Impact of Recruitment, Selection and Retention on Health Sector Service Delivery, Nyeri County Kenya

Abstract

Health sector service delivery in Kenya, impact in several ways on the health of the citizens who provide productive labour force in the economy.  The impact of recruitment, selection and retention on health sector service delivery is of great concern in the health sector. Several readjustment challenges have been witnessed in health sector service delivery. Health sector, building resilience within human resource is of crucial importance, to navigate challenges ensuring quality health service delivery. The sector requires proactive adaptation focusing on hardness, emotional intelligence and building of strong working relationships. This study undertaken in the context of devolved health system in Kenya focusing on Nyeri County, three sub-county hospitals and one level five referral hospital. The theoretical framework of the study was anchored on Human Capital Theory. The study adopted a mixed-methods approach anchored on the pragmatism paradigm and employed a convergent research design. The target population comprised 916 health workers drawn from three sub-county hospitals and one county referral hospital, from which a sample of 266 respondents was selected. Quantitative data were collected using structured questionnaires, while qualitative data were obtained through structured interviews with hospital directors, superintendents, and departmental heads. Quantitative data were analyzed using descriptive statistics, correlation, and regression analysis, while qualitative data were analyzed thematically. The findings revealed weaknesses in recruitment, selection, and retention practices, including inadequate staffing, limited training opportunities, low absorption of interns into permanent employment, infrequent internal promotions, and concerns regarding fairness in recruitment processes. Qualitative findings further indicated shortages of specialized personnel, high attrition rates, inadequate opportunities for career development, and centralized recruitment decisions that constrained hospitals' ability to address staffing needs. Regression analysis established a statistically significant positive relationship between recruitment, selection, and retention practices and health sector service delivery (β = 0.576, t = 9.484, p < 0.001). The model explained 32.8% of the variation in service delivery (R² = 0.328), indicating that effective human resource practices substantially influence healthcare service outcomes. The study concluded that strengthening recruitment, selection, and retention practices can significantly improve accessibility, responsiveness, reliability, empathy, and assurance in healthcare service delivery. The study recommends increased recruitment of skilled healthcare personnel, enhanced staff retention strategies, regular training and career development programs, and greater flexibility in human resource management to address staffing gaps and improve service delivery in public health facilities.