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REPUBLIC OF KENYA

MINISTRY OF HEALTH


ACKNOWLEDGEMENT OF CONTRIBUTORS


  1. Dr. John Odondi

  2. Dr Pacifica Onyancha

  3. Dr. Wycliffe Mogoa

  4. Mr. Geoffrey Kimani

  5. Mr. Micah Kisoo

  6. Dr. Izaq Odongo

  7. Dr. Njeri Mucheru

  8. Mr. Chris Rakuom

  9. Dr. Stephen Irungu

  10. Mr. Patrick Musichi

  11. Dr Peter Cherutich

  12. Mr. Fredrick Omiah

  13. Ms. Rahab Maina

  14. Ms. Dorcas Wandera

  15. Dr. Sarah Chuchu

  16. Ms. Fridah Omwangale

  17. Mr. Stephen Munene

  18. Mr. Mutinda Kissingú

  19. Mr. Patrick Wafula

  20. Dr. Angela Gichaga

  21. Dr Charles Kandie


GLOSSARY OF TERMS


Intern: Is a qualified health professional who is undergoing practical supervised training and mentorship in an approved health institution in order to obtain registration and a license to practice. unsupervised.

Internship: A prescribed period of compulsory hands on training for health professionals, which is a legal requirement to practice after graduation from an approved training institution

Internship coordinator: Senior member of staff responsible for organizing the internship programme at an approved centre, ensuring there is a proper setting for its smooth running

Internship  Supervisor: A head of department/unit where the intern gets his/her training and is the first person in line for responsibility of interns

Internship Mentor: A health professional within a rotation  who interacts with interns on a day to day basis for purposes of imparting appropriate attitude, knowledge and  practical skills. Mentors are multi-disciplinary.

Internship Preceptor: An instructor, expert or specialist who teaches, gives practical experience, counsels, and serves as a role model and supports the growth and development of an intern in a particular discipline for a limited time, with the specific purpose of socialising the novice in a new role.

Internship centers: These are health facilities that are approved and accredited by the relevant regulatory bodies and the Mministry of Hhealth as training centers especially in the main fields or rotations as identified by the cadre of health worker.

Soft skills: Skills that are hard to observe, quantify or measure but are necessary for day to day professional growth e.g. team work, time management, leadership and etiquette

Health Professional: refer to the draft health bill

Contract of Service: to define later

Foreign Intern: a health professional trained outside Kenya, and is not a Kenyan citizen trained Kenya and seeks to undertake internship in the country.

Table of Contents


ACKNOWLEDGEMENT OF CONTRIBUTORS ii

GLOSSARY OF TERMS iii

Table of Contents iv

1.0 INTRODUCTION 1

1.1 Rationale 3

1.2 Mandate 3

2.0 OBJECTIVESGOAL 4

2.1 Main objective 4

2.2 Specific Objectives 4

3.0 POLICY PURPOSE 4

This policy is provides direction for current and future internship training. It outlines the roles and responsibilities of various stakeholders in the implementation, supervision, coordination, and monitoring of internship programme. 4

4.0 PRINCIPLES 4

5.0 SCOPE OF INTERNSHIP POLICY 5

6.0 POLICY STATEMENTS 5

6.1 Internship Duration 5

There is hereby established an internship period which shall be twelve(12) calendar months. This period may be extended in exceptional circumstances outlined in section xxxxxx 5

6.2 Internship Training Centres 5

b.Expansion of Internship centres: The existing internship centres shall be equiped and staffed to meet international standards(name the standards) for training of health professionals 5

Internship training 5

6.4 6.2 Waiver ofing Internship 5

5

6.53 Internship management Committees 5



6.4 Internship Training Centres 7

6.65 Professional liability 7

6.76 Internee privileges 7

6.87 Budget 7

7.0 ROLES AND RESPONSIBILITIES 7

7.1 Roles and responsibilities of an intern 7

7.2 Head Of Department (HOD)/ Supervisor roles and responsibilities 8

7.3The internship coordinator roles and responsibilities: 9

7.4Mentor/ Preceptor roles and responsibilities 10

7.5The National Internship Steering Committee roles and responsibilities: 10

7.6Facility Internship Management Committee roles and responsibilities: 11

7.7Regulatory Bodies roles and responsibilities; 11

8.0 IMPLEMENTATION 13

8.1 Institutional Framework 13

8.2 Implementation Responsibilities 13

8.3 Tools for implementation the policy 13

9.0 FINANCIAL IMPLICATIONS 14

There is hereby established an internship period.The internship period will be a twelve (12) month contract of service during which a remuneration package equivalent to the entry point of respective schemes of service will apply. The remuneration of the interns in the Public Service shall be catered for in the annual budget of the Ministry of Health. 14

