MUNYIVAPHDroleofhrmonretentionofstaffinpublichealth

ROLE OF HUMAN RESOURCE MANAGEMENT
PRACTICES ON RETENTION OF STAFF IN PUBLIC

HEALTH INSTITUTIONS IN MACHAKOS COUNTY,
KENYA
JACINTA MUNYIVA KINYILI
DOCTOR OF PHILOSOPHY
(Human Resource Management)
JOMO KENYATTA UNIVERSITY OF

AGRICULTURE AND TECHNOLOGY
2015
Role of Human Resource Management Practices on Retention of Staff
in Public Health Institutions in Machakos County, Kenya
Jacinta Munyiva Kinyili
A thesis submitted in partial fulfilment for the degree of doctor

philosophy in human resource management in the Jomo
Kenyatta University of Agriculture and Technology
2015
DECLARATION
This thesis is my original work and has not been presented for a degree in any other
university.
Signature: ________________ Date: _________________
Jacinta Munyiva Kinyili
This thesis has been submitted for examination with our approval as the university
supervisors.
Signature: _____________________ Date: ___________________
Dr. Kabare Karanja

Jkuat, Kenya
Signature: ___________________ Date: _____________________
Prof. Gregory S Namusonge

Jkuat, Kenya
ii
DEDICATION
To the Almighty God, my husband and friend Cosmas, my lovely children Hope and
Hike and my dear loving parents Mutumi and Kinyili.
iii
ACKNOWLEDGEMENT
My sincere gratitude goes to my supervisors: Dr. Kabare Karanja and Prof. Gregory
Namusonge for their invaluable professional guidance during the development of the
proposal and the final thesis. I would also like to recognize the support of Chief
Executive Officer of Health, Machakos County and his team without whose authority
and assistance obtaining statistics and data of the county would have been difficult. I
also thank all the respondents for their cooperation and finding time to fill the
questionnaires and take the interviews despite their very busy and tight schedules given
their busy schedules. Sincere thanks also to my husband Cosmas and children for their
great, support, encouragement and patience throughout this period when I could be so
near yet so far. Lastly but most important, may glory and honour be to the Almighty
Lord through whom all things are possible for giving me the determination, patience
and courage to pursue this PhD degree programme.
iv
TABLE OF CONTENTS
DECLARATION ..................................................................................................................... ii
DEDICATION .................................................................................................................... iii
ACKNOWLEDGEMENT ..................................................................................................... iv
TABLE OF CONTENTS ........................................................................................................ v
LIST OF TABLES ................................................................................................................. ix
LIST OF FIGURES .............................................................................................................. xii
LIST OF APPENDICES ..................................................................................................... xiii
DEFINITION OF TERMS.………………………………………………………………..xv
ABBREVIATIONS AND ACRONYMS ............................................................................ xvi
ABSTRACT ................................................................................................................. xvii
CHAPTER ONE ..................................................................................................................... 1
INTRODUCTION ................................................................................................................... 1
1.1 Background of the Study..................................................................................................... 1
1.2 Statement of the Problem .................................................................................................... 9
1.3 Research Objectives .......................................................................................................... 11
1.3.1 General Objective........................................................................................................... 11
1.3.2 Specific Objectives......................................................................................................... 11
1.4 Research Questions ........................................................................................................... 11
1.5 Hypotheses ................................................................................................................... 12
1.6 Significance of the Study .................................................................................................. 13
CHAPTER TWO .................................................................................................................. 16
LITERATURE REVIEW..................................................................................................... 16
2.1. Introduction ................................................................................................................... 16
2.2. Theoretical Frameworks................................................................................................... 16
2.2.2 Victor Vroom‘s Expectancy Theory .............................................................................. 17
v
2.2.3 Stacey Adam‘s Equity Theory ....................................................................................... 19
2.3 Conceptual Framework ..................................................................................................... 20
2.4. Review of Literature on Variables ................................................................................... 22
2.4.1 Employee Retention and Organizational Success ........................................................ 22
2.4.2 Remuneration Practices and Retention. ......................................................................... 26
2.4.3 Career Advancement Practices and Retention ............................................................... 31
2.4.4 Work Environment Management Practices and Retention ............................................ 40
2.4.5 Work–Life Balance Practices. ........................................................................................ 43
2.5. Research Gaps .................................................................................................................. 49
CHAPTER THREE .............................................................................................................. 51
RESEARCH METHODOLOGY ........................................................................................ 51
3.1. Introduction ................................................................................................................... 51
3.3. Target Population ............................................................................................................. 52
3.4. Sample and Sampling Frame .......................................................................................... 54
3.4.1. Health Institutions ......................................................................................................... 54
3.5. Research Instruments ....................................................................................................... 56
3.7.1. Reliability ...................................................................................................................... 58
3.7.2. Validity ....................................................................................................................... 60
3.8. Data Analysis and Presentation ....................................................................................... 61
CHAPTER FOUR ................................................................................................................. 65
RESEARCH FINDINGS AND DISCUSSION ................................................................... 65
4.1. Introduction ................................................................................................................... 65
4.3.1. Response Rate .............................................................................................................. 66
4.3.3. Gender of the Respondents ........................................................................................... 68
4.3.4. Age of Respondents in Years ....................................................................................... 69
4.3.5. Marital Status of the Respondents ............................................................................... 71
4.3.6. Family Status of the Respondents ................................................................................. 73
4.3.7. Status of Children in the Family .................................................................................. 74
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4.3.8. Level of Education ........................................................................................................ 75
4.3.9. Designation of Respondents.......................................................................................... 76
4.3.10. Graduation Period ...................................................................................................... 77
4.4. Research Hypotheses ....................................................................................................... 79
4.4.1: H01: There is no significant relationship between employee remuneration practices and
retention of health care staff in Machakos County in Kenya. ...................... 79
4.4.2: H02: There is no significant relationship between career advancement practices and
4.4.3: H03: There is no significant relationship between work environment management
practices and retention of health care staff in Machakos County in Kenya. 84
4.4.4: H04: There is no significant relationship between work-life balance practices and
4.5 Collective Role of the Independent Variables pooled together on the Dependent
Variable Retention. ....................................................................................................... 89
4.5.1 Relationship Between HRM Practices ........................................................................... 89
4.5.2 Correlation between the Independent Variables and the Dependent Variable ............. 91
4.5.3 Multivariate Linear Regression Analysis between the Independent Variables and the
Dependent Variable ....................................................................................... 92
4.5.4 Significance of Each Independent Variable in the Model ............................................. 93
4.6 Analysis Based on Research Objectives ........................................................................... 94
4.6.1 Role of Remuneration Practices on the Retention of Health Care Staff ........................ 95
4.6.2 Role of Career Advancement Practices on the Retention of Health Care Staff ........... 100
4.6.3 Role of Work Environment Management Practices on the Retention of Health Care
Staff ............................................................................................................. 109
4.6.4 Role of Work life Balance Practices on the Retention of Health Care Staff ............... 116
4.6.5 Other Human Resource Management Practices that Influence Staff Retention .......... 122
in Organizations .......................................................................................................... 122
4.6.6 Employee Commitment and Tendency to Stay (Retention) ........................................ 122
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4.7 Presentation of Interview Findings. ................................................................................ 128
CHAPTER FIVE ................................................................................................................. 131
SUMMARY OF MAJOR RESEARCH FINDINGS, CONCLUSIONS AND
RECOMMENDATIONS .................................................................................................... 131
5.1. Introduction .................................................................................................................... 131
5.2. Summary of Major Findings .......................................................................................... 131
5.2.1. Remuneration Practices and Retention ....................................................................... 131
5.2.2 Career Advancement Practices and Retention ............................................................. 132
5.2.3 Work Environment Management Practices ................................................................. 133
5.2.4 Work-Life Balance Practices ....................................................................................... 134
5.2.5 Employee Commitment and Intent to Stay .................................................................. 135
5.3 Conclusion ................................................................................................................. 137
5.5 Suggestion for Further Research ..................................................................................... 141
REFERENCES ................................................................................................................. 143
APPENDICES…………………………………………………………………………….182
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LIST OF TABLES
Table 3.1. Target population .......................................................................................... 53
Table 3.2. Sample Size .................................................................................................. 56
Table 3.3 Cronbach‘s Alpha Analysis for the Pilot instruments .............................. 60
Table 4.1: Cronbach‘s Alpha Analysis for all Instruments used ............................... 66
Table 4.2: Graduation Period ..................................................................................... 78
Table 4.3: Anova results on role of remuneration practices on retention of health

care staff ................................................................................................... 79
Table 4.4: Model Summary ...................................................................................... 80
Table 4.5: Coefficientsa ............................................................................................. 81
Table 4.6: Anova results on role of career advancement practices on retention of

health care staff ......................................................................................... 82
Table 4.7 Linear regression analysis model summary.............................................. 83
Table 4.8 Regression analysis correlation coefficient .............................................. 84
Table 4.9: Anova results on role of work environment management practices on

retention of health care staff .................................................................... 85
Table 4.10 Model Summary ....................................................................................... 86
Table 4.11: A Simple Regression Analysis Correlation Coefficients ........................ 86
Table 4.12: Anova results on role of work life balance practices on retention of health
care staff ................................................................................................... 87
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Table 4.13: Model Summary........................................................................................ 88
Table 4.14: Simple regression analysis correlation Coefficients ................................ 89
Table 4.15: Correlation analysis between the HRM practices .................................... 90
Table 4.16: Summary of the correlation analysis of the bivariate relationship of

retention against the independent variables .............................................. 91
Table 4.17 Multiple linear regression analysis Model Summary ............................... 92
Table 4.18: Anova for the independent variable and the four independent variables
pooled together. ........................................................................................ 93
Table 4.19 : Multiple regression analysis correlation coefficients. ............................. 94
Table 4.20: Remuneration Practices Influence Staff Retention .................................. 95
Table 4.21: Role of Remuneration Practices on Retention of Health Care Staff ........ 96
Table 4.21: Role of Remuneration Practices on Retention of Health Care Staff (cont) ..
.................................................................................................................. 97
Table 4.22 Career Advancement Practices Affect Retention ................................... 101
Table 4.23 Role of Career Advancement Practices on Retention of Health Care Staff .
................................................................................................................ 102
Table 4.23 Role of Career Advancement Practices on Retention of Health Care Staff
(cont) ........................................................................................................... 104
Table 4.24: Work Environment Management Practices Influence Staff Retention ..... 109
Table 4.25: Role of Work Environment Management Practices on Retention of Health

Care Staff ................................................................................................ 110
x
Care Staff (cont) ..................................................................................... 112
Table 4.26: Work Life Balance Practices Affect Employee Retention .................... 116
Table 4.27 : Role of Work-life Balance Practices on Retention of Health Care Staff 117
Table 4.27: Role of Work-life Balance Practices on Retention of Health Care Staff
(cont) ........................................................................................................... 118
Table 4.28: Employees‘ Commitment ....................................................................... 123
Table 4.28: Employees‘ Commitment (cont) ............................................................ 124
Table 4.29: Employees‘ Intend to Stay ...................................................................... 126
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LIST OF FIGURES
Figure: 2.1 Conceptual frame work. ........................................................................... 21
Figure 4.1: Response Rate........................................................................................... 67
Figure 4.2. Response rate by designation ................................................................... 68
Figure 4.3: Gender ...................................................................................................... 69
Figure 4.4: Age in Years ............................................................................................. 70
Figure 4.5: Marital Status ........................................................................................... 72
Figure 4.7: Status of Children .................................................................................... 74
Figure 4.10: Level of Agreement with Reward Practices ............................................ 99
Figure 4.11: Level of Agreement with Career Advancement Practices ..................... 107
Figure 4.12: Level of Agreement with Work Environment Management Practices ... 114
Figure 4.13: Level of Agreement with Work Life Balance Practices ........................ 120
Figure 4.14: Employees‘ commitment and intent to stay ........................................... 128
xii
LIST OF APPENDICES
Appendix i: Authorityletter .......................................................................................... 180

Appendix ii: Authority letter from the county .............................................................. 181
Appendix iii Introduction Letter .................................................................................. 182
Appendix iv: Questionnaire ........................................................................................... 183
Appendix v: Interview Schedule .................................................................................... 194
Appendix vii: Means and standard deviation .................................................................. 196
Appendix viii: List of healthcare facilities ........................................................................ 197
Appendix ix: Maps ......................................................................................................... 191
xiii
DEFINITION OF TERMS
Brain Drain - The movement of health personnel in search of a better

standard of living and life quality, higher salaries, access
to advanced technology and more stable political
conditions in different places worldwide(Misau et al.,
2010).
Career advancement- Career advancement is the lifelong process of managing
progression in learning and work.(Gupta, 2008)
Retention - Retention is a voluntary move by an organization to create

an environment which engages employees for long term
(Chaminade, 2007).
Role - Function or position that something is expected to have in
a situation or the degree in which something is involved in
a situation or activity and the effect that they have on it
(Hornby, 2010). Terms have been used interchangeably in
the document.
Remuneration- Reward for employment in the form of pay, salary or wage
Including allowances, benefits like cars, bonuses cash
Incentives and monetary value of the noncash incentives
(Döckel 2003,Armstrong, 2009). Used synonymously/
interchangibly with word reward.
xiv
Work-life balance- An individual‘s ability to meet his or her work and family
commitments, as well as other non-work responsibilities
and activities, ( Parkes and Langford ,2008)
Working Environment- Surrounding conditions in which employees operate
including physical conditions like office, equipment,
ventilations as well as psychological conditions like the
nature of social interaction with peers , managers and
subordinates. (Gupta,2008)
xv
ABBREVIATIONS AND ACRONYMS
BOSTI The Buffallo Organization for Social and Technological Innovation
GOK- Government of Kenya

HIV/AIDS- Human Immunodeficiency Virus / Acquired Immunodeficiency
Syndrome
HR- Human Resource
HRM- Human Resource Management
IOM- Institute of occupational Medicine
KNBS- Kenya National Bureau of Statistics
MMS- Ministry of Medical Services
MOH- Ministry of Health
NCAPD- National Coordinating Agency for Population Development
MPHS- Ministry of Public Health and Sanitation
ROK- Republic of Kenya
TI-K - Transparency International -Kenya.
UK- United Kingdom
UNDP- United Nations Development Programme
UNHDR- United Nations Human Development Report
UNECA- United Nations Human Development Report
USA- United States of America
WHO- World Health Organization
xvi
ABSTRACT
The purpose of this study was to explore the role of HRM practices on the retention of
staff in public health institutions in Machakos County. The objectives of the study were
to explore the role of remuneration practices, to analyze the role of training and
development practices, to explore the role of career advancement practices and to
analyze the role of work-life balance practices on the retention of staff in public health
institutions in Machakos County. Four hypotheses were developed in line with the
research objectives. The study adopted a mixed methods research design and targeted all
the 772 health care staff in the 152 public health facilities in the eight sub-counties in the
county. The population was stratified into 8 main strata consisting of doctors, dentists,
clinical officers, nurses, physiotherapists, pharmacists, laboratory technicians and
radiographers. The hospitals were selected purposively while stratified random sampling
was used to select the health care and dispensaries from each of the sub-counties.
Stratified random and purposive sampling were used to select a total of 263 respondents
from the various strata identified. Interviews were used to collect data from 12 officers
in charge of sub county facilities and the four hospitals while self-administered
questionnaires were used on the rest of the respondents. With the help of the statistical
package for social sciences (SPSS) programme version 18 regression analysis was done
and the results used to test the hypotheses, determine the coefficients of the multiple
regression model to establish the sample regression model and to evaluate the reliability
of the estimated relationship. Through content analysis qualitative data collected was
analyzed in line with the major themes. The data was then presented using frequency
tables, bar graphs and pie charts. Positive responses were received from 227 respondents
out of the sampled 251 giving a 90% response rate. The findings were that there were
weak but statistically significant positive relationships between remuneration practices,
career advancement practices, work environment management practices and work-life
balance practices and retention. The reward practices, career advancement practices,
xvii
work environment management practices and work-life balance practices in place were
found to be unsatisfactory. For instances, salaries were poor and often delayed and
critical allowances were not provided, promotions were not done appropriately, there
facilities were not properly equipped and a number were in poor physical state while
flexi working programmes were not provided. Due to the poor remuneration, career
advancement, work environment and work-life balance practices, the employees‘ level
of commitment was low. However their intent to leave was also low because finding
alternative jobs was difficult among other reasons. Other HRM practices such as
leadership, employee involvement, performance management were also said to influence
retention in the health care facilities. Based on these findings, it was recommended that
Machakos county government should look into the aspects of remuneration, career
advancement, work environment and working life balance practices and put in place
mechanisms that would address these practices and thus minimize their negative effects
on staff satisfaction and commitment hence retention in the health care institutions in the
county.
xviii
CHAPTER ONE
INTRODUCTION
1.1 Background of the Study
Accelerating product and technological changes, global competition, deregulation and

