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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.
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(AMIU, 2026-07-14) Lawrence Mwenda
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