10.0 MONITORING AND EVALUATION 17

Monitoring and Evaluation Framework- internship Policy 2014 18

11.0 POLICY REVIEW AND DEVELOPMENT 18

APPENDICES 19

APPENDIX A 19

APPENDIX B 19

APPENDIX C 20

1.0 INTRODUCTION


Internship is a prescribed period of compulsory hands on training for health professionals,professionals. which It is a legal requirement to practice after graduation, from an approved training institution. It is a core component of training to intergrate the knowledge received by the graduates during their college studies with the clinical work in a way that will consolidate what they have learned. This will help them in developing and improving their necessary skills to practice and serve the public in a safe and satisfactory way.1
Completion of an approved internship is necessary to achieve registration as a practitioner with the relevant regulatory body. As of now, medical officers, dentists, pharmacists, nurses, clinical officers, dental technologists, community oral health officers (COHO) and public health officers undergo internship training in government, private and faith based institutions. However there is no policy in place to guide the internship training.
The first medical school, at the University of Nairobi was established in 1970 at the University of Nairobi with the first graduates qualifying in 1975. Since then, and internship placements have been occurring ad hoc since, without set guidelines. However, with time, the number of institutions and graduates has been increasing, disproportionately with to the placement positions available for interns thus leading to a long waiting period. In addition, more cadres are initiating internship therebyus increasing the complexity in management of the internship programme.
In line with the Constitution of Kenya 20102 (schedule 4), capacity building is a function of the national government while service delivery is mainly a function of the county governments. This necessitates the development of a policy to guide the smooth implementation of the internship programme.

The policy developed will guide the establishment of new training and internship sites, creating an opportunity to capture newly qualified graduates from local and international institutions and thus creating a pool of competent health professionals who can be drawn upon to improve the health worker/ population ratio.


The ministry will do the management of the internship programme – Dr Mucheru will draft a para.

Completion of an approved internship is necessary to achieve registration as a practitioner with the relevant regulatory body. As of now, medical officers, dentists, pharmacists, nurses, clinical officers, dental technologists, community oral health officers (COHO) and public health officers undergo internship training in government, private and faith based institutions. However there is no policy in place to guide the internship training.


1.1 Rationale


  1. Internship is a legal requirement for registration to practise after qualification

  2. For purposes of planning and projection, this internship policy is vital.

  3. The Healthcare professional to population ratio is undesirably low. WHO3 recommends a workforce density of 230 health professionals per 100,000 population as it assumes that the relative number of health professionals in a given area is one of the most important determinants of the ability to deliver health services. Kenya is below the WHO recommendations at approximately 169 health professionals for every 100,000 people. Considering that internship is a legal requirement to practice, the current waiting period by several cadres of staff to undertake internship has increased the loss of potential health professionals from the industry. To address this, the policy developed will guide the establishment of new training and internship sites, creating an opportunity to capture newly qualified graduates from local and international institutions and thus creating a pool of competent health professionals who can be drawn upon to improve the ratio.

  4. Interns are human capital as they provide critical labor even while still under supervision, as they augment quality health service provision in the backdrop of severe staff shortages. This policy advocates for the necessary support structures and privileges.

  5. The policy underscores the importance of mentorship and hands on skills acquisition where principles of fairness and quality service through standard training are instilled.