demographic changes are among the revolutionary trends that organizations have to
wrestle with while still striving to implement trends towards a service and information
age society (Kane, 2003). One of the challenges facing many organizations is the
retention of critical employees. Society has now become knowledge based where human
capital is considered a key resource and indispensable to the survival of businesses. In an
era where skills and knowledge of employees are amongst the main competitive
enablers, organizations cannot ignore the significance of attracting and retaining talented
people (Hallén, 2007; Minchington, 2010; Mohaptra, 2005; Prinsloo, 2008). The new
economy is characterised by a volatile talent demand–supply equation set against er
ratic attrition trends and boundless cutthroat competition, and organizations have never
had a tougher time in finding, managing and nurturing talent (Cheese,Thomas& Craig
,2007; Mohaptra, 2005).
The strength of any nation depends to a large extend on its productivity which in turn
depends on the well-being of the population (Misau , Al-Sadat & Gerei, 2010). Mischa
et al (2008) observed that a key constraint to achieving the MDGs is the absence of a
properly trained and motivated workforce. Health workers are vitally important for the
effective functioning of healthcare systems (Ndetei, Khasakhala & Omolo, 2008).
Health care is one of the sectors highly affected by turnover. An inadequate health
workforce (with a high population-to-health worker ratio) contributes to the general
1
deterioration of health indicators (Dolvo 1999; Dolvo, 2002; Dolvo, 2003). Loss of
clinical staff from low and middle-income countries is crippling already fragile health
care systems. Health worker retention is critical for health system performance and a key
problem is how best to motivate and retain health workers (Mischa, Bidwell, Thomas,
Wyness, Blaauw, & Ditlopo,2008)
The health care system in the developing countries faces many problems, human
resource retention being one of the majors. The system is structurally and systemically
fragile and weak to provide effective service where it is most
needed. Brain drain appears to have complicated the situation and made matters worse
(Oyelere, 2007). In deed the availability of health personnel in Africa is considerably
worse than in other regions of the world and it is one of the major stumbling blocks to
the delivery of adequate healthcare (Chankova , 2006).
Pang , Lansang and Haines (2002) estimates that 23,000 health care professionals
emigrate annually from Africa,. There are more African scientists and engineers in the
USA than in Africa. According to UNECA some 127,000 highly qualified African
professionals left the continent between 1960 and 1989.By contrast, North and South
America, which together have 14% of the world's population but only 10% of the global
disease burden, employ 37% of the global health workforce and contribute over 50% of
the pool of global health expenditure (WHO,2006). Malawi in southern Africa now has
about 100 doctors and 2000 nurses to serve a population of 12 million people. The
hospital beds in many poor countries are full and overflowing. Staff is unable to keep up
with the seemingly endless flow of patients near death (Green, 2007). The negative
impact of brain drain can be masked in the urban areas of developing countries with
higher concentration of public and private health centers, but such effects remain
clear in the rural areas.
2
As at 2006, more than 25% of doctors in the US were foreign trained, and US had an
estimated ratio of 25.6 doctors per 10,000 population. In comparison, the small country
of Lesotho in southern Africa has 0.5 doctors per 10,000 population, and an adult HIV
prevalence rate of 28.9%, in addition to tuberculosis, malaria, and the host of other
lower respiratory and gastrointestinal illnesses that plague that part of the world. Uganda
had only one doctor per 24,700 inhabitants, and Zambia needed 15,000 physicians for its
health care system to work properly, but only around 800 were registered
(Richards,2003). The physician-to-population ratio is estimated to be
13/100,000 in Africa, compared with 280/100,000 in the United States (Hagopian et al,
2004). Despite these loop-sided statistics, about 23,000 qualified academics emigrate
each year from Africa alone. In the year 2001, a Manila based newspaper reported
13,536 Filipino nurses left the country, whereas only 4780 graduated (UNDP, 2004).
A survey of Ghana‘s health-care facilities in 2002 found that 72% of all clinics and
hospitals were unable to provide the full range of expected services due to a lack of
personnel, 43% were unable to provide full child immunizations, 77% were unable to
provide 24-hour emergency services and round-the-clock safe deliveries for
women in childbirth. Figures released by the IOM showed that between 1993 and 2002,
Ghana lost 630 medical doctors, 410 pharmacists, 87 laboratory technicians and 11,325
nurses to international migration and brain drain (Oyelere, 2007). More than a quarter of
foreign nurses registered in the UK in the year1999-2000 came from South Africa.
According to Migration Watch UK, South Africa is among the three countries supplying
the largest number of overseas nurses to the UK (the others are The Philippines and
India). Other African countries such as Nigeria, Zimbabwe, Ghana, Kenya, Zambia and
Malawi are among those countries whose qualified nurses have been practicing in the
UK and US since 1998 (UN HDR 1993; Lalla,2000) . To date, Africa remains a
significant source of much needed nurses for the UK NHS. In 2003, 43% of nurses
3
registering in the UK, for example, were foreign trained, compared to 10% a decade
earlier (Buchan et al. 2004;).
Hunt (2009) notes that losing these critical employees negatively impacts the bottom
line of healthcare organization in a variety of ways including, decreased quality of
patient care, (Dana, 2005), loss of patients (Price Waterhouse Coopers, 2007), increased
contingent staff costs, increased nurse turnover (Anderson, Corazzini & McDaniel,
2004), increased turnover of medical support staff Anderson, Corazzini, & McDaniel,
2004)), increased staffing costs, increased accident and absenteeism rates (Glass,
McKnight, & Valdimarsdottir,1993).
According to Pang et al (2002) and Kupfer, Hofman , Jarawan , McDermott& Bridbord
(2004) emigration results from a combination of push factors (in source countries) and
pull factors (in recipient countries). The key push factors driving out health workers
include weak health systems, insecurity including violence at the workplace, poor living
conditions; low remunerations, lack of professional development opportunities such as
continuing education or training, lack of clear career development paths (Stiwel ,Zurn,
Connel, Awases, 2005) and risk of HIV infection due to lack of appropriate protective
gear when handling specimens, blood and blood products, in- recruitment and
promotion, political unrest/civil wars, widespread poverty, poor governance and work
overload. Torrington, Hall, Taylor and Atkinson (2011) also cite insufficient
development opportunities, boredom, ineffective supervision, poor levels of employee
involvement and straight forward personality clashes as most common precipitating
factors.
Some of the factors that pull professionals to developed countries may include:
availability of information, easy access to communication and technology, making it
easy to find jobs or complete visa applications and process, aggressive targeted
recruitment to fill vacancies in richer countries, availability of employment
opportunities, better remunerations and working conditions (Stilwel et al, 2004 and
4
Torrington, Hall, Taylor and Atkinson , 2011) , secure and conducive living conditions;
and opportunities for intellectual growth such as refresher courses, access to Internet
and modern library facilities.
Branham (2005) drawing on a research undertaken by the Saratoga Institute as cited in

Torrington, Hall, Taylor and Atkinson ( 2011) identified the seven ‗hidden reasons why
employees leave‘ as the job or workplace not living up to expectation, mismatch
between the person and the job, too little coaching and feedback, too few growth and
advancement opportunities, feeling devalued and unrecognized, stress from overwork
and work-life imbalance, loss of trust and confidence in senior leaders. These push and
pull factors in tandem have led to brain drain of health professionals from African
countries. This has exacerbated the already weak national and district health systems,
making it extremely difficult for countries in the Region to achieve the United Nations
Millennium Development Goals (MDGs) (UN,2000, UNDP,2004).
Like most countries in Africa, the shortage of healthcare workers is not unique to Kenya.
Indeed, Kenya is one of the countries identified by the WHO as having a ―critical
shortage‖ of healthcare workers. While WHO has set a minimum threshold of 23
doctors, nurses and midwives per population of 10 000 as necessary for the delivery of
essential child and maternal health services, Kenya‘s most recent ratio stands at 13 per
10 000 (WHO, 2010). This shortage is markedly worse in the rural areas where, as noted
in a recent study by Transparency International, under-staffing levels of between 50 and
80 percent were documented at provincial and rural health facilities (TI-K, 2011).
Kenya's health system faces a variety of human resource problems, primarily an overall
lack of personnel in key areas, which is worsened by high numbers of trained personnel
leaving the health sector to work overseas. Furthermore, those personnel who remain are
inequitably distributed between urban and rural areas (Dambisya, 2007).In Kenya the
brain drain of medical professionals is threatening the very existence of the country's
health services. Kenya loses on average 20 medical doctors each month through either
5
brain drain or brain waste (Ndetei et al, 2008). The emigration rate of doctors currently
stands at 51% with main destination being the UK; while the emigration rate of nurses is
8%. Hunt (2009) asserts that nurses in most healthcare organization have some of the
highest levels of direct patient contact of any employees. As a result, they play a pivotal
role in the financial performance of these organization ( Boudreau, & Ramstad, 2007).
The financial cost of losing a single nurse has been calculated to equal about twice the
nurse‘s annual salary (Atencio, Cohen, Gorenberg, 2007,). The average hospital is
estimated to lose highly (Kirigia et al,2006), about $300,000 per year for each
percentage increase in annual nurse turnover while on average for every doctor that
emigrates, a country loses about US$ 517,931 (Price Waterhouse Coopers ,2007).
A 2010 review (NCAPD,KNBS&ICF,2011) of the health situation in Kenya, performed
by the Ministry of Medical Services and the Ministry of Public Health and Sanitation,
reveals that improvements in health status have been marginal in the past few decades
and certain indicators have worsened . Maternal Mortality Rate (MMR) and Neonatal
Mortality Rate (NMR) have worsened over the past few decades, while Infant Mortality
Rate (IMR) has only marginally improved. The review shows that disease burden as a
result of malaria, tuberculosis and HIV/AIDS, which together account for almost 50
percent of all deaths in the country, have received the most attention GOK (2010) with
the government and donors focusing on prevention, treatment and eradication efforts.
While infectious diseases continue to be a burden to the Kenyan healthcare system, the
incidence of non-infectious diseases such as diabetes, cancer, cardiovascular disease and
high blood pressure are on the rise.
In terms of access to health care, Approximately 78 percent of Kenyans live in rural

areas, yet a disproportionate share of healthcare facilities are located in urban areas
(WHO,2012) .Those in rural areas often have to travel long distances, often on foot, to
seek care. According to the World Bank, the index of access to health services
(measuring the share of newborns delivered at a health facility) in Kenya, speaks
volumes to this disparity. For example, over eight in ten children born in Kirinyaga
6
County, which is located in the central part of the country, are delivered in a health
facility. In Wajir, which is located in one of the most remote and marginalized regions of
the country, one child in twenty is born in a health facility (World Bank, 2012).
The devolution of health care in Kenya is also likely to complicate management of

health care and staff retention endeavors. In the devolved government, the Kenya Health
Policy 2012 – 2030 provides guidance to the health sector in terms of identifying and
outlining the requisite activities in achieving the government‘s health goals. The policy
is aligned to Kenya‘s Vision 2030, the Constitution of Kenya and global health
commitments such as the Millennium Development Goals.(MMS & MPHS,2012)
According to the policy paper, the new Ministry of Health (MOH) key mandates are ;
development of national policy ,provision of technical support at all levels, monitoring
quality and standards in health services provision, provision of guidelines on tariffs for
health services and conducting studies required for administrative or management
purposes . At county level, the Kenya Health Policy 2012 – 2030 proposes the formation
of county health departments whose role will be to create and provide an enabling
institutional and management structure responsible for ―coordinating and managing the
delivery of healthcare mandates and services at the county level.‖ In addition to the
county health departments, the policy calls for the formation of county health
management teams. These will provide ―professional and technical management
structures‖ in each county to coordinate the delivery of health services through health
facilities available in each county.
Article 235 of the Constitution of Kenya ,2010 (RoK,2010 ), empowers the counties to
establish offices and employ individuals performing functions allocated to them in
Fourth Schedule. This means persons working in the county health departments
including the community services primary healthcare services and County Referral
Services are going to be employees of the County government. In effect some counties
7
will have the benefit of employing qualified healthcare providers than others. This may
lead to further marginalization. A study of five years of devolution in Philippines
revealed problems of understaffing, unmaintained infrastructure, unrepaired and un-
replaced equipment. A lot of resources were used on staffing and less on other resources
necessary to deliver the services to the people. Additionally the study in Philippines
showed inequitable distribution of resources with cities receiving 3.5 times more than
the provinces. This has resulted in many local government units being unable to finance
the health services that they were required to provide (KPMG, 2013).
Like in the Philippines, health care provision within the devolved system of government
as provided for in the Constitution of Kenya, 2010 will come up against several
obstacles. Key among these being the challenge posed by uneven inter-county levels of
development, unequal distribution of resources for health especially the distribution of
health facilities, human resources, and poorly developed communication infrastructure.
Also unevenly distributed across the country are poverty levels, the effect of which is to
make health services largely inaccessible to a large chunk of the population that cannot
afford the high out-of-pocket expenditures, which are known to be common in Kenya.
Some counties starting at a relative disadvantage will take time to build up their capacity
and ability to manage these facilities (Wamiti, 2013).
The background has shown that despite the enormous public finances spend in training
of healthcare workers in Kenya and the prevalence of diseases, emigration of these
workers continues to increase. These revelations prompted the researcher to empirically
investigate the role of HR practices such as remuneration, career advancement, working
environment, work-life balance and on the retention of healthcare professionals in public
healthcare institutions in Machakos County.
8
1.2 Statement of the Problem
Health workers are vitally important for the effective functioning of healthcare systems
(Ndetei et al, 2008). However studies show that health care is one of the sectors highly
affected by turnover. Empirical studies show that Kenya‘s health system faces a variety
of human resource problems, primarily an overall lack of personnel in key areas, which
is worsened by high numbers of trained personnel leaving the health sector to work
overseas (Dambisya, 2007). Indeed studies show that Kenya loses on average 20
medical doctors each month through either brain drain or brain waste (Ndetei et al,
2008). Furthermore, those personnel who remain are inequitably distributed between
urban and rural areas. If the current trend of poaching of scarce human resources for
health (and other professionals) from Kenya continues, the chances of achieving the
Millennium Development Goals on health and Kenya vision 2030 would remain bleak.
Machakos County Government in its 2012 integrated strategic plan commits itself to live
up to the vision 2030 expectations ―to provide equitable and affordable health care at
the highest affordable standard to her citizens‖. However the biggest challenge facing
the County in health care sector is the increasing cases HIV\AIDS in spite of the
awareness level of over 85 per cent. It also faces the challenges of providing medical
care for the infected and support for the affected. Currently the County estimates that
there are over 15,000 children who are in need of special care (CSP) and this numbers is
expected to rise due to the increasing number of HIV/AIDS orphans.
The most prevalent diseases are Malaria and Skin diseases while the childhood diseases
include anaemia, marasmus, eye infection, pneumonia, malaria, Kwashiorkor. Despite
this high levels of disease prevalence the Doctor to Population Ratio is at 1:62,325
which is far below prescribed WHO ratio of 1:435 ,while the Infant Mortality Rates and
Under Five Mortality Rates are 27/1000 and 38/1000 respectively; both of which are
high when compared against 25 / 1,000, and 33 /1,000 targeted in the vision 2030. These
9
statistics imply that the county government must strategies to keep the existing health
care staff and even attract more to be able to realize its 2017 goal of reducing the
current high maternal mortality rate 147 per 1000, high infant mortality rate 80 per
1000, high under five infant mortality rate 52 per 1000 , low Immunization rate- 54.3%
and low Safe delivery 30.5%, to desirable levels (Machakos Strategic Plan, 2012).
Theoretical and empirical studies have shown that there are many push and pull factors
affecting retention among them human resource management practices such as
remuneration (Dockel ,2003; Bierrglee,Nguyen, Clenney & Taylor 2009), career
advancement (Gupta,2008 and Mello, 2009), work-life balance (( Kar and Misra,2013),
work environment, (Winterton, 2011) , employee relations job design, recruitment and
selection among others can enhance employee motivation and attachment to the
organization hence retention.
While some studies have been conducted on the role of HR practices on employee
retention and turnover in organizations, the available literature shows that most of these
have been conducted in other countries like Pakistan (Rehman,2012), India ( Mathur,
Chhitorgarh, & Agarwal,2013) and United Arabs Emirates, (Alnaqbi, 2011). Only a few
have been done in Kenya such as Ngethe, et al., (2012) ; Obiero(2012); Bula, (2012);
Kuria, Wanderi & Ondigi (2011); Machayo & Keraro (2013); Kamau & Mberia (2012)
and Kiambati, Kiio & Toweett (2013) and mostly in other sectors. In particular none has
been done on the role of HRM practices on the retention of employees in the healthcare
sector in Machakos County. It is against this background that the researcher carried out a
research to explore the role of remuneration , career advancement , work environment
and work-life balance practices on the retention of staff in the health care institutions in
Kenya to provide a better insight into the relationship between these variables.
10
1.3 Research Objectives
1.3.1 General Objective

The general objective of the study was to investigate the role of human resource
management practices on retention of staff in public health institutions in Machakos
County in Kenya.
1.3.2 Specific Objectives

The specific objectives of the study were:
i. To explore the role of remuneration practices on the retention of staff in public

health institutions in Machakos County, Kenya.
ii. To analyze the role of career advancement practices on the retention of staff in
public health institutions in Machakos County, Kenya.
iii. To establish the role of work- environment management practices on the

retention of staff in public health institutions in Machakos County, Kenya.
iv. To investigate the role of work life balance practices on the retention of staff in
public health institutions in Machakos County, Kenya.
1.4 Research Questions
To meet these objectives, the following research questions were answered
i. What is the role of the remuneration practices on the retention of staff in public
health institutions in Machakos County, Kenya?
ii. What is health institutions in Machakos County, Kenya?
11
1.5 Hypotheses
iii. the role of career advancement practices on the retention of staff in public health
institutions in Machakos County, Kenya?
iv. What is the role of work environment practices on the retention of staff in public
health institutions in Machakos County, Kenya?
v. What is the role of work-life balance practices on the retention of staff in public
The study helped to test the following hypotheses.
i. H01: There is no significant relationship between remuneration practices and

H1: There is a significant relationship between remuneration practices and

ii. H02: There is no significant relationship between career advancement practices

and retention of staff in public health institutions in Machakos County, Kenya.
H2: There is a significant relationship between employee career advancement

practices and retention of staff in public health institutions in Machakos County,
Kenya.
iii. H03: There is no significant relationship between work-environment management

Kenya.
H3: There is no significant relationship between work-environment management

Kenya.
12
iv. H04: There is no significant relationship between employee work-life balance
Kenya.
H4: There is a significant relationship between employee work-life balance

Kenya.
1.6 Significance of the Study
The strength of any nation depends to a large extend on its productivity which in turn
depends on the well-being of the population. Universal health coverage depends on
having the necessary human resources to deliver health care services ( Kiambati, Kiio &
Toweett, 2013). The background has shown that Kenya is among the African countries
currently experiencing a crisis in the area of human resources for health and the situation
is likely to get worse with the devolution of healthcare services given that the different
counties in Kenya are differently endowed with resources.
The findings of this study will therefore be significant at the national and county policy
levels. The study is important since an investigation into the role of HR practices on the
retention of health care professionals in public facilities will help predict whether the
country and counties will realize the Kenya Vision 2030 goals in the health sector using
the existing practices. The research aims at providing information and guidance to the
employer (government) on the effect of HR practices on the retention of health care
professionals. As a result, the employer will understand the role of remuneration,
advancement, work environment and work life balance practices on retention of
employees hence be in a position to use practices that will not reduce the employees
motivation hence retention.
13
The government and the private sector employers can also use the research findings to
formulate policies on practices that will help improve employee retention hence
facilitate achievement of Kenya vision 2030.The findings of the study also act as a
yardstick against which the devolved governments (counties) as employers can gauge
themselves on their provision of conducive conditions that enhance employee job
satisfaction hence retention. Finally, the recommendations will ultimately generate
interest for more extensive research in other counties and ministries of the public service
and also in the private sector.
Thus this study provides a comprehensive approach to understanding the driving forces
that affect the retention of health workers, in order to provide a basis for developing
effective HR retention polices in the county and other counties that can contribute to
retention hence progress towards universal health care coverage.
1.7 Scope of the Study
The study was limited to the public health institutions in Kenya. It purposely confined
itself to the Machakos County because Machakos the county has high disease prevalence
rate yet low health workers population ratio. For instance the doctor population ratio
stood at 1:62,325 ( Machakos County Strategic Plan ,2012). It was also only limited to
the doctors, clinical officers, nurses and other technical people such as the pharmacists,
lab technicians and radiologists who are directly concerned with provision of health
care. It did not cover the support staff at the hospitals such as cleaners, mortuary
attendants, clerks and security officers for they are not directly involved in the provision
of medical care. The HR practices that influence retention of employees in organization
are many and varied such remuneration, supervisor support, recognition, feedback and
support, communication, leadership, job design, career advancement, organizational
climate, work-life balance, nature of work among others. To enhance effectiveness the
14
study only focused on the role of remuneration, career advancement, work environment
and work life balance practices since these are the factors that seemed to adversely
influence staff retention in organization from literature review.
1.8 Limitations of the Study
The study was limited to the technical health care staff in public facilities in the County
from where a sample was drawn. It was also limited to only four practices;
remuneration, career advancement, work environment management and work life
balance practices. Additionally, Some of the respondents especially the newly employed
were afraid of giving genuine responses for fear of victimization despite the fact that the
researcher had assured them of the confidentiality of the information provided. The
researcher had to however keep reminding them that the information provided was going
to be treated with ultimate confidence.
Since some of the respondents were newly employed, some of them did not seem to
understand some of the practices in place hence could not respond to some of the items
reducing the response rate for some of the items. Others were overexcited with the
employment and may have given some responses that are not truly reflective of the true
scenarios on the ground. Some of the respondents were also not co-operative and
attempted to ignore the questionnaires; this threatened to reduce the response rate. The
researcher minimized non response cases by taking and collecting questionnaires by
hand from each respondent. Also, by having trustworthy people (especially heads of
sections) to distribute and collect the questionnaires.
15
CHAPTER TWO
LITERATURE REVIEW
2.1. Introduction
This chapter consists of theoretical frameworks on retention, a conceptual framework for
the study, a review of related literature on role of HRM practices on staff retention and
the research gaps.
2.2. Theoretical Frameworks

The concept of employee motivation hence retention can best be explained using
Herzberg‘s two factor theory, Victor Vrooms expectancy theory and Stacy Adams
equity theory. These are discussed in the following sections.
2.2.1 Herzberg’s Two Factor Theory

