of health services and on physical and mental health in Kenya. Methods: This study adopted a socioecological framework, hypothesizing that funding changes would create ripple effects from macro to micro levels, ultimately shaping individuals’ health and wellbeing. Routinely collected data on service uptake from the Kenyan Health Information System were analyzed for temporal trends, with attention to changes following the funding cuts. We interviewed 14 key informants representing government, civil society and multilateral agencies to explore perceptions and experiences of the impacts of these funding cuts. Results: Striking declines are visible in recorded uptake of HIV testing, pre- and post-exposure prophylaxis for HIV, antiretroviral therapy, co-trimoxazole among people living with HIV, and tuberculosis screening among people living with HIV. While these indicators cannot determine whether declines reflect reduced service availability, changes in care-seeking behavior, or other factors, interview participants described layoffs of technical personnel, collapse of logistics systems and failures in the health information system as undermining the pipeline of data and services, with disproportionate impacts on HIV and TB services, particularly for key populations. Loss of employment and/or access to care led to deteriorations in mental health and in some cases, forced relocation. Long-term concerns included rising drug resistance, increasing HIV and TB incidence, greater morbidity and early mortality Conclusions: The withdrawal of USG health financing in Kenya constituted a system-level shock. Routine government health data paints an alarming picture, whether reflecting true declines or breakdowns in the data system itself. As global health financing contracts, Kenya’s experience illustrates challenges increasingly faced by donor-dependent health systems globally. As more countries negotiate bilateral aid agreements, it is critical to understand the differential impacts of the initial funding cuts, what priorities communities and front-line workers have for re-building better, and what compromises are (and are not) acceptable in negotiations with external funders of critical services