  6. As interns are from public, private and foreign institutions who have different approaches in training, this policy will standardize and harmonize requirements and provisions for the internship programme in the health sector

  7. This policy will contribute to an improvement of quality health care in line with Kenya Vision 2030.

1.2 Mandate


Internship for various health professionals is established through legal instruments as enumerated below;

  1. The Constitution of Kenya 2010 in schedule 4

  2. The Kenya Health Policy draft 2012-2030

  3. The Kenya Medical Practitioners and Dentists Act CAP 253

  4. The Pharmacy and Poisons Act, CAP 244

  5. The Clinical Officers Training, Registration And Licensing Act CAP 260

  6. The Public Health Officers And Technician Training, Registration And Licensing Act No.12 of 2013

  7. The Nurses Act CAP 257 (2011)



2.0 OBJECTIVESGOAL

2.1 Main objective


The main objective of this policy is to provide a unified management approach of the internship programme. harmonize the scope, management, financing, coordination and monitoring on internship in Kenya

2.2 Specific Objectives


  1. Define the scope of the internship training

  2. Define the roles and responsibilities of the stakeholders/ actors during internship.

  3. Improve coordination, collaboration and management of internship programmes


3.0 POLICY PURPOSE

This policy is provides direction for current and future internship training. It outlines the roles and responsibilities of various stakeholders in the implementation, supervision, coordination, and monitoring of internship programme.

4.0 PRINCIPLES


This policy is developed on the basis of the following principles;

  1. Excellence

  2. Quality

  3. Dignity

  4. Fairness

  5. Equity

  6. Consistency with other relevant legislation

  7. Gender and disadvantaged groups sensitivity

  8. Transparency

  9. Fiscal responsibility

5.0 SCOPE OF INTERNSHIP POLICY


The policy shall apply to all Health Professionals for whom internship is a legal requirement.

6.0 POLICY STATEMENTS

6.1 Internship Duration

There is hereby established an internship period which shall be twelve(12) calendar months. This period may be extended in exceptional circumstances outlined in section xxxxxx

6.2 Internship Training Centres


  1. Internship training shall be undertaken in institutions accredited and gazzetted for the purpose.
  2. Expansion of Internship centres: The existing internship centres shall be equiped and staffed to meet international standards(name the standards) for training of health professionals


  3. Internship centres to be increased progressivelly to attain x ratio, or x per sub-county

6.3 Remuneration Of Interns

Internship shall be non-remunerative. However, intership centres are strongly encouraged to provide stipends to interns as they provide critical labour. However, remuneration may be considered based on anticipated public health good and availability of resources.


Internship training


There is hereby established a prescribed by boards and councils on internship of health professionals for whom its a legal requirement.

6.4 6.2 Waiver ofing Internship


Internship for health professionals may be waived in line with the regulatory bodies guidelines.

6.53 Internship management Committees


The following committees shall be established for purposes of management of internship programme;
6.5.1 National Internship Steering Committee-The following shall constitute the membership of the National Steering Committee:

  1. National Internship Steering Committe chairperson will be theThe Principal Secretary of Health who shall be the chairperson of the committee;

  2. vice chairperson will be the The Director of Medical Services who shall be the vice chairperson

  3. Head of Human Resource Management in the Ministry of Health who shall bewill be the secretary of the committee

  4. Head, Human Rresource Ddevelopment

  5. One (1) CEC for Health representating the counties

  6. One (1) Hospital Internship Coordinator representing the hospitals approved as internship centres

  7. Five (5) representatives of heads of health proffessional cadres undertaking internship

  8. One (1) representative from among the Interns on a rotational basis by cadre.

  9. One (1) representative of the regulatory body

  10. Two(2) representatives of the training institutions, each from middle level colleges and universities


6.5.2 Facility Internship Management Committee -The following members shall constitute facility Management Committee:

  1. Head/ in -charge of the internship centre who will be the chairperson

  2. Internship coordinator who will be the secretary

  3. Internship supervisors/ HODs of the core rotational disciplines undertaking internship

  4. Dental School internship programme, HODs of the core rotational disciplines

  5. Heads of health proffessional undertaking internship in the internship centre

  6. Officer in charge of Human Resource

  7. One (1) representative of county health management team

  8. One (1) representative of the intern



6.4 Internship Training Centres


Internship training shall be undertaken in institutions accredited and gazzetted for the purpose.

6.65 Professional liability


During the period of internship, the specific internship institutions under which the intern is assigned, shall be liable for the actions and omissions committed by the intern in the exercise of his/her profession. However, the institution shall not be liable for acts committed through personal responsibility and negligence of the intern.