Herzberg (1969) two factor theory as cited in Bassett, Jones and Lloyd (2005) provides a
theoretical framework for this study. Herzberg argued that employees are motivated by
internal values rather than values that are external to the work. In other words,
motivation is internally generated and is propelled by variables that are intrinsic to the
work which Herzberg called ―motivators‖. These intrinsic variables include
achievement, recognition, the work itself, responsibility, advancement, and growth.
Conversely, certain factors cause dissatisfying experiences to employees; these factors
largely results from non-job related variables (extrinsic). These variables were referred
to by Herzberg as ―hygiene‖ factors which, although do not motivate employees;
nevertheless, they must be present in the workplace to make employees happy. The
dissatisfiers are company policies, salary, co-worker relationships, and supervisory
styles (Bassett-Jones and Lloyd, 2005, Armstrong, 2009). Herzberg (1959) as cited in
Bassett-Jones and Lloyd (2005) argued further that, eliminating the causes of
dissatisfaction (through hygiene factors) would not result in a state of satisfaction;
instead, it would result in a neutral state. Motivation would only occur as a result of the
16
use of intrinsic factors. Michael (2008) and Samuel and Chipuuza (2009) used this
theory to find out the motivational variables influencing staff retention in South Africa.
Empirical studies by Kinnear and Sutherland,( 2001), Meudell and Rodham, (1998)
and Maertz and Griffeth, (2004) have however revealed that extrinsic factors such as
competitive salary, good interpersonal relationships, friendly working environment, and
job security were cited by employees as key motivational variables that influenced their
retention in the organization‘s. The implication of this therefore is that management
should not rely only on intrinsic variables to influence employee retention; rather, a
combination of both intrinsic and extrinsic variables should be considered as an effective
retention strategy
2.2.2 Victor Vroom’s Expectancy Theory

Victor vroom‘s expectancy theory (1961), asserts that individuals have different sets of
goals and can be motivated if they have certain expectations. This theory is about
choice. It argues that the strength of a tendency to act in a certain way depends on the
strength of an expectation that the act will be followed by a given outcome and on the
attractiveness of the outcome to the individual. It includes three variables namely,
attractiveness, performance- reward linkage and effort -performance linkage. Thus,
whether one has the desire to produce at any given time depends on one‘s particular
goals and one‘s perception of the relative worth of performance as a path to the
attainment of those goals.
The theory has basically four steps. First, what perceived outcomes does the job offer to
the employee. The outcomes may be good such as pay, security, companionship, chance
to use talents among others or negative such as fatigue, boredom, harsh supervision,
treat of dismissal among others. Secondly, how attractive do employees consider these
17
outcomes? The individual who finds a particular outcome attractive; that is positively
valued will prefer attaining it to not attaining it. Third what behavior must the employee
exhibit in order to achieve these outcomes? The outcomes are not likely to have any
effect on the individual employee‘s behavior unless the employee knows clearly and
unambiguously, what she must do in order to achieve them. Lastly how does the
employee view the chances of doing what expected of her? After the employee has
considered her own competencies, and her ability to control that variable that will
determine her success, what probability does she place on successful attainment?
This theory thus emphasizes on payoffs, or rewards. As employees have to believe that
that the rewards the organization is offering align with their wants. It is a theory based
on self-interest, that is, each individual seeks to maximize his or her expected
satisfaction. A major concern here therefore is the attractiveness of the reward; hence
there is need for knowledge and understanding of what value the individuals put on
organizational payoffs so that employees can be rewarded with the things they positively
value. Therefore according to the theory, how motivated an employee is depends on the
link between effort and performance; the link between performance and outcome and the
link between outcome and individual needs.
According to Gupta (2011) the theory emphasizes that motivation is based on the
amount of effort required, the rewards or returns and the value the individual gives to the
rewards. The theory states that individuals base decisions on their expectations that one
or another alternate behavior is more likely to lead to needed or desired outcome
(Jackson and Mathis, 2004). Basic to this theory is the notion that people join
organization with expectations and if these expectations are met they will remain
members of the organization (Daly & Dee, 2006). Turnover and retention framework
developed from this theory assert that decisions to stay or leave an organization can be
18
explained by examining the relationship between structural, psychological and
environmental variables. Johnsrud& Rosser,(2002), Zhou & Volkwein,(2004), Daly &
Dee,(2006) employ a model of employees intent to stay that is grounded on expectancy
theory which includes structural, environmental and psychological variables. Structural
variables include work environment, autonomy, communication, distributive justice and
workload. Psychological variables include job satisfaction, organizational satisfaction
and organizational commitment while the environmental variables include availability of
job opportunities. If these are aligned to employees expectations, then the employee
develops loyalty and commitment to the organization and tends to stick with it.
2.2.3 Stacey Adam’s Equity Theory

According to Gupta, (2011), Stacey Adam‘s Equity theory is based on the premise that
people want to be treated fairly at work. It presumes that employees do not work in a
vacuum and asserts that employees weigh what they put into a job situation (input)
against what they get out of it (outcome) and then compare their input-outcome ratio
with the input-outcome ratio of relevant others with whom they compare themselves. If
ratios are equal, a state of equity is said to exist; they feel their situation is fair and that
justice prevails. If the ratio is unequal, inequity exists. That is employees tend to view
themselves as under rewarded and will therefore attempt to correct the inequity. Thus
the theory asserts that employees level of motivation is dependent on the perception of
whether they are being fairly treated for tasks related efforts, when compared with others
employees.
According to the theory an individual‘s motivation level is correlated to his or her

perception of equity, fairness and justice as practiced by the management. Robbins and
Decenzo (2012) and Gupta (2011) assert that equity exists if the employee‘s input-
output ratio is comparable to that of other peers in the professional network. However, if
their ratios are lower than others inequity is perceived, the employees become
19
dissatisfied and would be motivated to seek ways to attain equity. The employee might
perceive the existing work environment and culture as hopeless and might choose to
quite the current job in pursuit of a better and more equitable work environment.
The theory thus guides in understanding what may influence an employee to leave or
stay in that they keep comparing what employees earn in other comparable organization
in order to realize a balanced state of the of the input-outcome ratios. This in turn
contributes to labour mobility inside and outside the organization
2.3 Conceptual Framework

The conceptual framework for this study is informed by retention models and studies by
Muhammad & Fahad (2010), Adzei and Atinga (2012), Muhammad and Iqbal (2011),
and Chibolwa, Samuel and Chipunza (2010). The study was based on the following
conceptual framework.
20
Remuneration practices
Allowances, salaries, overtime pay, pay
programmes, incentives
Career advancement practices

Staff retention
T&D , position movement, mentoring , study
leaves, career progression, scholarships, networks  Intent to continue
working,
Compensation Equitable and satisfactory salaries
 loyalty
Mortgages
Work environment management practices
 commitment
office space and equipment,
Pay programmes protective
eg. Competency materials, ,
pay, PFP
ventilation and lighting, interaction.  length of service
Work-life balance practices

Flexi schedules, telecommuting, leaves, shift
schedules, baby care centers, company sponsored
family events.
Independent variables Dependent variable
Figure: 2.1 Conceptual frame work.

The independent variables of the study are remuneration, career advancement, work
environment and work-life balance practices while the dependent variable of the study is
retention which is the intent to stay with an organization. The researcher wanted to
investigate their role in the retention of staff in the public health institutions in the
county because no similar studies exist. When employees are provided with
remuneration that they believe is competitive, equitable and consistent with their
21
capabilities, experience and performance (Jackson& Mathis, 2004), they develop loyalty
and commitments to an organization hence tend to stay. Remuneration aspects that were
considered include salaries, allowances, bonuses, and other financial gains, pay mode-
competency, pay for performance. Career advancement enhances employees‘
employability hence commitment to the organization (Gupta, 2008). The researcher
explored various aspect of career advancement such as internal promotions, position
movement, training and development opportunities, mentoring programmes,
networking and scholarships among others.
According to George & Jones (2008), work environment is one of the factors that
influence employees‘ decision to stay with the organization. Work environment aspects
such as physical facilities like offices, furniture ventilations and psychological aspects
like relationships, teamwork and counseling services were explored. Organization that
help employees to work in a way which best supports them to balance work and personal
needs are more likely to have engaged and committed employees (Devi, 2009). The
work- life balance practices analyzed include among others leaves and off-days, flexi
schedules, baby care centers, children education schemes, pension schemes and medical
cover., health and wellbeing programmes, and health insurance for self and dependents.
2.4. Review of Literature on Variables
2.4.1 Employee Retention and Organizational Success

Retention is considered as all-around module of an organization‘s human resource
management practices. It is a voluntary move by an organization to create an
environment which engages employees for long term (Chaminade, 2007). The main
purpose of retention is to prevent the loss of competent employees from the organization
as this could have adverse effect on productivity and service delivery. It commences
with the recruiting of right people and continues with practicing programs to keep them
engaged and committed to the organization (Freyermuth, 2007). Drucker, (2001) asserts
22
that knowledge is always embodied in a person; carried by a person; created, augmented,
or improved by a person; applied by a person; taught and passed on by a person; used or
misused by a person. The shift to the knowledge society therefore puts the person in the
center. Retaining employees whose knowledge has high competitive value is becoming a
critical and well-recognized challenge (DeLong, 2004; Frank, Finnegan, & Taylor,
2004; Jamrog, 2004; Ready & Conger, 2008; Somaya & Williamson, 2008). Such
employees are known as knowledge workers in that they ―have high degrees of
expertise, education, or experience, and the primary purpose of their jobs involves the
creation, distribution or application of knowledge‖ (Davenport, 2005).
However, retention of high performing employees has become more challenging for
managers as this category of employees frequently move from one job to another as they
are being attracted by more than one organization at a time. For instance, research has
shown that medical (Hill 2011; Holtom & O‘Neill 2004) and information technology
(IT) professionals have a strong tendency to leave the organizations for which they work
(Korunka, Hoonakker & Carayon 2008) and the country where they live (Bezuidenhout,
Joubert, Hiemstra & Struwig 2009). Professionals such as these are regarded as
‗intellectual capital‘ and are necessary in the knowledge economy; therefore,
understanding and managing their turnover can have significant consequences for the
organization‘s competitive advantage (Niederman, Sumner & Maertz 2007; Powell &
Snellman 2004).
The retention challenge of these workers is the result of increasing job mobility in the
global knowledge economy where workers average six employers over the course of a
career (O‘Neal, 2005), coupled with the baby boomer retirement, ―brain drain‖ and a
smaller generation of workers entering their prime working age during this time
(Jamrog, 2004). It is occurring in all types of organization across all management levels.
23
Hendricks (2006) concurs when he notes that employees with scarce skills are in great
demand by the South African government and are becoming difficult to source. When
these categories of employees are eventually sourced, they become even more difficult
for government to retain. It is not only government that is finding it difficult retaining
highly skilled employees. The private sector managers also admit that one of the most
difficult aspects of their jobs is the retention of key employees in their Organization
(Litheko, 2008). Most of the time when these employees move, they migrate to
competing Organization with the knowledge and trade secrets acquired from their
former thereby creating an even more critical situation for the latter (Abassi and
Hollman, 2000).
Irshad and Afridi (2012) and Muhammad et al (2011) assert that employee retention is
the most imperative target for the organization because hiring of qualified candidate is
essential for organization but their retention is more important than hiring, because a
huge amount is spent on the orientation and training of potential employees. When
employees leave the job, Organization loose not only the employees, but also loose
customers and clients who were loyal with the employee, knowledge of production
,current projects, competitors and past history of the organization,(Naseem et al,2011).
Previous studies by Cappelli (2000) indicate that several factors are considered
important in a well-functioning of employee retention. The determinants considered to
have a direct effect are career opportunities, work environment and work-life balance.
Cole (2000) suggests that the reasons to stay are work environment, rewards, growth and
development and work-life balance. Samuel and Chipunza (2009) in their study in four
South African organizations on why long-serving staff had remained in their jobs found
out that the four key factors that served to retain staff were training and development,
challenging and interesting work, freedom for innovative thinking and job security.
According to Machayo and Keraro (2013), in a study titled incentives for health worker
24
retention in Kenya: An assessment of current practice, Ndetei ,Khasakhala and Omolo
(2008) stressed that incentives are not only financial. According to the feedback they
received from health workers, non-financial incentives such as improved working
conditions, training and supervision, good living conditions, communications, health
care and educational opportunities for themselves and their families were highly valued
. In their view the government needs to invest not only in its health workers but in its
facilities, by ensuring regular medical supplies, upgrading facilities and improving
working conditions in rural and poorer areas.
Kaushik (2009) in a study on workplace issues- ―Exit interview‖, mentioned the freedom
of the talented worker to work his work schedule , incentive packages , keeping and
maintaining personal touch with the people , regular training sessions to help the
employees achieve goals on their personalized career graphs , positive and constructive
feedback on a regular basis, socialization of the employees to corporate culture, senior
managers role as a committed leader and finally the practice of fair treatment of all the
employees so as to foster a positive work environment as determinants of employee
retention while Shoaib, Noor, Tirmizi and Bashir (2009) identified career opportunities,
supervisor support, working environment, rewards and work-life policies as the
determinants of employee retention in telecom sector of Pakistan.
Janki (2009) said for retaining valuable employees the practices of proper attention
should be given to every employee, get the right people at right time, provide training
and coaching, plan for succession and acceleration pool, offer better career visibility, use
explicit ranking systems tied to incentive and differentiate the organization with unique
culture, can be adopted. Muhammad et al (2011) found out that the reasons for which
employee wants to stay in leather industry were good career prospects, good attitude of
employer, or a supervisor or a manager, good working conditions , benefits and fair pay,
fair recruitment ,work and family life balance and job security .
25
Empirical studies such as Stovel=- and Bontis (2002) have shown that employees, on
average switch employers every six years. This situation demands that management
should identify the reason(s) for this frequent change of employment by employees.
Once this reason(s) has been identified, management can then device retention strategies
that will help in keeping essential employees for a rather longer tenure.
This study empirically investigates the role of HR practices such as remuneration, career
advancement, working environment and work-life balance on the retention of healthcare
staff in public healthcare institutions in Machakos County.
2.4.2 Remuneration Practices and Retention.

Remuneration is clearly central to employment relationships. How much we are paid and
in what form is an issue that matters hugely to us (Byars&Rue, 2008, Torrington, Hall,
Taylor and Atkinson, 2011). For commercial organizations, it is a major determinant of
both profitability and competitive advantage. The aim is to design competitive reward
packages which serve to attract, retain and motivate staff, while at the same time
keeping a lid on the costs so as to ensure the organization‘s commercial and financial
viability,
(Torrington, Hall, Taylor & Atkinson, 2011; Byars&Rue, 2008).
Armstrong and Brown (2009) in their model adapted from work by Towers Perrin
reward consultancy identify four categories of rewards each of which has equal potential
significance as a source of reward from the employee perspective. The categories are,
individual such as base pay, contingent pay, bonuses, incentives, shares and profit
sharing often referred to as compensation. Transactional rewards include pensions,
holidays, healthcare, other perks and flexibility. Relational rewards include career
development while communal rewards comprise leadership, organizational values,
26
voice, and recognition, and achievement among others, (Torrington, Hall, Taylor and
Atkinson, 2011).
Both monetary and non-monetary rewards and incentives can enhance employees‘
motivation and attachment to the organization (Bergiel, Nguyen, Clenney & Taylor
2009; Döckel 2003). Mello (2009) concurs when he asserts that compensation, a key
strategic area for organizations impacts an employer‘s ability to attract applicants, retain
employees, and ensure optimal levels of performance from the employees in meeting the
organizations strategic objectives.
Attractive remuneration packages are one of the very important factors of retention
because it fulfills the financial and material desires (Shoab et al, 2009). Tettey (2006)
concurs with this when he states that dissatisfaction with salaries is one of the key
factors undermining the commitment of employees to their institutions and careers, and
consequently their decision to stay or intent to leave. Also as noted by Nawab & Bhatti
(2011), compensation plays significant role in attracting and retaining good employees
specially those employees whose give outstanding performance or unique skill which is
indispensable to the organization because company invest more amounts on their
training and orientation. (Bergiel et al., 2009) notes that research findings suggest that
there is a significant and positive relationship between compensation and job
embededness. Accordingly, it seems that the higher the compensation, the greater the
losses employees would feel if they leave the organization (Holtom & O‘Neill. 2004).
Some researchers argue that on the company side competitive compensation package is
the only strong commitment and also build strong commitment on the workers side.
According to Lawler (1990) companies adopt the strategy of low wages if the work is
simple and requires little training and companies competing in high labor markets adopt
the high wages strategy. However, the contribution of compensation towards retention,
27
help in retention of employee irrespective of their skill and contribution to the company
and it likely affect both turnovers desirable and undesirable. The total amount of
compensation offered by other companies also affects the turnover. Organization
offering high compensation package have large numbers of candidates applying for
induction and have lower turnover rate when compared to others. Moreover high
compensation package organizations also create culture of excellence (Lawler 1990).
Gupta (2008) asserts that one of the objectives of paying at competitive levels is to
enable the organization to retain it personnel by minimizing the incidences of quitting
and increasing employees loyalty. Indeed Ihsan and Naeem (2009) in a study indicated
that Pharmaceutical sales force rated pay and fringe benefits as the most important
retention factor. In addition, it indicated that pay and fringe benefits is highly valued by
the sales force of all demographic backgrounds. The possible explanation could be that
pay and fringe benefits enable salespersons to fulfill their physiological as well as
esteem needs. Thus, for companies that have objective to retain their valuable employee,
pay is considered as important factor for it (Brannick & Joan, 1999). Compensation is
considered the most important factor for attracting and retaining the talent (Willis,
2000).
Fair wages are the foundation elements of the implied and contractual bond between
employers and employees, the underlying supposition being that monetary reward can
persuade behavior (Parker & Wright, 2001). Organization often offer high pay packages
i.e. stock options, special pay, retention pay, gain share pay, performance base pay and
bonus etc. for attraction and retention of talented employees of the market. Williams and
Dreher (1992) note that wage is the key factor influence in the employee attraction and
retention, and play important role in the recruitment process. The report therefore says a
critical review of the current incentive schemes is required to make them more effective
to cater to needs of the sales in both multinational and local pharmaceutical companies
to retain their talent workers says the report.
28
Armstrong (2009) also notes that terms and conditions of service play an important role
but other factors are often important. He notes that problems arise because of
uncompetitive, inequitable and unfair pay systems. This calls for companies to undertake
regular market surveys to ensure that the salaries and benefits that they pay are
competitive and comparable with the labor market. Good and competitive pay structure
is likely to encourage employees to stay for a longer period. Thus, organization should
provide competitive remuneration packages to their employees as a deliberate employee
retention strategy.
Other than the rewards themselves the reward practices adopted influence retention.
Mello (2009) observes that in designing a reward or compensation strategy or system, an
organization needs to be concerned with the perceived equity or fairness of the system
for the employees. He asserts that the design of an equitable compensation system must
incorporate three types of equity; internal, external and individual. Internal equity
involves the perceived fairness of pay differential among different jobs within an
organization (Mello, 2009; Byars &Rue, 2008). Employees should feel that the pay
differential between jobs is fair, given the corresponding responsibilities. External equity
involves employee‘s perception of the fairness of their compensation relative to those
outside the organization (Mello 2009; Armstrong, 2009). Obviously, employees would
not be thrilled to discover that those who do similar work in other organizations receive
higher compensation. Individual equity considers employees perception of pay
differential among individuals who hold identical jobs in the same organization. (Byars
& Rue, 2008; Sababu, 2010).
Historically, the pay systems of most organizations have been based on jobs and job
evaluation technology. This approach however made sense in a world where individuals
had stable duties and the market value of individuals was largely determined by the way
29
in which their jobs were designed and managed. However in a world in which
individuals do not have traditional jobs and are often able to add considerable value due
to their high level of knowledge and skill, it would be very dangerous and misleading to
pay them according to job worth. Other competitive reward practices would therefore
suffice. These practices would include paying the individual for their worth, rewarding
excellence and individualizing the pay system (Mello, 2009).
One of the reward practices that an organization can use is the use of base wages and
salaries which consists of the hourly, weekly or monthly pay that employees receive in
exchange for their work (Byars & Rue, 2008; Sababu, 2010). The basic objective of any
base wage and salary system is to establish a structure for equitable compensation of
employees depending on their jobs and their level of performance in their jobs (Byars &
Rue, 2008)
Skill-based pay also known as knowledge based pay is another pay strategy that an
organization can adopt (Ingram, 1990 ; Murray & Gerhart, 1990). This strategy is used
in an effort to develop more versatile employees that are often required in today‘s
organizations where jobs can be rapidly changing. It compensates employees for skills
they bring to the job. Specifically the strategy pays employees for their range of
knowledge, the number of business-related skills mastered, the level of those skills or
knowledge, or some combination of level and range. In a conventional job based pay,
employees must wait for a job opening before they can be promoted. However under
skill based pay system, employees are eligible for a pay increase when they have learned
a new skill and demonstrated they can progress another step. The advantages of this
reward strategy according to Ingram (1990) and Murray and Gerhart, (1990) as cited by
Byars and Rue (2008) is that it fits workforce values, increases staffing flexibility, builds
leaner staffing requirements, encourages flatter organizational structure, inspires higher
quality and quantity production levels and broadens incentives to increase knowledge
and skills. Additionally, they reinforce group participation, deepens commitment when
30
promotions are unavailable, decreases overall labour costs, improves understanding of
operations, leads to greater productivity, favorable quality outcomes and scrap reduction
(Byars & Rue ,2008).
An organization can also adopt competency-based pay strategy (Byars & Rue, 2008). A
competency is a trait or characteristic that is required by a job holder to perform that job
well (Gerald & Ledford, 1995). The strategy is intuitively compelling in that it makes
sense to put into account those traits that the organization values. An organization can
also use the market based pay system (Byars & Rue, 2008; Kimberly, 2006) in which
the employees are paid by the market rates. This entails carrying out at least three
surveys to ensure proper representativeness of the jobs being priced (Grigson, Delaney
& Jones, 2004).
Other than pay systems the organization can make use of incentive as rewards, whether
at individual, group or organizational level (Byars & Rue, 2008). Individual incentive
plans include differential piece rate plan, plans based on time saved, plans based on
commissions, individual bonuses, suggestion systems, incentive for managerial staff and
employee options (Jarboe,2004; Schwanhausser,2004) for non-managerial personnel(
sababu,2010; Byars & Rue ,2008,). Group incentives include gain sharing, profit sharing
and revenue sharing (Mello, 2009).
2.4.3 Career Advancement Practices and Retention
Career development opportunities and training have a direct effect on employee

