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Primary Submission Category: Health systems
When health systems earn trust: Rethinking population health from the frontlines of rural Kenya
Authors: Nema Aluku,
Presenting Author: Nema Aluku*
Background: Trust in the primary health care systems plays an essential role in shaping workforce stability, service delivery and population health outcomes. In low- and middle-income countries like Kenya, fragile workplace environments and weak supervisory structures limit trust between primary health workers and health institutions hence contributing to workforce instability in rural settings. In Kenya, shortages and migration of nurses and clinical officers from rural primary health care (PHC) facilities continue to limit equitable access to essential health services. This study examines how trust building processes within health systems influence the retention of frontline health workers in rural western Kenya.
Methods: A cross-sectional mixed methods study was conducted in government of Kenya PHC facilities in Kakamega County. A total of 93 participants were included: 42 health workers currently employed (“Stayers”), 23 who had recently left their positions (“leavers”), and 28 facility administrators and managers. Quantitative data were collected using structured questionnaires and analysed using descriptive statistics, chi-square tests, and multinominal logistics regression. Qualitative data from key informant interviews and focus group discussions explored health workers’ perceptions of leadership, recognition, and support systems that influence trust in health institutions.
Results: Trust related facility dynamics were strongly associated with health worker retention. Health workers who reported encouragement from supervisors, fair performance evaluation and recognition for good work were significantly more likely to remain in rural PHC facilities. Perceptions of competent and committed facility leadership were also positively associated with retention, suggesting that credible management strengthens trust in the health system. Structural conditions like – manageable workloads, access to equipment necessary for service delivery, and flexibility to balance professional and personal responsibilities – further reinforced health workers confidence in their PHC facilities. On the contrary, lack of recognition, heavy workloads, and limited managerial support eroded trust and contributed to decision to leave rural facilities.
Conclusion: Strengthening trust within health systems is central to improving PHC facility workers stability and advancing population health in rural underserved communities. Supportive leadership, fair management practices, and enabling facility environments can foster trust in primary health workers and influence the sustainability of rural PHC services.