6.76 Internee privileges


The period of engagement shall be on the basis of contract of service which shall not exceed twelve months (12). For those in public service, a remuneration package equivalent to the entry point of respective schemes of service will apply. Private sector internship centers shall remunerate interns using the government rate as the base. Foreign interns will undertake internship at their own cost.

6.87 Budget


The renumeration of interns in Public Service shall be catered for in the annual budget of the Ministry of Health. For planning purposes, training institutions and regulatory bodies shall give the National Internship Steering Committee adequate notice.
6.9 Employment

Employment after internship shall be subject to availability of vacancies.



N/B: The national Steering committee shall advice on cases of interns who for one reason or the other are not able to complete the internship as prescribed by the regulatory body.

7.0 ROLES AND RESPONSIBILITIES


This policy outlines various roles and responsibiltirs of the various actors who shall be involved in the intership programme as indicated below:

7.1 Roles and responsibilities of an intern


    1. To complete internship as per the guidelines provided by the regulatory bodies.

    2. to adhere to all the rules and regulations as shall be stipulated by the Ministry of Health coordinating mechanisms, the code of professional conduct, regulatory boards and the rules of the internship centres as long as they are part of the internship program. Each intern has to maintain a professional demeanour and conduct .

    3. Seek guidance/ opinion of their supervisor/ mentor when in doubt on decision making

    4. To gather the relevant documents required to facilitate the internship training and present them to the supervisor as per the guidelines of the regulatory bodies

    5. To cover the entire intern’s logbook with daily documentation as per the requirements

    6. After the completion of the internship program, the intern bears the responsibility to forward the completion of internship letter to the Internship coordinator



7.2 Head Of Department (HOD)/ Supervisor roles and responsibilities4


The Head Of Department (HOD)/ Supervisor responsibilities are:

  1. To induct and orientate the interns within the department

  2. To respond to the educational needs of the interns and facilitate learning.

  3. To attest to the acquisition of the expected level of competency by intern at the end of the training in that particular department and make sure of the completion of the necessary entries in the Interns’ Logbook by the correct people with the completion of the feedback form about the intern and his/her progress in the rotation.

  4. To aid the intern in acquiring skills in communication and documentation in addition to competencies in their respective fields.

  5. To identify areas where the intern may not have acquired the requisite competency and suggest corrective measures. Such information should be communicated to the intern and brought to the attention of the internship coordinator and the MOH as soon as possible, ensuring enough time for corrective measures to be initiated.

  6. To ensure that common precautions observed in the internship centres are learnt and followed by the intern to ensure safety of self, clients and present staff during the training process

  7. To assist the intern in learning the importance of ethical and legal procedures.

  8. To conduct investigations on instances of professional misconduct raised against an intern and advise accordingly.

The specific responsibilities of the HOD’s for different cadres are further elaborated in the guidelines of the respective regulatory bodies.



    1. The internship coordinator roles and responsibilities5:


For purposes of efficiency and accountability, one internship coordiantor should be responsible for all cadres of interns per facility.

    1. To ensure all the interns are inducted and orientated at the beginning of their internship period

    2. To prepare master rotation for the interns.

    3. To ensure that the interns are provided with necessary educational support during their entire training period in the department.

    4. To collaborate with the internship centre administration and the national committee at regular intervals to ensure satisfactory progress internship.

    5. To validate the Internship logbook at regular intervals and ensure documentation of the competencies are complete.

    6. To ensure the overall welfare of the intern

    7. To conduct second line authority investigations on instances of professional misconduct raised against an intern and advise accordingly. .

    8. To present to the MOH details of the progress of the intern, and to complete the feedback and assessment reports about each intern at the end of the training period and compile a final evaluation report. The Internship coordinator will communicate the outcome of internship to MOH.



    1. Mentor/ Preceptor roles and responsibilities


  1. To interact with interns on a day to day basis for purposes of imparting appropriate attitude, knowledge and  practical skills.

  2. To monitor interns adherence to the set rules and regulations

  3. To aid the intern in acquiring skills in communication, documentation and competencies in their respective fields

  4. To respond to the educational needs of the interns and facilitate learning.

  5. To ensure that common precautions observed in the internship centres are learnt and followed by the intern to ensure safety of self, clients and present staff during the training process

  6. To assist the intern in learning the importance of ethical and legal procedures.

  7. To guide the Interns in the realization of their learning objectives. The mentor must give each intern individual attention.