retention. Employees career advancement is a phenomenon which is formalized,
organized and it is planned effort to accomplish the balance between requirement of
organization workforce and individual career needs. The challenge of the HR
professionals is to identify and develop the career development practices which would
improve the commitment of employees as they would feel valued; helping the
31
organizations to retain the employees as they would be motivated to work hard and
enthusiastically (Hassan et al, 2013). It is challenge for todays‘ HR Managers to identify
the organization developmental practices which enthuses the employee commitment to
the organization vision and values to motivate the employees and help the organization
to gain and sustain the competitive advantage (Graddick, 1988). Organizations that
desire to strengthen their bond with employees must spend on the development of
employees (Hall & Moss, 1998; Woodruffe, 1999; Steel et al., 2002; Hsu, Jiang, Klein
& Tang, 2003).
Career development involves creating opportunities for promotion within an

organization and providing opportunity for training and skill development that allows
employees to improve their employability on the internal and the external labour market
(Meyer & Smith, 2003). Woodruffe (1999); Steel & Griffeth., (2002) and Hsu, Jiang,
Klein & Tang, (2003) believe that an organization that wants to strengthen its
relationship with its employees must invest in the development of its employees. They
further argue that organizations will do a better retention job by spending more resources
on training and development of employees. Employees who benefit from their
organizations through training and educational facilities tend to be more committed and
loyal to that organization.
Ongori and Agolla (2009), contend that lack of personal growth in organizations results
in career plateau which in turn leads to increased employee intention to quit. Many
employees find themselves in jobs that offer them limited mobility opportunities in
terms of upward movement in the organization. Career plateau is thus seen as a major
contributing factor to employees to quit in organizations. Human Resource professionals
thus have a greater responsibility of managing career plateau and hence minimize
employee turnover. According to Lee (2003), plateau employees are likely to have
higher labour turnover because they want to advance their careers elsewhere in the
32
environment. Studies have shown that employees who have attained plateau have a high
degree of intention to quit due to reduced opportunity in the present organization
(Yamamoto, 2006
Armstrong (2009) concurs when he asserts that, lack of clear career path or
development is a major cause of poor employee retention. To maintain a stable work
force, employers should learn to plan to provide career opportunities by providing
employees with wider expectations, encouraging promotion from within and developing
equitable promotion procedures. Armstrong (2009) and Sinha and Sinha (2012), say
that the purpose of career planning as part of an employee development program is not
only to help employees feel like their employer is investing in them, but also to help
people manage the many aspects of their lives and deal with the fact that there is not a
clear promotion track. Employers can no longer promise job security, but they can help
people maintain the skills they need to remain viable in the job market.
Career opportunities may include the internal and external career options that an
employee may have. Internal career opportunities may be in the employee‘s current
organization, for example, a promotion or movement to a different position within the
same organization. External career opportunities would mean obtaining a position at
another organization (Coetzee & Roythorne-Jacobs, 2012). These career orientations of
employees may reflect an employee‘s perceived compatibility or comfort with an
organization (Mitchell et al., 2001). Butler and Waldrop (2001) also assert that it creates
promotion opportunities within organization and provides training opportunities and
skill development to improve their employee‘s employability on the internal and / or
external labour market.
Rahman and Nas (2013) assert that the purpose of employee development programmes
is to improve employee capabilities which lead to increased productivity for them and
33
their team thus sustaining a competitive position for their organizations. Thus career
development is a vital and mutual beneficial process for both the employees and
employer because it gives imperative outcomes to employer and employees (Hall, 1996;
Hall, 2002; Kyriakidou & Ozbilgin, 2004). To gain and maintain competitive advantage
organization required talented & productive employees and these employees need career
development to enhance and cultivate their competencies (Prince, 2005).
Traditionally, HRD‘s contribution to career development has been through formalized

programs such as training, mentoring, tuition reimbursement, job posting, and career-
planning workshops. Hite & McDonald (2003) refer to these as ―bounded‖ activities
because access to and availability of these events is contingent on the organization‘s
ability and willingness to offer them. According to Mello (2009), if an organization
considers its employees to be the human assets, training and development represents an
ongoing investment in these assets and one of the most significant investments an
organization can make. Tettey (2006) notes that engaging in training and development
widens ones compatibility with opportunities for advancement contingent upon one‘s
ability to competently tackle new levels of responsibility and challenges. Hence it is an
investment in human capital whether initiated by the individual or the organization. She
further observes that professional development is the engine that keeps universities true
to their mandate as centers of ideas and innovation.
Providing employees with sufficient training opportunities should be viewed as an

essential investment strategy for employee growth and development. (Döckel, 2003;
Kraimer, Seibert, Wayne, Liden & Bravo, 2011). This practice constitutes an important
part of the organization‘s fulfillment of the informal contract between itself and
employees, which deepens employees‘ sense of attachment to the organization (Bergiel
et al. 2009 & Mitchell et al. 2001).
34
Mello (2009) asserts that employee training and development is increasingly becoming a
major strategic issue for organizations due to rapid changes in technology , the redesign
of jobs, mergers and acquisitions, frequent movement of employees and lastly due to
globalization of business operations requiring managers to acquire knowledge and skills
related to language and cultural differences. Muhammad (2008) notes that investment on
employee training and career development is an important factor in employee retention.
Garg and Rastogi (2006) explain that in today‘s competitive environment feedback is
essential for organization to give and receive from employees and the more knowledge
the employee learn the more he or she will perform and meet the global challenges of
the market place.
Rahman and Nas (2013) state that as skilled employees benefit both employees and the
organization, both should contribute their respective shares to the process. Organizations
are thus required to provide environment and opportunities for continuous learning and
practical implementation. Strategically targeted training in critical skills and knowledge
bases adds to employee marketability and employability security which is critical in the
current environment of rapid development in technologies and changing jobs and work
processes. Currently organizations seek out and employ knowledge workers with
narrowly defined technical skills (Mello, 2008). Organizations can benefit from training,
beyond bottom line and general efficiency and profitability measures, when they create
more flexible workers who can assume varied responsibilities and have a more holistic
understanding of what the organizations does and the role they play in the
organization‘s success.
Strategic training and development is crucial for the attraction and retention of a
committed and efficient workforce. According to Gupta (2008), the first step to strategic
training and development is training needs assessment at organizational, task and
individual levels in order to determine the specific training activities required and place
the training within the organizational context. After the training needs have been
35
identified, objectives for the training activities must be developed. These objectives
should follow from the assessed need and be described in measurable terms (Gupta,
2008; Mello, 2008). In strategic design of training programs the issue of transfer should
be taken into account.
Apart from on the job training (Gupta, 2008), another development with regard to
training and development delivery strategies involves attempts to increase the efficiency
and cost- effectiveness of off –the –job training and development. This can be achieved
by shortening the time for design, delivery and administration of new training and
development products and services Moskal (1990). Training and development
programmes can be shortened by making the learning curve steeper through for example
simulations, shifting the burden of learning to employees and introducing company
supported off-hour learning (Mello, 2008).
Increased exploitation of computer aided learning especially information and

telecommunication technologies is another development in training and development
strategies (Mello, 2008). A study comparing the effectiveness of training and
development delivered in the classroom to videodisk technology revealed that, although
both groups of trainees scored the same on learning outcomes, the conventional training
and development took 7.5 hours, versus 2.5 hours for the videodisks (Wilson, 1991).
Another training and development strategy is use of teams. This strategy takes a number
of forms including training intact work teams to maximize relevance to job conditions,
delegating decision making authority to the team to determine perceptions of its training
and development requirements, including the team in training and development design
and most importantly, using the team or selected team members as deliverers of training
and development content (Michael, Sweet & Parmalee,2009). Lastly mentoring is
becoming an increasingly important vehicle for the development of management and
36
executive succession capabilities, especially with regard to historically disadvantaged
groups (Mello, 2008; Gupta, 2008,).
The findings from a research by Chay and Norman (2003) on creating value for
employees shows that perception of investment in development can improve nurses‘
morale and dedication to the level that emotionally binds them to the organization and
encourages them to stay on. This implies that healthcare organization need to pay greater
attention, both in investing and planning development activities that promote and
develop organizational commitment and job satisfaction among nurses. Although these
types of programs will continue to be important in developing some individuals‘ careers,
the reality is that many organizations do not have the resources or the time to offer
numerous formalized programs. There are however some less traditional, less formalized
(boundary-spanning) learning opportunities that organizations can utilize. These
bounded and ―boundary-spanning‖ activities may overlap and be used in conjunction
with each other to support the organization‘s career-development efforts. Hall (2002)
concurs, noting that ―the natural resources‖ within the organization offer quick, cost-
effective career-development activities that reinforce the business strategy and promote
learning through day-to-day work.
Hite and McDonald (2003) specifically highlighted and recommended four learning
activities as alternative ways of developing employees‘ careers namely informal
learning, networks, community involvement, and alternative forms of mentoring.
Increasingly, scholars are focusing on ―boundary-spanning‖ activities like informal
learning as an alternative means of career development (Conlon, 2004; van Dijk, 2004).
As Powell , Hubschman and Doran, (2001) write, ―Currently, with the organizational
community facing reorganization, downsizing and the constant evolving of job
descriptions and roles, formal learning, implemented usually through training classes
and workshops is diminishing; informal learning has become the mindset‖. Hall (2002)
37
concurs, noting that ―the natural resources‖ within the organization offer quick, cost-
effective career-development activities that reinforce the business strategy and promote
learning through day-to-day work.
Powell et al. (2001) present a model to illustrate the role informal learning can take in
―re-creating career development‖. In their model, HRD plays a critical role in facilitating
the ―learning how‖ level of the experience, which involves reflection and critical
thinking about the learning and in the ―learning why‖ level, which involves integrating
―the original learning experience into both professional and personal aspects of their
lives‖ . According to Powell et al. (2001), the learner who gets to the ―learning why‖
level will have greater self-efficacy, hence improved performance, and will
consequently set more challenging career goals.
Another potential boundary-spanning activity to support career-development efforts is

developing informal and or formal networks for employees both within and outside their
work environments. For example, Forret and Sullivan (2002) recommend individuals
develop and take advantage of networking opportunities within the organization, the
profession, and the community. However, many networking opportunities, particularly
informal ones, are not readily available to minority professionals and managers (Combs,
2003; Ibarra, 1993). In addition, nonexempt employees often find themselves excluded
from informal and formal networks, despite some evidence that hourly employees see
strong benefits in networking and desire such opportunities (McDonald ., 2002).
Networks can serve multiple purposes, such as providing socio emotional support as
employees attempt to balance life-work issues (Martins, Eddleston & Veiga, 2002) and
facilitating knowledge acquisition (Friedman, 1996).
Networking also has been positively linked to perceived career success and
marketability (Eby, Butts, & Lockwood, 2003).These results indicate organizations
should play an active role in promoting networking opportunities for employees. Among
the benefits the organization may derive from this activity includes a strong ―knowledge
38
base within the company‖ and an increase in ―cross-fertilization of ideas and
information across business units and departments‖ (Eby, Butts, & Lockwood, 2003).
Martins, Eddleston & Veiga (2002) suggest that organizations might create
―organization-wide networking groups‖ to provide social support for individuals in the
minority gender in their work groups, as well as encourage employees to develop
stronger ties to their communities. HRD can play a valuable role in advocating the
benefits of networks to upper management, offering expertise and or assistance in
facilitating such groups, providing information on how to set them up, and monitoring
their effectiveness.
Following Martins, Eddleston and Veiga (2002) observation, the third boundary-
spanning activity suggested is community involvement. In today‘s corporate
environment, employees often recognize the need to develop their careers beyond the
walls of corporate America. Serving on community boards, volunteering in nonprofit
organizations, and assisting in community events can develop skills as well as provide
additional networking opportunities and socio-emotional support (Martins, Eddleston &
Veiga, 2002; McDonald et al., 2002). Organizations benefit as well from the skills,
knowledge, and confidence employees gain from participating in these activities. Again,
HRD can take the lead in encouraging volunteerism, acting as a resource for employees
wanting to become more involved in their communities, and advocating for flexible
work schedules so employees can engage in such activities.
Finally, alternative forms of mentoring should be considered as examples of boundary-

spanning activities. The literature on traditional dyadic mentoring relationships has
documented the various benefits individuals derive from having a mentor. Practitioners
have suggested other forms of mentoring such as mentor networks (de Janasz, Sullivan,
& Whiting, 2003), group or team mentoring (Dansky, 1996; Mitchell, 1999), and virtual
or e-mentoring (Bierema& Merriam, 2002; Hamilton & Scandura, 2002). Various
39
benefits of these alternative forms have been noted, such as reducing the number of
mentors needed and creating more opportunities to access more diverse mentors (de
Janasz et al., 2003; Hamilton & Scandura, 2002) , providing more flexible
developmental opportunities for individuals telecommuting, working in remote sites or
with work-life balance conflicts (de Janasz et al., 2003; Hamilton & Scandura, 2002);
and making mentoring more accessible and egalitarian (Bierema & Merriam, 2002;
Mueller,2004). HRD‘s involvement in these alternative forms of mentoring vary
depending on the resources the organization is willing to commit to these activities.
Organizations planning to offer these developmental activities will need HRD‘s
involvement in connecting individuals and/or groups and providing training and
coaching to mentors and participants. If group or team mentoring is employed, HRD
practitioners may be asked to help facilitate these teams. Some organizations will not
have the resources to fully implement these mentoring activities. In these cases, HRD
practitioners should be aware of potential ways employees might become involved in
mentoring outside of the work setting.
These boundary-spanning activities typically require fewer organizational resources than

more traditional bounded-development initiatives. However, they have the potential to
be very effective in meeting the needs of employees in turbulent organizational
environments for two major reasons. First, these activities may expand individuals‘
perspectives of what a career can involve. For example, networking and community
involvement may help employees better understand the multiple facets of how work and
life intersect. Second, these initiatives may help individuals develop new and different
skill sets, increasing resiliency and employability. Together they respond to employee
needs and interests in the age of the protean career (Mueller, 2004).
2.4.4 Work Environment Management Practices and Retention

Numerous studies have attempted to explain work environment in various areas such as
for example employee job satisfaction (Iaffaldano & Muchinsky, 1985), employee
40
turnover, job involvement and organizational commitment (Sjöberg & Sverke 2000).
Work environment is one of the factors that affect employee‘s decision to stay with the
organization (George & Jones 2008; Zeytinoglu & Denton, 2005). Hay Group (2007)
contends that work environment includes a friendly, well designed, safe physical space,
good equipment and effective communication which will improve productivity. Well
designed and organized offices and work areas make significant differences to how
people feel about their work.
Levi (2002), asserts that people enjoy to work in those organizations that provide
positive work environment where they feel they are making a contribution to the
achievement of the organization‘s objectives and moving the organization forward.
Bushe, (2012) notes that working conditions refers to a work environment that promotes
the efficient performance of job tasks by employees and touches on aspects such as
space, tools and equipment, hours of work, internal customer support from the
administration departments, nature and tenure of contract, safety in the workplace, and
requisite support from supervisors. All these make job performance easier.
Hytter (2008) asserts that in industrial perspective, work environment focuses on

physical aspects such as, heavy lifts, noise and exposure to toxic substances. However
characteristics of work environment vary in services sector as compared to production
sector because it has to interact with the clients/consumers (Normann, 1986). Irshid and
Afrid (2012) conquer with this when they note that the interaction between employees
and clients or customers move from physical to psychological dimension. They assert
that the physiological environment consists of workload, decision, support, stressors,
and attitude among others. Working environment that is comfortable, relatively low in
physical and psychological stress and facilities attainment of work goals will tend to
produce high levels of satisfaction among employees.
In contrast, stressful working environment result to low levels of satisfaction. Daly and
Dee (2006) observe that heavy workloads, including assignments to teach large classes
41
may generate hostility towards the organization and diminish levels of faculty
commitment to the institutions and mostly affects employees‘ retention negatively.
Milory (2004) reported that people enjoy working, and strive to work in those
organizations that provide positive work environment where they feel they are making
difference and where most people in the organization are proficient and pulling together
to move the organization forward. Workspace designs have a profound impact on
workers and they tend to live with job as long as satisfied (Brill, Weidemann, Olsen,
Keable & Bosti, 2001). To keep better privacy and to avoid distractions, the design of
office equipment and furniture must be correspondence to it (Redman, Snape, &
Ashurst, 2009). Netswera (2005) notes that flexible working hours, a challenging job, a
sense of purpose and minimal grievances between staff and employers provide a
favorable work environment. The psychological environment, which provides support
for handling stress, and physical support infrastructures such as psychologists or a nurse,
etc. on site provide a sense of security to employees.
Working environment can give some depressing messages about how much the
organization value employees and the standards it expects from them (Armstrong &
Murlis, 2007). An independent study conducted by the Society for Human Resource
Management, demonstrated that physical work environment contributes a major factor
affecting the decision of employee‘s whether to stay or leave the job (Sutherland, 2004).
Access to friendly and natural environment helps to reduce job stress, depression and
apprehension which are beneficial for health environment as well (Steel & Griffeth
2002).
Sutherland (2004) asserts that the focus of organizations must be on how to provide
better jobs with great work environment to retain employees. The key to retaining
employees is to create an environment employees choose to work in and will stay given
the availability of other job opportunities (Winterton, 2011). Organizations can create
the necessary environment by meeting the needs of current and future employees.
42
Communication and recognition to employees are essential factors in retaining
employees. Organizations must be able to communicate their past, present, and future
plans to employees so they are secure with the strength and stability of the organization.
Research shows that organizations that are transparent and involve their high performing
employees in finding solutions will be able to retain these individuals during downturns
in the economy (Ongori, 2008).
The Hay Group study on the work environment also mentioned job autonomy. Job
autonomy is defined as the amount of discretion that an employee has in carrying out his
work activities (Perez, 2008). The research study demonstrated that job autonomy
constitute an aspect of work environment. When employees have some control over their
jobs and its outcomes, they feel less stressful and more interested in an organization to
stay. Armstrong (2010), identified job autonomy as the degree to which the job provides
substantial freedom, independence, and discretion to the individual‘ in work content, the
method for accomplishing the work, and the pace at which work is accomplished. Job
autonomy emerged as an important dimension of job outcomes following deCharm‘s
theory of personal causation, which asserted that individuals will cherish behaviour and
results that they perceived as stemming from their own choice (Sutherland, 2004). When
employees are given the chance to control their own work outcomes, they become
owners of the decisions, feel more involved in the organization, and are thus more
willing to stay
.
2.4.5 Work–Life Balance Practices.

