Data collection procedures

We collected and/or assembled data from three sources namely: review of official national and county government documents; official county government HRH records; and interviews with key informants. For official government documents we reviewed all legal, policy and guideline documents that touched on the management of HRH at county level (Table 1). We summarized data from these documents using a content extraction tool. We developed this content extraction tool guided by our study objectives and study conceptual framework.

Legal, policy and guideline documents on HRH management reviewed

For the records review, although we initially intended to use records from the CDoH, on accessing these, we realised that the HRH recruitment and deployment records held by the CDoH were incomplete and had inconsistencies – especially for the early years of devolution. We, therefore, accessed and utilized the data from the overall county government master pay-roll held at the County Department of Public Services to extract the HRH data. We used the payroll data of December each year between 2013 and 2018 to estimate the total number of health workers and new recruitments that the county had annually since 2013. We used a table extraction form to extract data from the county master pay-roll database and interpreted the annual increments in payroll HRH numbers to mean new HRH recruitments each year (though continuous of natural attrition). We validated the payroll numbers by checking for concurrence with the managers we interviewed.

Finally, JM and NK conducted eight interviews with Key Informants involved in the recruitment, distribution and general HRH management in the county government. These were drawn from the CDoH at county, sub-county and facility levels; from the County Department of Public Services, and from the CPSB. We were unable to get an interview appointment with a sitting Member of County Assembly (MCA) even after several attempts of trying to schedule this. For all the interviews, we used an interview guide that we had developed with questions guided by our study objectives, our conceptual framework, themes from literature review, documents review findings and records review findings. We obtained informed consent for all interviews, audio recorded them and later transcribed verbatim.