  8. To guide the intern in the acquisition and strengthening of the soft skills required in health service delivery

  9. To be involved in the welfare of the intern

  10. To contribute to the appraisal of the interns by the internship supervisor

  11. The specific responsibilities of the mentor for different cadres are further elaborated in the guidelines of the respective regulatory bodies.



    1. The National Internship Steering Committee roles and responsibilities:


The Committee shall be the overall organ in charge of regulating the matters relating to the internship programme. It will have the following responsibilities;

  1. Determine and publish the internship programme schedules

  2. Select accredited institutions for gazzettement as internship training centres

  3. Approving the number, distribution and allocation of internship candidates to each internship centres;

  4. Recieve the list of interns who completed the stipulated internship period. For the unsuccessful interns, the national steering committee will discuss the recommendations from the facility management committee and take appropriate action

  5. Arbitrate as an appeal body for interns where required and communicate the outcome of the appeal.

  6. To prepare budgets for planning and forecasting.

  7. To facilitate stakeholder collaboration and coordination

  8. Monitoring and evaluation of the internship programme

  9. Monitoring and evaluation of the implementation of this policy

  10. To interpret the guidelines on internship

  11. To disseminate the policy document and other relevant guidelines to key stakeholders

  12. To receive, interrogate, recommend and approve application for internship from other cadres of health professionalsprofessionals not currently undertaking internship

The committee shall meet atleast quarterly with a two thirds quorum



    1. Facility Internship Management Committee roles and responsibilities:


There shall be a facility committee in internship centres that shall meet atleast quarterly with a two thirds quorum. The role of the committee shall be:

The committee will have the following responsibilities;



  1. coordinate and supervise the internship programme

  2. To preside over the welfare of the interns

  3. To preside over the administrative and disciplinary matters

  4. To preside over the final assessment of the interns

  5. To receive and deliberate on complaints of interns

  6. To ensure the standards and quality of internship training as per the regulatory bodies guidelines are maintained
    1. Regulatory Bodies roles and responsibilities;


  1. Develop programs consistent with the fulfillment of the learning objectives for the internship program.

  2. ReviewDetermine the duration of internship

  3. Develop the norms and standards as an evaluation criteria for the internship program

  4. Accreditation of new internship centres

  5. Undertake periodic(2 years) inspection of established internship centres for the purposes of retention of accreditation;

  6. Set the criteria to be fulfilled by applicants to be allowed to undertake internship

  7. Administer pre-internship examination where necessary

  8. Issuance of provisional internship licenses

  9. Develop mentorship, training guidelines and log books for assessment of internship

  10. Registration of health professionalsprofessionals after due successful completion of internship

  11. Dissemination of code of professional conduct. Will collaborate with the internship committees in implementation of disciplinary measures including professional negligence.

8.0 IMPLEMENTATION

8.1 Institutional Framework


The following institutions will be responsible implentation of this policy:

  1. Ministry of Health

  2. The National Treasury

  3. Ministry of Devolution and Planning

  4. Public Serrvice Commission

  5. County governments

  6. Regulatory bodies

  7. Accredited internship training centers



8.2 Implementation Responsibilities


  1. Ministry of Health

Planning and coordination for internship program

Maintaining quality of internship centres



  1. The National Treasury

Financing the program and the

  1. Ministry of Devolution and Planning

Issuance of personal numbers

  1. Public Serrvice Commission

Establishment of internship complement

  1. County governments

Providing an enabling enviroment for internship including provision of housing, stipends and security

  1. Regulatory bodies

Design, develop and monitor internship program

7. Gazzetted internship training centers

  • Providing an enabling enviroment and training of interns



8.3 Tools for implementation the policy


This policy shall be used in line with other relevant policies, rules and guidelines including but not limited to

  1. The Constitution of Kenya

  2. Kenya Health Bill

  3. Kenya Health Policy

  4. Code of Regulations (Revised 2006)

9.0 FINANCIAL IMPLICATIONS

There is hereby established an internship period.The internship period will be a twelve (12) month contract of service during which a remuneration package equivalent to the entry point of respective schemes of service will apply. The remuneration of the interns in the Public Service shall be catered for in the annual budget of the Ministry of Health.





