The challenges of integrating work and family life (work life balance) is a part of
everyday reality for majority of workforce (Cleveland, 2007). Work–life balance refers
to perceiving a satisfactory balance between one‘s personal life and work schedule, and
minimal conflict between the multiple roles one has to fulfill in terms of one‘s personal
and work lives (Döckel, 2003). Parkes and Langford (2008) describe work–life balance
43
as an individual‘s ability to meet his or her work and family commitments, as well as
other non-work responsibilities and activities. Shrotriya (2009) said that work life
balance entails attaining equilibrium between professional work and other activities, so
that it reduces friction between official and domestic/personal life and thus enhances
efficiency and productivity of employees with increase in commitment and contentment.
Work-life balance practices are thus those institutionalized structural and procedural
arrangements as well as formal and informal practices that enable individuals to easily
manage the conflicting worlds of work and family, (Osterman,1995).
Munsamy and Bosch-Venter (2009) state that, the focus of work–life balance is on the
notion of a flexible and stress-free work environment by making provision for childcare
facilities and access to families. Employees work hard to strike a balance to fulfill the
demands of the working life and meeting the commitments of family life. Those who fail
to do so either quit the organization thereby increasing the rate of attrition or become
less productive. In the personal front also they feel unhappy. At this cross road
organizational culture plays a crucial role to support the employees; high culture has a
mediating effect to link the Work Life Policies and practices with talent retention. ( Kar
and Misra,2013)
Increasing flexibility around work has therefore become more important to dual-income
families. As a result, organizations that provide for this may be perceived as concerned
employers, which positively influence employees and a positive attitude towards the
organization (Döckel, 2003). Pasewark and Viator (2006) places flexible work
arrangement as a very important part of wok family support that plays pivotal rule in the
retention of employees.
Work-life balance programmes have the potential to significantly improve employee

morale, reduce absenteeism and retain organizational knowledge, particularly during the
difficult economic times (Lockwood, 2003; Landaur, 1997). Indeed Rahman and Nas
44
(2013) assert that obtaining a balance between work and life has a great role in
employee‘s decision to remain with the organization. They assert that the conflict
between these dimensions of human activity can cause both job dissatisfaction and
hence an intention to leave the organization as well as causing conflict with family
members and family activities. Thompson and Prottas (2005) and Yanadoria and Katob
(2010) examined the relationship between employee turnover intention and organization
support such as supervisor support, flex time work family culture and co-worker support
etc, and they conclude that organization support reduced the employee turnover
intention.
Studies have shown that there are several work-life balance practices that organizations
may adopt in order to increase employee commitment and hence retain them (Estes &
Michael, 2005). These practices include flexible scheduling (Perry-Smith et al., 2000)
such as flextime, which permits workers to vary their start and finish times provided a
certain number of hours is worked. Flexi time allows employees, to determine (or be
involved in determining) the start and end times of their working day, provided a certain
number of hours is worked. This can allow them to meet family or personal
commitments/emergencies (enable employees to respond to both predictable and
unpredictable circumstances), during the day or to reduce their commuting time by
starting and ending work before or after the rush hour.
Another practice is compressed or condensed work week ( Byars & Rue, 2008). A
compressed or condensed work week is an arrangement whereby employees work longer
shifts in exchange for a reduction in the number of working days in their work cycle for
instance on a weekly or biweekly basis. This can be beneficial for employees in terms
of additional days off work (e.g. longer weekends allowing ―mini vacations‖) and
reduced commuting time, whereas employers can extend their daily operating hours,
with less need to resort to overtime. Compressed work week arrangements may be
45
particularly useful for employees who wish to reduce the number of days per week spent
at work, but who cannot financially afford to decrease their working hours. Compressed
work weeks are often initiated by the employee, but sometimes the employer may
initiate the option to improve operational efficiency, to maximize production (reduced
daily startup costs) or to establish longer business hours which can enhance customer
service. Common arrangements for a forty hours work week are working ten hours per
day, four days a week; working an extra hour a day with one day off every two weeks;
or working an extra half hour a day and having one day every three or four weeks off.(
Byars & Rue, 2008; Lazar, Osolan, & Ratiu, 2010 )
Teleworking also called telecommuting (Kathy, 2006; Byars & Rue, 2008) is another
work life balance practice This type of arrangement is often called 'telework' or
'telecommuting'. It is the practice of working at home or while travelling and being able
to interact with the office (Byars & Rue, 2008). It can be advantageous for employees
by allowing them to organize their work day around their personal and family needs, to
decrease work-related expenses, to reduce commuting time, and to work in a less
stressful and disruptive environment. It may also help to accommodate employees who
because of particular disabilities, are unable to leave home (Kathy, 2006; Byars & Rue,
2008). The fact that employees who telework can use this added flexibility to capitalize
on their personal peak productivity periods can also favorable influence a company‘s
bottom line ( Lazar et al., 2010 ).
Despite these benefits and the attention that telecommuting has attracted in the media,
very few collective agreements contain telework provisions. The paucity of telework
clauses is partly due to the fact that not all occupations are amenable to such an
arrangement. Moreover, employers may be concerned by the initial implementation
costs, potential legal liabilities, and difficulties in supervising and appraising the
performance of teleworkers. Trade-Unions may disapprove of work-at-home clauses if
they perceive them as leading to greater isolation of employees, reduced job security and
46
promotion opportunities, and diminished health and safety protection (Lazar et al.,
2010). Other Potential disadvantages of telecommuting are insurance concerns relating
to health and safety of employees working at home and lack of the professional and
social environment of the workplace. Another drawback is that some state and local laws
restrict what kind of work can just be done at home. (Byars & Rue, 2008).
Part-time arrangements, ( Lazar et al., 2010) is another work-life practice that can also
allow people with health problems, disabilities or limited disposable time (like students)
to participate in the labour force, develop their skills and obtain work experience.
Finally, they can facilitate re-entry into the workforce for those who have had career
breaks —particularly mothers (or fathers) who have stayed at home to raise their
children or provide a gradual exit for employees nearing retirement. From the
employer‘s point of view, the use of part-time workers, where feasible, can help
maximize the use of human resources and increase operational flexibility, by providing
additional coverage during peak periods. Part-time employment can also be considered
unsatisfactory for those employees who would prefer working longer hours to increase
their income, thereby ensuring a higher standard of living for their families. (Lazar et al.,
2010). The European Working Conditions Survey found that 85% of those working less
than 30 hours per week were satisfied with their work–life balance. Furthermore, part-
time workers and those working less than 35 hours a week reported the lowest levels of
both physical and psychological health problems. Part-time work is one strategy
frequently used by workers who wish to better balance their work and family life. Part-
time work should be promoted in more, higher-level occupations, for instance, Daimler
Chrysler in Germany promotes part-time work in leading positions in the company
(Clarke, 2001).
Job sharing is an arrangement which allows two (or sometimes more) employees to
jointly fill one fulltime job, with responsibilities and working time shared or divided
47
between them. It can be in the form of shared responsibilities, split duties, or a
combination of both. (Byars & Rue 2008). Job sharing may be appropriate where
opportunities for part-time jobs or other arrangements are limited. Apart from the
obvious advantage of allowing employees more time for other commitments, including
family responsibilities, job sharing also facilitates the development of partnerships,
where job sharers can learn from each other while providing mutual support. It can
benefit employers as well by improving staff retention, increasing productivity and
combining a wider range of skills and experience in a single job. In some cases, such an
arrangement can also provide additional coverage during busy periods, while ensuring
continuity of coverage when one partner is on sick leave or holidays. (Byars & Rue,
2008 & Lazar et al., 2010 ).
Other practices may support children‘s education, employees‘ participation in volunteer
work, or facilitate phased retirement (Lazar et al., 2010). In addition, employers may
provide a range of benefits related to employees‘ health and well-being, including
extended health insurance for the employee and dependents, personal days, and access to
programs or services to encourage fitness and physical and mental
health,(Shrotriya,2009). Employees who had access to family-friendly policies showed
significantly greater organizational commitment and expressed significantly lower
intention to quit their jobs (Grover & Crooker, 1995), whereas the problem of work life
balance is clearly linked with withdrawal behavior ,including turnover and non-genuine
sick absence (Hughes &Bozionelos, 2007). Indeed research by Kenexa Research
Institute in 2007 shows that those employees who were more favorable toward their
organization‘s efforts to support work-life balance also indicated a much lower intent to
leave the organization, greater pride in their organization, a willingness to recommend it
as a place to work and higher overall job satisfaction.
48
2.5. Research Gaps
As alluded in the background, retention of employees in public service is key in driving

economic development in Kenya (Ministry of State for Public Services, 2008). Evidence
in the background has shown that retention of staff in particular that of the Ministry of
Health is below expectations as is supported by the data on brain drain and turnover in
the background of the study. Literature reviewed has shown that various factors account
for low retention of employees in organization.
Similarly past researches have been done in other organization and sectors in Kenya
such as sugar industry (Bula, 2012), Kenya Airways (Mokaya,2008), three and five star
rated hotel (Kuria, Wanderi & Ondigi, 2011), health (Machayo & Keraro, 2013), public
universities (Ng‘ethe, Namusonge & Iravo,2012; Kamau & Mberia, 2012), sugar
companies (Bula, 2012), health (Kiambati, Kiio & Toweett,2013) and financial
institutions (Obiero,2012 ). They have also been done in other countries like Pakistan
(Rehman, 2012), Australia (Chew, 2004), Pakistan (Nawaz,2012), India (Mathur,
Chhitorgarh & Agarwal, 2013) and United Arabs Emirates (Alnaqbi, 2011). However
the few done on the Ministry of Health were done before devolution of these services
and non has been done on retention of staff in Machakos county. It is against this
background that the researcher decided to investigate the role of the human resource
practices on the retention of staff in public health institutions in Machakos County.
49
2.6 Summary of Literature Review
Related literature has been reviewed on various theories behind retention, models of
retention and on remuneration, career advancement work-environment and work-life
balance practices and their on retention retention practices. Empirical studies on the
influence of these practices on retention in various sectors have also been reviewed
which show a positive relationship between these practices and retention in the sectors
studied.
2.7 Critique of the Existing Literature
The reviewed literature identified several theories such as Herzberg theory, Victor
Vrooms Expectancy theory and equity on which the study is successfully anchored.
Various empirical studies reviewed have to a great extend assisted in bringing a better
understanding of the role of remuneration, career advancement, work environment
management practices and work-life balance practices on staff satisfaction and
commitment hence retention in organizations. The literature reviewed on retention has
also indicated that besides the HRM practices being investigated in the study, there are
other practices that also influence retention and therefore may influence employees
intent to stay.
However the tendency to be retained may not only be due to HRM practices. employees
may stay due to external factors such as job unemployment, financial demands and job
security among others.
50
CHAPTER THREE
RESEARCH METHODOLOGY
3.1. Introduction
This chapter discusses the research design, target population, sampling frame, sample
and sampling techniques, research instruments, data collection procedure, piloting of the
instruments, data processing and analysis.
3.2. Research Design

Zikmund (2003) states that research design is a master plan specifying the methods and
procedures for collecting and analyzing the needed information. In this study, the
researcher adopted a mixed methods research design to investigate the role of HR
practices on the retention of staff in public health facilities in Machakos County.
Creswell (2012) and Wallen, & Fraenkel, (2001) asserts that a mixed methods research
design is a procedure for collecting, analyzing, and ―mixing‖ both quantitative and
qualitative research methods in a single study to understand a research problem. The
designs utilizes both quantitative and qualitative data collection methodologies such as
interviews and questionnaires, performance tests and observation, questionnaires and
follow up focus groups and document analysis, performance tests, questionnaire, and
interviews.
According to Creswell (2008) this design is used when both quantitative and qualitative
data, together, provide a better understanding of the research problem than either type by
itself, when one type of research (qualitative or quantitative) is not enough to address the
research problem or answer the research questions and in case of pragmatism
(practicality; multiple view points; biased and unbiased; subjective and objective). It can
also be used to incorporate a qualitative component into an otherwise quantitative study
or to build from one phase of a study to another like for example, to explore qualitatively
51
then develop an instrument or to follow-up a quantitative study qualitatively to obtain
more detailed information( Creswell,2012; Wallen & Fraenkel,2001).
Common mixed methods designs are sequential explanatory design, sequential
exploratory design, concurrent triangulation design, concurrent embedded design and
concurrent transformative design. In this study the researcher used concurrent
triangulation design. The purpose of this concurrent mixed methods study is to better
understand a research problem by converging both quantitative and qualitative data
(Creswell, 2012; Martens,2011). In this study, questionnaires with both open ended and
closed ended questions were used to establish the relationship between the remuneration,
work environment, career advancement and work-life balance practices and employee
retention. The closed- ended questions generated quantitative data. At the same time in
the study, the roles of these variables on the retention of the staff were explored using
qualitative interviews with the managerial health care staff at the hospital and those in
charge of the health facilities in each of the sub counties. Mixed methods research
design was therefore appropriate for gathering and analyzing this kind of data.
3.3. Target Population
Kombo and Tromp (2006) define a population as a group of individuals, objects or items
from which samples are taken for measurements. Sommer & Sommer (1997) on the
other hand defined target population as all members of a real or hypothetical set of
subjects, people or events in which a researcher wishes to generalize the results of a
study. The researcher targeted all the 152 public health institutions in the county which
consists of 1 level five hospital, 4 level four hospitals (sub county hospitals),19 health
centers and 128 dispensaries. The number of the healthcare staff is as tabulated below:
52
Table 3.1. Target population
_________________________________________________________________
Category of health care staff Number
_________________________________________________________________
Doctors 67
Dentists 10
Clinical officers 81
Nurses 479
Pharmacists 15
Radiographers 13
Physiotherapists 20
Orthopedics 5
Laboratory technicians 82
Totals 772
__________________________________________________________________
Source: Machakos County Office for Preventive and Promotive Services (2014)
The doctors, dentists and clinical officers were targeted because they are responsible for
diagnosis and prescriptions of the appropriate medical service. They are also in charge
of health care facilities. The nurses were targeted because they administer the medical
care including drugs to patients as prescribed by the doctors and clinical officers. The
radiologists and laboratory technicians were targeted because they assist the doctors and
clinical officers by carrying out tests to assist in diagnosis of patients‘ problems. Wrong
tests can lead to wrong diagnosis hence wrong prescriptions that can have adverse
effects on the patient. The pharmacists were targeted because they dispense drugs to the
patients as prescribed by the doctors and the clinical officers. Dispensing the wrong drug
or wrong dosage can adversely affect the efficiency and effectiveness of the health care
services All these health care professionals were targeted because each plays are critical
53
role in the provision of health care hence the loss of any has a very significant effect in
health care delivery.
3.4. Sample and Sampling Frame
Orodho (2005) & KIM (2009) define a sample as a part of a large population, which is
thought to be representative of the larger population. Sampling is a process of selecting a
number of individuals or objects from a population such that the selected group contains
elements representative of characteristics in the entire group (Orodho and Kombo,
2002). In the study, the researcher used both probability and non- probability sampling
designs to select facilities and respondents to be included in the sample. Sampling in this
study was necessary to minimize costs and time of the research.
3.4.1. Health Institutions

Purposive sampling a non-probability sampling design was used to pick the level five
and level four hospitals which are referral hospitals in the county while stratified random
sampling was used to select 16 health centers and 50 dispensaries out the remaining 147
from where were respondents to be included in the sample were picked. Stratification
was done on the basis of the sub counties to ensure representativeness. The number of
health centres and dispensaries respectively from each of the sub counties was as
indicated in parenthesis . Yatta (1 and 8) , Mwala (4 and 9), Matungulu (2 and 6),
Masinga (2 and 10), Machakos (1 and 8), Kathiani (2 and 4), Kangundo (3 and 3) and
Athi River (1 and 2). Purposive sampling in this study was necessary to ensure gathering
of information from respondents in these facilities which may not have been possible if
probability sampling was done.
54
3.4.2. Respondents.
The study used the Yamane‘s (1989) formula for categorical data as cited by Odhiambo
et al (2010) in determining the sample size.
Where:
N is the target population
n is the desired sample size
δ is the critical value of the confidence level (0.05)
Using the formula and given a target population (N) of 772 respondents a sample of 263
respondents was drawn. The investigator then employed stratified random sampling
method, a probability design to select respondents. The method involves dividing the
population into homogenous sub groups (strata) and then taking a simple random sample
in each sub-group (Kombo, 2006).
Krathwohi (1993), Kothari (2006) and KIM (2009) contend that one major advantage of
this method is that the researcher classifies the units into strata on the basis of
characteristics that if not properly represented in sample, may bias the inferences of the
researcher. There are different categories of staff in the healthcare facilities hence the
choice of the method. For this study, the strata were doctors, dentists, clinical officers,
nurses, pharmacists, radiographers, physiotherapists, orthopedics and laboratory
technicians. The researcher used the lottery method, a simple random sampling
technique to choose subjects from the strata of doctors, clinical officers, nurses and lab
technologists and purposive sampling for the rest of the strata
55
Table 3.2. Sample Size
______________________________________________________________________
Category of Staff Target Population Sample size

_______________________________________________________________
Medical doctors 67 22
Dentists 10 4
Clinical officers 81 28
Nurses 479 163
Pharmacists 15 5
Radiographers 13 5
Physiotherapists 20 7
Orthopedic technologists 5 2
Lab technicians 82 27
__________________________________________________________________
Total 772 263
3.5. Research Instruments
The researcher used the questionnaire and interview schedules to facilitate gathering of
information from the selected respondents. Sommer & Sommer (1997) defines a
questionnaire as a series of questions on a topic about which respondents‘ opinions are
sought, while Borg (1996) & Mugenda (2003) says that a questionnaire is a document
that asks the same question to all individuals in the sample. In this study, the researcher
used structured questionnaires with both open ended and closed ended questions. The
questionnaires were self-administered questionnaires in which the respondents filled on
their own since they were all literate. The investigator chose to use the questionnaire on
most of the respondents because it is economical to administer in terms of time and cost
to a large number of respondents. It ensures anonymity hence respondents can respond
56
genuinely without fear of identification. Finally, the questions are on paper and are
standardized hence no opportunity for the researcher to be biased.
The questionnaire consisted of a section on demographic information of the respondents

and a set of items to measure the role of the selected human resource management
practices on the retention of staff. A five- point likert scale anchored by strongly
disagrees and strongly agrees was used to measure the perceived role of the human
resource management practices on retention of staff in the health care facilities. The
likert scale was used because its relatively easy to construct, it facilitates quantifications
of the responses, enables ranking of items thus tendencies can be identified , the
respondents are more likely to respond to all the statements in the instrument and can
best help capture people opinions(Kothari and Garg, 2014).
Structured interviews were also conducted on some of the participants especially those
in charge of the facilities in order to get in-depth information on the issues under
investigation. In-depth interviews help to discover underlying needs, motives, feelings
and desires of the respondents.
3.6. Data Collection Procedure