JG

Current In-post 2013/2014

Projected Posts 2014/2015

Projected Posts 2015/2016

Projected Posts 2016/2017

Salary

Allowances

Current Payment (2013/2014)

Projected Total for 2014/2015

Projected Total for 2015/2016

Projected Total for 2016/2017

H

0

2,552

2,970

3,340

19,323

25,500

-

1,385,419,552

1,612,341,720

1,813,205,840

K

200

744

950

1,300

31,020

41,850

176,088,000

655,047,360

836,418,000

1,144,572,000

L

831

1,210

1,210

1,210

35,910

93,000

1,290,476,520

1,879,033,200

1,879,033,200

1,879,033,200













 

 

 

 




 

 













Total

 

 

1,466,564,520

3,919,500,112

4,327,792,920

4,836,811,040



































10.0 MONITORING AND EVALUATION


An effective Monitoring and Evaluation (M & E) System is critical for the successful implementation of the Internship Policy. The M & E system shall be put in place to promote evidence based decision making involving stakeholders at all levels. Effectiveness of the framework put in place to monitor and evaluate this policy shall depend on the coordinated action of MOH.
In this regard, the MOH shall work closely with relevant line ministries, regulatory agencies and other stakeholders to ensure that there is an effective implementation of this policy. Further, it shall be expected that the partners shall develop their own frameworks and guidelines to monitor the activities that they will be implementing. The M&E system shall, therefore, encourage communication between different stakeholders involved in national as well as county needs.
The objectives of the Internship Policy shall systematically be monitored. This is particularly important for Kenya where counties are responsible for the health services delivery as provided for in the Constitution. Therefore, the MoH shall take appropriate measures, including the provision of adequate resources to institutionalize the monitoring of the achievements towards policy objectives.
Verifiable indicators and measurement tools shall be developed to monitor progress. The MoH, with the relevant stakeholders, shall identify the appropriate indicators and shall install mechanisms to measure, monitor the achievement of the implementation of the policy and assist in a decision making. The input, output and outcome indicators shall determine progress in the implementation of this Policy based on the Monitoring and Evaluation Framework on internship Policy shown overleaf;

Monitoring and Evaluation Framework- internship Policy 2014





11.0 POLICY REVIEW AND DEVELOPMENT


The steering committee, upon consultation with relevant stakeholders, will undertake periodic review of the policy with a view to address emerging issues.


APPENDICES

APPENDIX A


List of accredited and gazzetted internship centres

APPENDIX B


  1. Bungoma Level 4 Hospital

  2. Kakamega County Referal and Teaching Hospital

  3. Jaramogi Oginga Odinga Referral and Teaching Hospital (JOORT)

  4. Kisii Level 5 Hospital

  5. Kitale Level 4 Hospital

  6. Moi Teaching and Referrel Hospital

  7. Nakuru County Referral Hospital

  8. Kijabe AIC Hospital

  9. Kiambu County referral Hospital

  10. Thika Level 5 Hospital

  11. Machakos County Referral Hospital

  12. Kitui Level 4 Hospital

  13. Garissa County Referal Hospital

  14. Nyeri County Referral Hospital

  15. Kirinyaga Level 4 Hospital

  16. Meru County Referral Hospital

  17. Embu County Referral Hospital

  18. Kenyatta Nationl Hospital

  19. Aga Khan University Hospital

  20. Nazarete Hospital

  21. The Mater Hospital

  22. St. Mary’s Hospital

  23. Kendu Adventist Hospital

  24. Homa Bay Level 4 Hospital



Financial requirements

APPENDIX C


List of existing regulatory bodies

  1. Clinical Officers Council

  2. Kenya Medical Practioners and dentists Baorder

  3. Medical Laboratory Scientific Officers Board

  4. Nursing Council of Kenya

  5. Pharmacy and Poisons Board

  6. Public Health Officers Council

  7. Radiation and Protection Board

1 UAE

2 Constitution of Kenya 2010

3 World Health Report 2006

4 Rwanda

5 Rwanda



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