The following procedure was used to collect data:
i. A letter of introduction was obtained from the chairperson ETLM department in
JKUAT (see appendix I)
ii. The researcher then visited and sought authority from the Chief Officer of
Health, Machakos County from where authority to carry out a research in the
health institutions was granted through a letter (see appendix II).
iii. Using this letters the researcher visited the officers in in charge of each of the sub-
counties where she sought authority to collect data from each of the selected
health institutions.
57
iv. The researcher then visited the selected health institutions and with the help of the
medical officer in charge, sampled some staff from each of the strata to whom
the questionnaire would be administered.
v. The researcher then administered the questionnaires to the sampled staff with
the assistant of those in charge of various sections in the hospitals or the facility
in-charge.
vi. The researcher then administered interviews to the medical superintendents in
charge of each of the four hospitals and the sub-county public Health officers in
charge of the eight counties
vii. Finally, the researcher collected the questionnaires after one week from the
persons in charge of the health facilities selected as had been agreed.
3.7 Piloting
Piloting of the research instruments means administering the instruments to a small
representative sample identical to but not including the group one is going to survey.
This is important, in order to determine the validity and reliability of the instruments
(Orodho, 2005).
3.7.1. Reliability
Orodho (2005) says; ―Reliability of a measurement concerns the degree to which a
particular measuring procedure gives equivalent results over a number of repeated trials
while Wallen & Fraenkel, (2001) say reliability relates to the consistency of the data
collected. In this study, reliability of the questionnaires were assessed through use of
Cronbach‘s Alpha. This is a technique of estimating reliability that does not require
either splitting of a scale or the subjects retaking the test for a given construct hence
eliminating the challenges inherent in split-half and the test-retest
techniques(Mugenda,2011). This coefficient of internal consistency is computed as
follows:
58
Alpha=Nr/(1+r(N-1)
Where r=the mean inter-item correlation
N=number of items in the scale
In this technique, the more the number of items in a scale, the higher the reliability as
long as the added items do not reduce the average inter-item reliability (Mugenda, 2011,
KIM 2009). Cronbach‘s alpha reliability coefficient normally ranges between 0 and 1.
The closer Cronbach‘s alpha coefficient is to 1.0 the greater the internal consistency of
the items in the scale. The size of alpha is determined by both the number of items in the
scale and the mean inter-item correlations. George and Mallery (2003) provide the
following rules of thumb: ―_ > .9 – Excellent, _ > .8 – Good, _ > .7 – Acceptable, _ > .6
– Questionable, _ > .5 – Poor, and _ < .5 – Unacceptable‖. However an alpha of .8 is
probably a reasonable goal.
In this study 25 respondents from the level five hospital, one health center and three
dispensaries were picked from strata of doctors nurses, clinical officers and laboratory
technicians. These were not included in the study sample. The results of the pilot study
were as represented in table 3.3 below.
59
Table 3.3 Cronbach’s Alpha Analysis for the Pilot instruments
Variable Cronbach's Cronbach's Alpha Based on N of
Alpha Standardized Items Items
Reward .963 .964 13
Career Advancement .957 .957 16
Working Environment .961 .963 18
Work life balance .945 .948 16
Retention .763 .763 17
Overall Cronbach’s .972 .970 80
Table 3.3 above shows the Cronbach‘s alpha values for reward, career advancement,
work environment management and that of work-life balance practices were all above
0.9 while that of the dependent variable retention was 0.763. These were excellent and
acceptable respectively according to George& Mallery, (2003). This meant that the
instrument was reliable and could be used to collect data for the study.
3.7.2. Validity
Nachmias and Nachmias (2008) points out that validity is the degree to which the
instrument measures what it purports to measure and consequently permits appropriate
interpretation of scores. According to Mugenda (2011), validity is the accuracy,
truthfulness and meaningfulness of inferences that are based on the data obtained from
60
the use of a tool or a scale for each construct or variable in the study. An instrument is
valid if it measures what it is intended to measure and accurately achieves the purpose
for which it was designed (Patten, 2004; Wallen & Fraenkel, 2001). According to Patten
(2004) validity is a matter of degree and no test instrument is perfectly valid. The
instrument used should result in accurate conclusions (Wallen & Fraenkel, 2001).
Validity involves the appropriateness, meaningfulness, and usefulness of inferences
made by the researcher on the basis of the data collected (Wallen & Fraenkel, 2001).
According to Patten (2004) content validity is determined by judgments on the
appropriateness of the instrument‘s content. Patten (2004) identifies three principles to
improve content validity: 1) use a broad sample of content rather than a narrow one, 2)
emphasize important material, and 3) write questions to measure the appropriate skill.
These three principles were addressed when writing the survey items. Additionally the
supervisors who are experts went through the instrument to check the content coverage
and clarity of the questions on the issues that were to be investigated.
3.8. Data Analysis and Presentation
Kerlinger (1986) defines data analysis as categorizing, manipulating and summarizing of

data in order to obtain answers to research questions. Gay (1981) asserts that
quantitative data is commonly represented by use of frequency tables, graphs, pie-charts
and frequency polygons. Zikmund (2003) states: ―interpretation is the process of making
inferences and drawing conclusions concerning the meaning and implications of a
research investigation‖.
The researcher used the SPSS program (Nachmias&Nachmias, 2008) version18 to

analyze the quantitative data collected. This program is appropriate for social sciences
for it enables the researcher to recode variables, to deal with missing values, to sample,
to weight and select cases and to compute new variables and effect permanent or
temporary transformations. Through this tool, the researcher determined partial
61
correlation coefficient (Kothari, 2006, Nachmias&Nachmias, 2008 & Mukras, 1993)
between the dependent variable and each of the independent variable. This helped the
researcher to confirm the existence of a relationship between the dependent variable and
each of the identified independent variables, the direction of the relationship as well as
the strength of the relationship.
The researcher also used the least square method (Kothari, 2006) through the SPSS tool
to determine the coefficients of the multiple linear regression model below to establish
the estimated/ sample regression model.
Yi= β0 + β1 X1 + β2 X2 + β3 X3 + β4 X4 + e
Where: Yi is the dependent variable retention

β0, β1, β2, β3 and β4 are coefficients of the model
X1 is remuneration
X2 is career advancement
X3 is work environment
X4 is work-life balance and
e is error term representing omitted variables
To evaluate the reliability of the estimated multiple linear relationship, the researcher
made use of coefficient of determination to establish the goodness of fit of the estimated
model. (Mukras, 1996). Secondly, the researcher carried out analysis of variance
(ANOVA) to determine the contribution of each of the explanatory variable to the
change in the dependent variable. (Kothari, 2006). In addition researcher did thematic
analysis (Clarke & Braun, 2013,) an analytic technique used with qualitative data to
analyze the qualitative data which is one of the types of data that that was collected.
They define thematic analysis as: ―a method for identifying, analyzing and reporting
patterns within data.‖ It entails perusing through the collected data and identifying
62
information that is relevant to the research questions and objectives. It also involves
coding of data, highlighting key quotations or insights and interpretations, placing
together all materials relevant to a certain topic and finally developing a summary report
identifying major themes and the associations between them (Kombo and Tromp, 2006).
The data was represented using tables using tables, bar graphs, and pie charts.
3.8.1 Variable Definition and Measurement

The dependent variable retention was measured through the employee‘s expression of
intent to continue working for the organization, satisfaction with their jobs and also
through their loyalty and commitment to the organization. Remuneration which in this
context refers to compensation and other rewards was be measured in terms of
provision of equitable and satisfactory salaries and allowances including risk
allowances, strenuous allowances, housing allowances, overtime pay, pension schemes,
benefits like car loans, mortgages and any other payable allowances. Existence of
Payment programmes such as base pay, competency pay, pay for performance among
others was also explored. Career advancement here refers to opportunities to develop or
grow in one‘s career and was measured through assessment of availability of training
and development opportunities, position movement, mentoring programmes , succession
management programmes, study leaves, scholarships, clear progression scheme of
service, policy on career progression, full or partial tuition fee payment and existence of
formal and informal networks.
Working environment here refers to the location where tasks are completed and was
measured in reference to physical aspects such as geographical location, office space
and furnishings, equipment, protective materials, , dust, noise , ventilation, lighting
among others. It also included psychological aspects such as social interactions at the
work place including interaction with peers, subordinates and managers. Lastly work-
life balance here refers to the efforts of employees to split their time and efforts between
63
work and other important aspects of their lives. It was measured through existence of
policies , procedures and actions that enable employees to easily pursue more balanced
lives such as flexible schedules, paid time off policies, responsible time and
communication, expectations and company-sponsored family events and expectations.
64
CHAPTER FOUR
RESEARCH FINDINGS AND DISCUSSION
4.1. Introduction
Data in this chapter is presented, analyzed and interpreted in five major sections. The
first section is on the demographic (background) data of the respondents. The second is
on testing of the hypotheses, the third is an analysis based on the four research
objectives that were guiding the study while the last section is analysis of the interview
responses. .
Data were analyzed to identify, describe and explore the relationship between Human
resources management practices retention of staff in Health institutions in Machakos
County, Kenya. The level of significance was set at 0.05.
4.2 Reliability
Although a pilot test (Cronbach test) was done to establish the reliability of instruments,
it was done again with the whole set of the returned questionnaires to confirm the
consistency in the reliability of the instruments. Table 4.1 below shows the reliability
results for the final research instruments.
65
Table 4.1: Cronbach’s Alpha Analysis for all Instruments used
Variable Alpha N of items
Reward Compensation Practices .883 13
Career Advancement Practices .896 16
Working Environment .806 18
Work life Balance .856 , 16
Retention(commitment and intent to stay) .807 17
The Overall Cronbach’s Alpha Test .935 80
Table 4.1 above shows that the test items were highly reliable. The individual
Cronbach‘s alpha values were all above 0.8 while the overall was above 0.9 which are
good and excellent respectively according to George& Mallery, (2003).
4.3. Response Rate and Demographic Information
4.3.1. Response Rate

The sample for the study comprised of a total of 263 employees drawn from 128 public
health care institutions in Machakos County. A total of 251 questionnaires were
distributed to employees in selected health care facilities in each of the 8 sub counties.
12 employees mainly the sub county health officers and medical superintendents who
are in charge of the health care facilities and hospital respectively in each of the sub
counties were targeted for interviews. Out of this a total of 227 questionnaires were
dully filled and returned from the health care facilities in the 8 sub counties while the 8
66
sub county health officers and 4 medical superintendents were successfully interviewed.
24 of the questionnaires distributed were not returned as some of the respondents were
unavailable when they were being collected while others simply declined to return
despite continued request by the officers in charge. The response rate was thus 90%
which was adequate for the researcher to continue with the data analysis. Indeed
O‘Regan et al., (2012) asserts that a response rate of 27% is too high given that typical
response rates for studies addressing strategic issues are in the range of 10-12% (Koch &
McGrath, 1996 & GeletKanycz, 1997). Contacts prior to the dispatch of the
questionnaires and follow up calls could account for the fairly high response rate. The
response rate in the study is shown in Figure 4.1.
Figure 4.1: Response Rate
67
4.3.2. The Response Rates by Designation
The response rates by designation were as represented in figure 4.2 below
100
90
80
70
60
50
40
30
20
10
0
Figure 4.2. Response rate by designation

The figure shows all (100%) the radiographers, pharmacists and orthopedic
technologists chosen responded, 89%, 88% and 86% of the clinical officers, nurses and
clinical officers respectively responded while 75% of the dentists and 71% of the
physiotherapists chosen responded. The high response rates for each of the categories of
selected samples indicate that the results of the study are quite reliable.
4.3.3. Gender of the Respondents

The researcher also sort to find out the composition of the respondents by sex and the
findings are as shown in the figure 4.3 below.
68
34%
Male
Female
66%
Figure 4.3: Gender

The findings in figure 4.3 show that 66% of the respondents were female while 34%
were males. This shows that there are more female employees in the health care sector
than the female. The staff mix however shows that gender distribution in the health
care sector is in line with the requirements of Kenya constitution (2010) which requires
that no one gender should take up more than two thirds of employment positions in
public institutions.
4.3.4. Age of Respondents in Years

Information on the age of the respondents was sort to find out the staff mix in terms of
age and also to establish if there was a correlation between the age of the respondents
and the tendency to stay in the facilities.
69
11%
35%
20%
20-30
years
31-40
years
41-50
34% years
51-60
years
Figure 4.4: Age in Years
The findings as shown in in fig. 4.4 show that majority of the respondents were aged
between 20-30 years (35%) followed by those aged between 30-40 years (34%) then 41-
50 years (20%) with the minority having been aged between 50-60 years(11%). Several
factors could account for the trend in the ages. First the number of health care facilities
has progressively been increasing over the years and that could account for the
70
progressive increase in the number of young people joining the service. Secondly with
the devolution of health care services, most county governments have employed their
staff in most of the sectors, the health care sector being one of them; with majority of
those employed being the young. Thirdly the relatively low number of the aged
employees could be due to departure from service due to natural attrition as a result of
death or resignation to join private practice or other engagements having gained enough
experience in the service. Correlation test between age and retention show that there is a
weak and negative (-0.025) correlation between age of the respondents and retention
(see appendix VI). This shows that age in the health care sector is a poor predictor of
retention and that as age increases the tendency to stay (retention) decreases.
4.3.5. Marital Status of the Respondents

The researcher also sought information on the respondents‘ marital status. The results
indicated that a great majority (90%) was married and only a minority (10%) was
unmarried. The high number of the married suggests that majority of the workers had
fulfilled their lower order needs to some extent, the physiological and security needs due
to their permanent employment hence could satisfy the social need of love and
belonging through marriage. This is in line with propositions of Maslow in his Hierarchy
of needs Theory (1949) where he proposes that human beings strive to satisfy their
lower order needs before they begin striving to satisfy higher needs. The results are as
shown in Figure 4.5 below.
71
20%
Married
Unmarried
80%
Figure 4.5: Marital Status
Correlation test between marital status and retention indicate that there is a weak but
positive (0.015) relationship between the marital status of the employees and retention
(see appendix VI). Thus marital status is a weak predictor of retention although it
contributes to some extend to the tendency to stay. This could be because the married
sometimes tend to settle in on place to avoid disrupting their children from school
especially those with school going children while others prefer to stick closer to their
spouses yet turn over could disrupt these .
72
4.3.6. Family Status of the Respondents
A person‘s family status is likely to influence their decision to stay in an organization.
Employees with children are less likely to leave an organization unless they get an
opportunity with better financial returns or other benefits. Of the respondents who were
married, 78% had children while 22% did not have children. However a correlation
analysis between family status and retention of employee showed that there is a very
weak and negative correlation (-0.013) between family status and retention. The
proportion of those with children to those without can be represented as follows.
22%
With children
Without children
78%
Figure 4.6: Family Status
73
4.3.7. Status of Children in the Family
If the children are young hence dependents an employee would be more cautious to
quite a job unless they are assured of another with better terms. They are also hesitant to
leave because that is likely to disrupt dependent children who are in school. 66% of the
respondents who had children had dependents while the rest 34% were non dependents.
This shows that majority of them would have to be cautious when quitting their jobs.
These results are represented in the pie chart below.
34%
Dependents
Not dependents
66%
Figure 4.7: Status of Children
Correlation results between the status of the children in the family and retention
however showed that there was a weak and negative correlation (-0.045) between the
status of the children in the family and the decision to stay in the health care sector (see
74
appendix V). This results show that the status of children in a family is a poor predictor
of the intention to stay in the public health care sector.
4.3.8. Level of Education

The researcher also sort to find out the academic qualification of the respondents. All the
227 respondents respondent to this question. Of these only 1 representing 0.4% held a
master‘s degree, 13.2% had a bachelor‘s degree, and 25.5% were certificate holders
while the majority representing 60.7% had diploma qualifications in their respective
areas of specialization. This results indicate that only a few of the health care staff with
high academic qualification (only 13.6% had a bachelors and masters qualification) tend
to stay in the service. This observation could be due to the fact that those who attain
higher qualification tend to leave and join private practice as consultants while high
qualification also increases their employability in Non-Governmental Organizations
(NGO) and also private health care facilities that have better remuneration and other
terms of service. This observation was also confirmed by interviews administered to the
sub-county health care officers who said that most of the health care workers upon
attainment of high qualification tended to quit for private practice and engagement in in
the NGO and prominent private health care facilities. These findings are represented in
figure 4.8 below.
75
160
138
140
120
100
80
58
60
40 30
20
1
-
Certificate Diploma Bachelors Masters
Certificate Diploma Bachelors Masters
Figure 4.8: Level of Education

The results of correlation analysis between the level of education and the intention to
stay showed there was a weak but positive (0.089) correlation between the level of
education and the intent to stay. This means that academic qualification is a weak
predictor of intention to stay in the health care sector.
4.3.9. Designation of Respondents

The respondents were requested to indicate their designation and their responses were as
represented in the bar graph below
76
70
60
50
40
30
20
10
0
Figure 4.9 Proportion of respondents by designation
A correlation test showed a weak and negative (-0.119) correlation between the
employees designation and the tendency to stay. This suggests that the decision to stay is
often taken irrespective of the employees‘ designation in the health care sector.
4.3.10. Graduation Period

Information on the year of graduation and therefore the length of service was sort in
order to establish the reliability of the information given. The results show majority of
the employees (47%) were employed between 2001 and 2010 and that generally
over80% of the employees had more than 5 years‘ experience which is sufficient to give
reliable information about the variables under investigation.
The trend also shows that the number of engagement have been increasing over the
years. This could be attributed to increase in the number of health care facilities. This
information on year of graduation can be represented on a frequency table as shown
below
77
Table 4.2: Graduation Period
Period Frequency Percentage [%]
1971-1980 6 2.7
1981-1990 30 13.2
1991-2000 41 18.1
2001-2010 108 47.5
2011-2014 42 18.5
Total 227 100.0
The correlation analysis value between year of engagement and retention is very low and
negative (-0.060). This implies that the duration of working is a poor predictor of
retention in the health care sector. The negative sign however implies that as the number
of years increase retention is reduced. This could be due to several factors, among them,
resignation to engage in private practice or consultancy. This is further confirmed by the
fact that of the doctors who responded to the items none had over five years‘ experience.
Further interviews with the subcounty public health officers and medical
superintendents revealed that most of the long serving doctors were only visiting
consultants and that the highest turnover was usually experienced among the doctors
majority of whom tended to quit for private practice or to be employed in the highly
paying private hospitals and non-governmental facilities especially on attaining their
master degrees.
78
4.4. Research Hypotheses
In order to achieve the objectives designed for this study, the following research
hypotheses were formulated and tested based on the revelations in the review of
literature concerning human resources management practices and staff retention. The
statistical test results (regression and correlation analyses) of each null hypothesis at
95% confidence level are as shown in the hypotheses that follow:
4.4.1: H01: There is no significant relationship between employee remuneration

practices and retention of health care staff in Machakos County in Kenya.
An ANOVA was done to test the null hypothesis that there is no significant
relationship between employee remuneration practices and retention of health care staff
in Machakos County. The results are presented in table 4.3
Table 4.3: ANOVA Results on Role of Remuneration Practices on Retention of

Health Care Staff
Model Sum of df Mean Square F Sig.
Squares
Regression 387.383 1 387.383 9.847 .002b
1Residual 8851.692 225 39.341
Total 9239.075 226
a. Dependent Variable: Retention
b. Predictors: (Constant), Reward
Since P(0.002) is less than alpha (.05), the researcher rejected the null hypothesis and
adopted the alternative hence concluded that with the data obtained, there is evidence
79
of significant relationship between remuneration practices and the retention of health
care staff in Machakos county in Kenya ( F (9.847, df=1, and P<0.05). Thus
remuneration practices play a significant role in the retention of health care staff in
public health care institutions in Machakos County.
This finding is consistent with the study by Bergiel et al. (2009) who noted that
research findings suggest that there is a significant and positive relationship between
compensation and job embededness. Additionally Ihsan and Naeem (2009), indicated
that Pharmaceutical sales force rated pay and fringe benefits as the most important
retention factor which is supported by the findings of past studies. They further it
indicates that pay and fringe benefits is highly valued by the sales force of all
demographic backgrounds. Shoab et al, (2009) also noted that attractive remuneration
packages are one of the very important factors of retention because it fulfills the
financial and material desires Tettey (2006) concurs with this when he states that
dissatisfaction with salaries is one of the key factors undermining the commitment of
employees to their institutions and careers, and consequently their decision to stay or
intent to leave.
A correlation analysis show a significant relationship between retention and

remuneration practices (r=0.166, α =0.05). To test whether the relationship between
retention and remuneration practices is linear, a regression analysis was run whose
results are as shown in table 4.4 below.
Table 4.4: Model Summary

Model R R Square Adjusted R Square Std. Error of the
Estimate
1 .205a .042 .038 6.272
a. Predictors: (Constant), Reward
80
The Karl Pearson product moment of coefficient of correlation r=0.205 is low and
suggests a weak relationship. The adjusted r squared=0.038 indicates that only 3.8% of
the change in retention can be explained by a change in the remuneration practices.
Other factors therefore account for the remaining percentage.
As shown in table 4.5 below, the beta β=0.194 value is however significantly higher
than 0 hence the linear relationship holds with a model R= 58.164+0.194Rw
Table 4.5: Coefficientsa

Model Unstandardized Standardized t Sig.
Coefficients Coefficients
B Std. Error Beta
(Constant) 58.164 3.347 17.377 .000
1
Reward .194 .062 .205 3.138 .002
These findings indicate that although the relationship is weak, the remuneration
practices cannot be ignored and should be improved to have a greater role in the
retention of staff in the public health institutions.
4.4.2: H02: There is no significant relationship between career advancement

practices and retention of health care staff in Machakos County in Kenya.
To test the above hypothesis a simple linear regression was done and the an analysis of
variance (ANOVA) results are presented in table 4.6 below.
81
Table 4.6: ANOVA results on role of career advancement practices on retention of
health care staff
Model Sum of df Mean F Sig.

Squares Square
Regression 586.818 1 586.818 15.260 .000b
1Residual 8652.257 225 38.454
Total 9239.075 226
b. Predictors: (Constant), Career advancement
Since P(0.000) is less than alpha (0.05), the researcher rejected the null hypothesis and
adopted the alternative hypothesis and concluded that with the data obtained, there is a
significant relationship between career advancement practices and retention. Thus
career advancement practices play a significant role in the retention of health care staff
in public health care institutions in Machakos County.
The above findings are in line with the findings from a research by Chay and Norman
(2003) on creating value for employees: investment in employee development which
showed that perception of investment in development can improve nurses‘ morale and
dedication to the level that emotionally binds them to the organization and encourages
them to stay on. This implies that healthcare organization need to pay greater attention,
both in investing and planning development activities that promote and develop
organizational commitment and job satisfaction among nurses. Armstrong (2009)
concurs when he asserts that, lack of clear career path or development is a major cause
of poor employee retention. He further says that to maintain a stable work force,
employers should learn to plan to provide career opportunities by providing employees
82
with wider expectations, encouraging promotion from within and developing equitable
promotion procedures. (Armstrong, 2009).
A correlation analysis show a significant positive relationship between retention and

career advancement practices (r=0.245, α =0.01). A regression analysis was run to test
whether the relationship between retention and remuneration practices is linear and
results are as shown in table 4.7 below.
Table 4.7 Linear Regression Analysis Model Summary

Model R R Square AdjustedR Std Eror of
Square the Estimate
1 .252a .064 .059 6.201
a. Predictors: (Constant), Career_advancement
The Karl Pearson product moment of coefficient of correlation r=0.252 is low and
suggests a weak relationship. The adjusted r squared=0.059 indicates that only 5.9 % of
the change in retention can be explained by a change in the career advancement
practices. Thus other factors could be accounting for the remaining 94.1%.
As shown in table 4.8 on the correlation coefficient below, the beta β=0.150 value is
however significantly higher than 0 hence a simple linear regression relationship holds
with a model ; R= 59.661+0.150 CA
83
Table 4.8 Regression Analysis Correlation Coefficient
B Std. Error Beta
(Constant) 59.661 2.321 25.700 .000
1 Career_advanceme
.150 .038 .252 3.906 .000
nt
This indicates that although there is a relationship it is weak hence the career
advancement practices should be improved to have a greater role in the retention of
staff in the public health institutions in the county.
4.4.3: H03: There is no significant relationship between work environment

management practices and retention of health care staff in Machakos County in
Kenya.
An analysis of variance (ANOVA) was done to test the above hypothesis whose results
are presented in table 4.9 below.
84
Table 4.9: ANOVA Results on Role of Work Environment Management Practices
On Retention Of Health Care Staff
Model Sum of df Mean F Sig.

Squares Square
Regression 635.236 1 635.236 16.612 .000b
1Residual 8603.839 225 38.239
Total 9239.075 226
b. Predictors: (Constant), Work_environment
The P(0.000) is less than alpha (0.05). The researcher therefore rejected the null
hypothesis and adopted the alternative hypothesis and concluded that with the data
obtained there is significant relationship between work environment management
practices and the retention of health care staff in Machakos County Kenya ( F 16.612,
df=1, and P<0.05). Thus work environment management practices play a significant
role in the retention of health care staff in public health care institutions in Machakos
County .
These findings are in line with the findings from an independent study conducted by the
Society for Human Resource Management which demonstrated that physical work
environment contributes a major factor affecting the decision of employee‘s whether to
stay or leave the job (Sutherland & Jordaan, 2004). Indeed Winterton, (2011) asserts
that the key to retaining employees is to create an environment employees choose to
work in and will stay given the availability of other job opportunities.
A correlation analysis show no significant relationship between work environment

management practices and retention (r=0.126, at either α =0.01 or 0.5). The positive
85
value of the correlation however show there exists a positive relationship at an alpha
value higher than 0.05.
The simple regression analysis ran also gave a low Karl Pearson‘s product moment
coefficient r=0.262 which suggests a weak relationship. The adjusted r squared=0.065
value indicate that only 6.5% of the change in retention of staff in public health
institutions in Machakos County can be attributed to work environment management.
This is represented in table 4.10 .
Table 4.10 Model Summary

Estimate
1 .262a .069 .065 6.184
a. Predictors: (Constant), Work_environment
However the beta β=0.203 value is significantly higher than 0 and hence a linear
relationship R=54.069+0.203WE. These values are as shown in table 4.11 below.
Table 4.11: A Simple Regression Analysis Correlation Coefficients

Model Unstandardized Standardized T Sig.
B Std. Error Beta
(Constant) 54.069 3.585 15.081 .000
1
Work_environment .203 .050 .262 4.076 .000
The findings imply that the work environment management practices are not good and a
lot needs to be done to improve them so that the correlation coefficient improves.
86
4.4.4: H04: There is no significant relationship between work-life balance practices
and retention of health care staff in Machakos County in Kenya.
To test the above hypothesis, a simple regression analysis was done whose ANOVA
results were as shown in the table 4.12.
Table 4.12: ANOVA Results on Role of Work Life Balance Practices on Retention
of Health Care Staff
Model Sum of Df Mean Square F Sig.
Squares
Regression 692.244 1 692.244 18.224 .000b
1Residual 8546.831 225 37.986
Total 9239.075 226
b. Predictors: (Constant), Work_life_balance
Since P(0.00) is far much less than alpha (.05), the null hypothesis was rejected and
the alternative adopted hence concluded that with the data obtained, there is evidence
of significant relationship between work-life balance practices and the retention of
health care staff in Machakos County in Kenya ( F (18.224, df=1, and P<0.05). Thus
work-life balance practices play a significant role in the retention of health care staff in
public health care institutions in the county.
These observations are in line with the findings of Thompson and Prottas (2005) and
Yanadoria and Katob (2010) who examined the relationship between employee turnover
intention and organization support such as supervisor support, flex time, work family
culture and co-worker support and concluded that organization support reduced the
employee turnover intention. A correlation analysis show a statistically significant weak
but positive relationship between retention and work-life balance practices (r=0.211, α
=0.05) (see appendix VI).
87
A linear regression analysis shows that the relationship is very weak with Karl Pearson‘s
product moment coefficient of linear correlation r= 0.274 as shown in table 4.13 below
. The adjusted r squared= 0.071 indicates that only 7.1% of the change in retention can
be explained by change in work-life balance practices. Other factors therefore account
for the rest of the retention.
Table 4.13: Model Summary

Estimate
1 .274a .075 .071 6.163
a. Predictors: (Constant), Work_life_balance
As shown on table 4.14 below, testing the simple regression model R= α+ βWL where
α=53.553 and β=0.253 shows that the beta value is significantly higher than 0 and so
the model holds hence R=53.553+0.253WL .
88
Table 4.14: Simple regression analysis correlation Coefficients
B Std. Error Beta
(Constant) 53.553 3.545 15.106 .000
1
Work_life_balance .253 .059 .274 4.269 .000
These findings indicate that although the work-life balance practices enhance retention,
various parameters that enhance their attractiveness should be looked into to make them
better so that the correlation coefficient can improve.
4.5 Collective Role of the Independent Variables pooled together on the Dependent
Variable Retention.
A multivariate regression analysis was done in order to answer the questions; How do
the independent variables influence each other?; How does each independent variable
influence the dependent variable?; To what extent does the model R= β0 + β1 R + β2 CA
+ β3 WE + β4 WL represent what is actually happening on the ground?; How do the

independent variables influence the dependent variable collectively? ; To what extent
does each independent variable affect the dependent variable in the collective set up?
and which are the more significant factors?
4.5.1 Relationship Between HRM Practices

To establish if there are significant relationships between the different HRM practices
used by the public health care institutions in Kenya, a correlation analysis was done.
Table 4.15 represents the results.
89
The results in table 4.15, there exists a moderate but statistically significant relationship
between career advancement and work-life balance practices (r=0.395, p<0.05),
remuneration and career advancement practices (r=0.336, p<0.05) and career
advancement and work environment management practices (r=0.318, p<0.05) used by
public healthcare institutions in Kenya. However, there exists a weak but statistically
significant relationship between work-life balance and work environment management
practices (r=.289, p<0.05), remuneration and work environment management practices
(0.231. p<0.05) and reward and work life balance practices (0.190, p<0.05) .
Table 4.15: Correlation analysis between the HRM practices

N=227 Reward career.ca worlifebala Workenviro
.cat t nce.cat nment.cat
Spearma Reward.c Correlation 1.000 .336** .190** .231**

n at Coefficient
correlatio Sig. (2- . .000 .004 .001

n tailed)
career.cat Correlation .336** 1.000 .395** .318**

Coefficient
Sig. (2- .000 . .000 .000

tailed)
worlifebal Correlation .190** .395** 1.000 .289**

ance.cat Coefficient
Sig. (2- .004 .000 . .000

tailed)
workenvir Correlation .231** .318** .289** 1.000

onment.ca Coefficient
t
Sig. (2- .001 .000 .000 .
tailed)
**. Correlation is significant at the 0.01 level (2-tailed).

90
4.5.2 Correlation between the Independent Variables and the Dependent Variable
A correlation analysis between each of the independent variables and the dependent
variable was done to establish how these independent variables influence the dependent
variable and the results were as shown in table 4.16 below
Table 4.16: Summary of the correlation analysis of the bivariate relationship of

retention against the independent variables
Reward. career.c worlifebala Work retention.
cat at nce.cat environment cat
cat
retention. Correlati .166* .245** .211** .124 1.000

cat on
Coefficie
nt
Sig. (2- .012 .000 .001 .068 .

tailed)
N 227 227 227 219 227
*. Correlation is significant at the 0.05 level (2-tailed).

**. Correlation is significant at the 0.01 level (2-tailed).
From the results it was found that there are weak but statistically significant positive
relationships between career advancement practices and retention (r=0.245, p<0.05),
work-life balance practices and retention (r=0.211, p<0.05) and remuneration
management practices and retention (r=0.166, p<0.05). However, the results show a
weak positive relationships which is not statistically significant at either 0.01 or 0.05
91
between work environment management practices and retention (r=0.124, p>0.5),
Therefore, there is a positive correlation between the human resource management
practices and retention of staff in the public health care institutions in Kenya ,
particularly Machakos county since the table shows the zero order coefficient for the
dependent variable against each independent variable.
4.5.3 Multivariate Linear Regression Analysis between the Independent Variables

and the Dependent Variable
A multivariate linear regression analysis shows that the relationship between all the
independent variables pooled together and the dependent variable is weak but positively
significant with the value of R the model collective correlation coefficient=0.349 as
shown in table 4.17 .
Table 4.17 Multiple linear regression analysis Model Summary

Model R R Square Adjusted R Std. Error of the Estimate
Square
1 .349a .122 .106 6.045
a. Predictors: (Constant), Work_environment, Reward, Work_life_balance,
Career_advancement
The value of adjusted R squared is 0.106 implying that only 10.6% of the change in the
level of retention in the public health institutions in Machakos County can be
explained by a change in the four variables pooled together. This shows that besides
the four human resource management practices, there are other factors that play a
significant role in the retention of staff in the institutions. The R value also shows that
the model improved when more variables are incorporated when trying to analyze the
factors that affect the retention of staff in public health institutions in Kenya.
92
The ANOVA results show that P (0.000) is less than alpha (0.05). Thus the four
variables play a significant role in the retention of health care staff in Kenya (F (7.700),
df=4, and P<0.05), table 4.18
Table 4.18: ANOVA For The Independent Variable And The Four Independent
Variables Pooled Together.
Model Sum of Df Mean Square F Sig.
Squares
Regression 1125.614 4 281.403 7.700 .000b
1Residual 8113.461 222 36.547
Total 9239.075 226
b. Predictors: (Constant), Work environment, Reward, Work life balance, Career
advancement
4.5.4 Significance of Each Independent Variable in the Model
The beta value is used to answer the question which of the independent factors play a
more important role in the retention of staff. Table 4.19 below indicates that the most
important factor is work life balance, followed by work environment, then career
advancement and finally remuneration. The beta values for these variables; 0.147, 0.134,
0.103 and 0.100 respectively indicate that the dependent variable retention would change
by a corresponding number of standard deviations when the respective independent
variables change by one standard deviation. The order of importance of the factors is
similar to that suggested by the bivariate regression analysis using the zero order
correlation coefficients as shown in table 4.16 above.
93
Table 4.19 : Multiple regression analysis correlation coefficients.
Coefficientsa

B Std. Beta
Error
1 (Constant) 44.359 4.643 9.555 .000
Work_life_balance .136 .068 .147 1.985 .048
Reward .095 .065 .100 1.447 .149
Career_advancement .061 .044 .103 1.385 .167
Work_environment .104 .056 .134 1.842 .067
The resulting multiple regression equation is therefore:
Retention(R)= 44.359 + 0.095Remuneration(Rn) + 0.061Carreer advancement(CA)

+ 0.104Working Conditions (WC) + 0.136 Work Life Balance .
Thus , R= 44.359+0,095Rn +0.061CA+0.104WC+0.136WL
4.6 Analysis Based on Research Objectives

The analysis of the findings based on the research objectives were as follows
94
4.6.1 Role of Remuneration Practices on the Retention of Health Care Staff
The first research objective was to analyze the role of remuneration practices on the
retention of staff in public health care institutions in Machakos county; Kenya. To meet
this objective, four research questions were formulated. The first question sought to find
out if in the respondents‘ opinion, remuneration practices affected staff retention. The
respondents were required to tick against Yes if they thought it affected or against No if
they thought it never affected staff retention. The responses were as shown in the table
4.20.
Table 4.20: Remuneration Practices Influence Staff Retention

Response Frequency Percentage
Yes 199 88.8

No 25 11.2
Total 224 100.0
Almost all (88.8%) of the respondents in each category said remuneration practices
affected staff retention while the remaining 11.2% said it did not affect
The second question sought to get the respondents‘ views about remuneration practices
in their institutions. The respondents were requested to react to various statements on
this issue remuneration by ticking whichever was applicable at their workplace on a five
point scale of Strongly Agree (SA), Agree (A), Undecided (UN), Disagree (DA) and
strongly disagree (SDA). The responses obtained were quantified using frequencies and
percentages and tabulated as follows:-
95
Table 4.21: Role of Remuneration Practices on Retention of Health Care Staff
Response
Statament SA A UD DA SDA TOTAL
Retention is enhanced
because
F % F % F % F % F % TOTA %
L
Salaries and benefit 0 0 0 0 1 6 11 52 96 42 227 100

provided are adequate 3 8
There are periodic salary 0 0 0 0 1 6 11 50 99 44 226 100

review 4 3
salaries and benefits are 3 1 3 1 0 0 86 38 74 33 227 100

paid promptly 1 4 6 6
provision of incentives 4 2 5 2 9 4 53 24 63 28 225 100

results into retention 4 0 6 5
due to competitive, fair 0 0 0 0 2 12 10 49 88 39 224 100

and equitable pay system 7 9
provided
Salaries and benefit 2 1 3 1 2 11. 79 35. 67 30 224 100

policy is fairly and 3 0 0 3 5 2 3
equitably administered
to employee benefits 0 0 0 0 0 0 56 25 170 75 226 100

such as car loans
adoption of competency 2 1 2 1 4 18 63 28 68 31 223 100

based pay strategy 3 0 8 3 1
implementationof 1 8 4 1 0 0 68 31 96 43 223 100

performance related pay 8 1 8
strategy
96
Table 4.21: Role of Remuneration Practices on Retention of Health Care Staff (cont)
Statement Response
SA A UD DA SDA TOTAL
F % F % F % F % F % TOTA %
L
to employees being 2 1 2 1 6 3 83 37 84 37 225 100

rewarded fairly for their 5 1 7 2
performance
Retention is enhanced 2 1 2 1 0 0 67 30 110 49 224 100

because employees are 2 0 5 1
rewarded for their
excellence

due to provision of group
incentives such as profit
sharing

due to implementation of 8 8 7 5
skill based pay system
The table shows that all (100%) the respondents either strongly disagreed or disagreed
that retention was enhanced due to provision of benefits such as car allowances and due
provision of group incentives such as profit sharing. 214 (94%) felt that the salaries and
benefits provided were inadequate while another 212 (94%) either disagreed or strongly
97
disagreed that there were periodic salary reviews. 197 (88%) and 177 (79%) either
disagreed or strongly disagreed that retention was enhanced due to competitive, fair and
equitable pay systems provided and because of employees being paid for their
excellence respectively.
Of those who responded, 165(74%) and another 166 (74%) also either strongly
disagreed or disagreed that retention was enhanced due to implementation of
performance related pay strategy or due to employees being rewarded for their
performance. 160(71%), 146(65.5%) and 145(65%) either strongly disagreed or
disagreed that salaries and benefits were paid promptly, salary and benefits policy was
fair and equitably administered and that retention was enhanced due to implementation
of competency based pay strategy.
The above responses from the respondents indicate that despite the high value attached
to rewards, the salaries and allowances provided were inadequate, were not reviewed
regularly, they were not paid promptly and that the salary and benefits policy was unfair
and not administered equitably. Additionally the salaries and benefits systems and
policies were unfair and inequitable while benefits such as car loans, profit sharing were
not provided. Excellence/ competence and performance was not recognized and
rewarded.
In general out of the 227 respondents 90% either disagreed or strongly disagreed with
the remuneration practices, 9% were undecided while only 1% either agreed with the
practices. The mean response was 4.12 with a standard deviation of 0.592. The total
score on the responses was thus 53.56 which is significantly higher than half of 65 (the
expected maximum score). The reward index obtained by dividing the total score by the
maximum possible score is 0.824 which is significantly higher than 0.5. All these values
shows a high level of dissatisfaction with the remuneration practices. The summary of
responses on the reward practices can be represented on a pie chart as follows.
98
24%
agree
1% undecided
disagree
strongly disagree
9%
66%
Figure 4.10: Level of Agreement with Reward Practices

In the third research question the researcher sought to find out what other reward
management aspects in the respondents‘ opinion affected employees in their
organizations. A majority of the respondents said that salary delays, non-remittance of
various dues such as loan deductions, insurance premiums, and statutory deductions
among others all of which were usually deducted from their salaries negatively affected
staff morale and commitment hence intent to stay. Others cited provision of payment for
overtime, salary increment, rewarding the best performers, recognition of the best
workers in various departments either through awarding of trophies, word of mouth or
just giving a small token. Others said that said that giving special allowances such as
night duty allowance (a form of premia pay), travelling and commuter allowances, leave
allowance affected are reward management practices that affected employee retention
health care facilities. However they indicated that these were not provided for in their
99
institutions and this greatly negatively affected the employees‘ levels of attachment and
commitment to the healthcare institutions in the county.
In the last question in this section the researcher sought to get the respondents opinions
on the remunerations practices that they thought need to be put in place in the
organization to help enhance retention . Among the responses were that there should be
timely payment of salaries and remittance of any dues deducted to the relevant
institutions, payment of adequate and competitive salaries (salary increments),
employees be rewarded for excellence and that performance related pay policy be
introduced. Others felt that there should be rewards for excellence, the terms of service
should be improved and allowances such as risk allowances, house allowance,
commuter allowance and leave should be increased. Additionally others felt that
mortgage loans and car loans should be provided , entertainment allowances be given,
staff be paid for overtime work, night call/duty allowances and responsibility
allowances be introduced and that staff efforts be recognized through periodic rewards
especially at the end of the year by being given gift or shopping vouchers. There was
also a suggestion that salaries and allowances in the public service be harmonized
including harmonizing with those county employed officers of equivalent qualification
and experience. Staff employed on contract should also give be put on permanent terms
while those in hardship areas be given hardship allowance for these would increase
financial and job security hence commitment to the organizations.
4.6.2 Role of Career Advancement Practices on the Retention of Health Care Staff
The second research objective was to analyze the role of career advancement practices
on the retention of staff in public health care institutions in Machakos county; Kenya. To
meet this objective, four research questions were formulated. The first question sought
to find out if in the respondents‘ opinion, career advancement practices affected staff
retention. The respondents were required to tick against Yes if they thought it affected or
100
against No if they thought it never affected staff retention. The responses were as in
table 4.22.
Table 4.22 Career Advancement Practices Affect Retention

Yes 180 80.8

No 43 19.2
Total 223 100.0
Almost all 180 (88.8% )of the respondents said career advancement practices affected
staff retention while only 43(19.2%) said it did not really affect.
The second question sought to get the respondents‘ views about career advancement
practices in their institutions. The respondents were requested to react to various
statements on this issue by ticking whichever was applicable at their workplace on a five
point likert scale of Strongly Agree (SA), Agree (A), Undecided (UN), and Disagree
(DA) and strongly disagree (SDA). The closer the responses are to five, the higher their
dissatisfaction with the career advancement practices. A score of 3 would indicate
indecisiveness while scores significantly below 3 shows dissatisfaction with career
advancement practices. The responses obtained were quantified using frequencies and
percentages and tabulated as follows:-
101
Table 4.23 Role of Career Advancement Practices on Retention of Health Care
Staff
Response
Statement SA A UD DA SDA TOTAL
F % F % F % F % F % TOTA %
L
comprehensive 60 27 5 25 0 0 80 3 28 12 223 100

progression scheme 5 6
of service exists
The scheme of 41 18 6 28 1 8 69 3 33 15 224 100

service is very clear 3 8 1
on the criteria for
promotion and
career progression
The policy on 38 17 3 16 0 0 96 4 53 24 222 100

employee promotion 5 3
is equitably applied
among all the
employee
There is provision of 0 0 0 0 0 0 119 5 106 47 225 100

wide career 3
expectations
advancement opportunities
102
There exists 38 17 6 29 0 0 58 2 61 28 222 100
opportunities to 5 6
grow internally in
the institutions
Internal promotion is 0 0 0 0 0 0 114 5 111 49 225 100

encouraged 1
Promotions in the 33 15 5 26 2 10 67 3 43 19 223 100

health facilities are 7 3 0
based on merit
There exists position 33 15 7 35 0 0 73 3 39 18 223 100

movement which 8 3
enhances learning
and retention
There is provision 39 17 7 35 0 0 77 3 29 13 224 100

for training and 9 4
development
opportunities
enhancing
employability
103
Table 4.23 Role of Career Advancement Practices on Retention of Health Care Staff (cont)
Response
F % F % F % F % F % TOTA %
L
Training and 37 17 34 15 0 0 98 44 53 24 222 100

development
opportunities are
fairly distributed
Tuition payment 2 1 0 0 0 0 97 43 126 56 225 100

(reimbursement is
done)
There are 35 16 30 13 0 0 84 38 73 33 227 100

provision of
scholarships
There is provision 44 20 50 22 0 0 75 33 55 25 224 100

of paid study
leaves or time-off
to participate in
development
programmes
Mentoring is 39 18 65 29 28 13 46 20 45 20 223 100

embraced as a
104
career
advancement
strategy
There are formal 0 0 0 0 25 11 118 53 79 36 222 100

and informal
networks strategy
for career
advancement are
embraced
Position 0 0 0 0 0 0 145 66 75 34 220 100

movement is used
as a career
progression
strategy
The table shows that all representing (100%) the respondents in each case either
strongly disagreed or disagreed that there existed wide career advancement
opportunities , that internal promotions were encouraged and that position movement
was used as a career advancement strategy. 225(100%), 197(89%) and 157(71%)
respectively either disagreed or strongly disagreed that tuition fees was reimbursed,
formal and informal network strategies were embraced for career advancement and that
scholarships were provided. A further 151(68%) either disagreed or strongly disagreed
that training and development opportunities were fairly distributed while 149 (67%) felt
that the policy on employee promotion was not equitably applied.
The above responses from the respondents show that despite the high value attached to
career advancement , the career advancement practices were not good, opportunities
105
were not equitably provided while sponsorship in the form of scholarships or tuition
reimbursements. Even cheaper career advancement practices such as position movement
and internal promotion to facilitate career advancement were not in place.
In general out of the 227 respondents 67% either disagreed or strongly disagreed with
the appropriateness of the career advancement practices, 32% were undecided while
only 1% strongly agreed with the practices. The mean response was 3.85 with a
standard deviation of 0.793. The total score on the responses was thus 61.6 which is
significantly higher than half of 80 (the expected maximum score). The reward index
obtained by dividing the total score by the maximum possible score is 0.77 which is
significantly higher than 0.5. The above responses and values show a high level of
dissatisfaction with the career advancement practices. The summary of responses on
the career advancement practices can be represented on a pie chart/ bar graph as follows.
106
25%
1%
33%
strongly agree
undecided
disagree
strongly disagree
41%
Figure 4.11: Level of Agreement with Career Advancement Practices
The third research question sought to establish other career advancement practices that
the respondents thought influenced the retention of staff. Their responses included
encouragement of internal promotion, provision of equal opportunities for career
advancement, on the job training opportunities and provision of equitable training
opportunities for all. Others cited prompt promotion on attainment of higher
qualifications, promotion on merit, holding of seminars, provision of study leaves and
exposure of staff through bench marking with more advanced facilities.
107
In the last question the respondents were requested to state career advancement practices
that they thought needed to be adopted in their institutions to enhance staff retention.
Their responses included, sponsorship of staff to specialize in their career fields,
establishment of staff development kitty which should fairly be administered, provision
of scholarships and granting of paid study leaves. Others felt that there should be
equitable promotion of staff based on merit and devoid of nepotism and tribalism and
prompt promotion on attainment of higher qualification for delays tended to discourage
the staff. Others felt there should be opportunities for continuous training including on
the job training/ internal training while others felt that practical assessment should be
part of the career advancement practices.
A number felt that the period of work required before one qualified for study leave
should be shortened, that there should be fair and equitable selection of staff for career
advancement that the qualified should be recognized and that promotion should be based
on merit. Seminars, refresher training mentorship programmes, position movement and
regular capacity building in rural areas should also be embraced as career advancement
practices to enhance retention. Some also indicated that the criteria for promotion and
career advancement should made clear and that information on advancement
opportunities should be provided such as on seminars and courses available. Some
respondents also suggested that there should be loan facilities to facilitate career
advancement and that there should be opportunities for internal promotion. Lastly
exchange programmes with other countries and networking should also be used as career
advancement practices.
108
4.6.3 Role of Work Environment Management Practices on the Retention of Health
Care Staff
In the third research objective the researcher was to explore the role of work
environment management practices on the retention of staff in public health care
institutions in Machakos county; Kenya. To meet this objective, four research questions
were formulated. The first question sought to find out if in the respondents‘ opinion,
work environment management practices affected staff retention. The respondents were
required to tick against Yes if they thought they affected or against No if they thought it
never affected staff retention. The responses were as shown in table 4.24 below.
Table 4.24: Work Environment Management Practices Influence Staff Retention

Yes 192 87.7
No 27 12.3
Total 219 100.0
Majority (87.7%) of the respondents indicated that work environment management

practices affected staff retention while 12.3% felt it did not affect staff retention.
In the second question the researcher sought to get the respondents‘ views about work
environment management practices in their institutions. The respondents were requested
to react to various statements on this issue by ticking whichever was applicable at their
workplace on a five point likert scale of Strongly Agree (SA), Agree (A), Undecided
(UN), Disagree (DA) and strongly disagree (SDA). The closer the responses are to five,
the higher their dissatisfaction with the work environment management practices. A
score of 3 would indicate indecisiveness while scores significantly below 3 shows
109
dissatisfaction with work environment management practices. The responses obtained
were quantified using frequencies and percentages and tabulated as shown on table 4.25
Table 4.25: Role of Work Environment Management Practices on Retention of

Health Care Staff
Statement Response
Retention is enhance SA A UD DA SDA TOTAL
because F % F % F % F % F % F %
because there are 0 0 0 0 0 0 118 52 108 48 226 100

sufficient working tools
because working tools 0 0 0 0 0 0 106 47 119 53 225 100

are provided as and
when needed
because office space is 37 17 51 23 0 0 73 33 63 27 224 100

sufficient
because offices are well 0 0 0 0 0 0 114 51 111 49 225 100

furnished
because offices and 47 21 77 34 0 0 64 28 38 17 226 100

working rooms are well
ventilated
because offices and 47 21 88 39 0 0 64 28 27 12 226 100

rooms are well lit
because working area is 44 20 83 36 0 0 72 32 26 12 225 100

free of pollution of noise
110
and dust
because workspace is 0 0 0 0 0 0 135 60 90 40 225 100

well designed to provide
privacy
because protective gear 0 0 0 0 0 0 129 58 93 42 222 100

is provided where
necessary
because risk allowance is 0 0 0 0 0 0 89 40 134 60 223 100

sufficient
because offices are well 0 0 0 0 0 0 118 53 103 47 221 100

furnished
because workload is 38 17 51 23 0 0 77 34 58 26 224 100

manageable
111
Care Staff (cont)
Statement Response
Retention is enhanced SA A UD DA SDA TOTAL
because: F % F % F % F % F % F %
employees are involved 0 0 0 0 0 0 105 47 116 53 221 100

in decision making

because of job security
there is support by 59 26 96 43 0 0 46 21 23 10 224 100

colleagues supervisors
and administrators
there are minimal 0 0 0 0 0 0 133 59 93 41 226 100

conflicts at the work
place
there is provision of 0 0 0 0 0 0 101 45 123 55 224 100

support to handle work
stress eg psychologist
The table shows that all the respondents in each case either strongly disagreed or
disagreed that retention was enhanced because there were sufficient work tools, work
tools were provided as and when needed, offices were well furnished and because
workspace was well designed to provide privacy. All again representing 100% in each
112
category either disagreed or strongly disagreed that retention was enhanced due to
provision of protective gear when necessary, because risk allowance was sufficient,
employees, because employees were involved in decision making, because there were
minimal conflicts in the work place or because there was provision of support to handle
work stress from specialists such as psychologists. Instead they indicated that all these
practices were either absent or insufficiently. 60% disagreed that retention was enhanced
because the workloads were manageable. However 161 (72%) either agreed or strongly
agreed that retention was enhanced due to support from supervisors and colleagues
while 135 (60%) felt it was due to teamwork. Generally the responses indicate that
despite the high value attached to work environment, the work environment
management practices were not good, work tools were insufficient, offices were poorly
furnished, risk allowance was insufficient, employees were not involved in decision
making and there weren‘t support to manage work stress.
In general 71% out of the 219 respondents either disagreed or strongly disagreed that
retention was enhanced due to existence of good environment management practices
while 10% were undecided. The mean response was 3.79 with a standard deviation of
0.604. The total score on the responses was thus 68.22 which is significantly higher than
half of 90 (the expected maximum score). The work environment management index
significantly higher than 0.5. These responses and values signify a high level of
dissatisfaction with the work environment management practices. Figure 4.12 below
shows a summary of responses on the work environment management practices.
113
10%Strongly
Disagree
29% Undecided
61% Disagree
Figure 4.12: Level of Agreement with Work Environment Management Practices
To answer the third question which was on the respondents opinion on other aspects of
work environment management practices that played a role in staff retention, the
respondents cited amount of workload, quality of infrastructure such as safety of
buildings, number of staff, physical security, working space , delegation, work schedules
and managerial/ supervisor support. Others were division of work, presence of well
ventilated, lit and furnished offices, disability friendly facilities, availability of medical
supplies like drugs and other essentials like protective materials and equipment and
availability of staff houses. The nature of political relationship, clientele relationship and
embracing of technology were other practices cited. However all these were rated as
being poor in almost all the health care institutions in the county.
In the fourth question the respondents were requested to outline some of the work
environment management practices which they felt needed to be put in place to enhance
retention. Their responses included provision of conducive working environment
114
characterized by proper communication both vertical and horizontal, involvement in
decision making, a conducive organizational climate and work place civility. They also
felt that some of the facilities were too small and required expansion, that storage spaces
should be expanded and provided for in each department, and that operational spaces
should be well cleaned, ventilated, lit and furnished. Safety in the working space should
be enhanced as some cited that they were prone to insecurity incidences especially
during night shifts while others felt that protective gears and equipment should be
readily available to minimize exposure to health hazards while on duty. Working tools
and other supplies such as drugs need to be readily available and provided as and when
required and water supply required to be improved. Indeed some facilities did have
readily available water supply and this exposed the staff and patients to serious health
hazards.
Others felt that the work places should be well designed to provide privacy and that the
staff should be housed within the institutions because at times they would be on call at
night and security would be more certain if they were in a close proximity. In the
absence of housing, some felt that provision of transport facilities would come in handy
especially given that they sometimes were on duty until late. Disability friendly
facilities such as ramps, walk-ways wash rooms and sitting facilities needed to be
provided as almost all facilities did not have a provision for this which posed lots of
challenges to the physically disabled staff.
To deal with the issues of workloads they felt staffing levels should be improved,
technology embraced and team work improved through team building exercise for this
would encourage members to assist one another where possible. Public awareness also
needed to be created on the role of health care staff to manage public expectations and
employee clientele (patients) relationship while the supervisors also need to be
friendlier. The staff on contract should be engaged permanently as this would enhance
their commitment hence retention.
115
4.6.4 Role of Work life Balance Practices on the Retention of Health Care Staff
The fourth objective was to analyze the role of work life balance practices on the
retention of staff in public health care institutions in Machakos county; Kenya. To meet
this objective, four research questions were also formulated. The first question sought to
find out if in the respondents‘ opinion, work-life practices affected staff retention. The
respondents were required to tick against Yes if they thought they affected or against No
if they thought they never affected staff retention.
Table 4.26: Work Life Balance Practices Affect Employee Retention

Yes 185 88.5
No 24 11.5
Total 209 100.0
185 (85.5%) of the respondents said that work life balance practices affected staff
retention while the rest 24 (11.5%) felt that it did not affect the staff retention.
In the second question the researcher sought to get the respondents‘ views about work
life balance practices in their institutions. The respondents were requested to react to
various statements on this issue by ticking whichever was applicable at their workplace
on a five point likert scale of Strongly Agree (SA), Agree (A), Undecided (UN), and
Disagree (DA) and strongly disagree (SDA). The closer the responses are to five, the
higher their dissatisfaction with the work environment management practices. A score of
3 would indicate indecisiveness while scores significantly below 3 shows dissatisfaction
116
with work life balance practices. The responses obtained were quantified using
frequencies and percentages and tabulated as follows:-
Table 4.27: Role of Work-life Balance Practices on Retention of Health Care Staff
Responses
Statement SDA A UD DA SDA TOTAL
F % F % F % F % F % F %
Retention is enhanced because 96 42 106 47 4 2 11 5 10 4 227 100

annual leave is given

there is provision of sick leave

compassionate leave is granted.

sabbatical leave is granted

study leave are given to
employees

staffs are given their off days as
required
117
Table 4.27: Role of Work-life Balance Practices on Retention of Health Care Staff (cont)
Response
F % F % F % F % F % F %

employees are given time away
whenever they have issues to
attend to

there is part time working

there is provision of onsite
child care services

work schedule are flexible

of provision of social and
family events

there is gym and mental
relaxation programmes

there provision for children
118
education schemes

there is availability of health
and well-being programmes
like health insurance for self
and dependents
The table shows that all the respondents in each case either strongly disagreed or
disagreed that retention was enhanced because there provision of onsite childcare
services, because work schedules were flexible, because there was provision of social
and family events, there were gym and mental relaxation programme and because there
was provision of child education schemes another 146 (65%) disagreed or strongly
disagreed that retention was because there was part-time working arrangement.
However 202 (89%), 189 (88%), 154 (69%), 154(67%) and 143(64%) respectively
either strongly agreed or agreed that annual leave, sick leave, off days, time away and
study leave were granted to the staff accordingly and this could have enhanced retention
of staff in the institutions. Generally the responses indicate that despite the high value
attached to work environment and there being in place some work-life balance practices
in place the staff was still dissatisfied because some of the work- life balance practices
were such as flexible schedules, provision of social and family events, mental relaxation
programmes and child education schemes not in place.
In general 98 % out of the 227 respondents either disagreed or strongly disagreed that
retention was enhanced due to existence of good work-life balance practices while only
1% were undecided and another 1% strongly agreed with the work-life balance practices
in place (Appendix VIII). The mean response was 4.17 with a standard deviation of
119
0.479. The total score on the responses was thus 58.38 which is significantly higher than
half of 70 (the expected maximum score). The work-life balance practices index
significantly higher than 0.5. These responses and values signify a high level of
dissatisfaction with the work life balance practices in place. Figure 4.13 shows a
summary of responses on the work –life balance practices.
1% Strongly 1%Undecide
Agree d
20%
Strongly
Disagree
78%Strongly
Disagree
Figure 4.13: Level of Agreement with Work Life Balance Practices
In the third research question, the researcher sought to find out other work life balance
practices that affected staff retention. The respondents cited provision of means of
transport, comfortable housing, and availability of loans, emergency loan schemes, and
insurance schemes such as life insurance for self and family, health insurance schemes
and friendly working hours as other factors that play a significant role in staff retention
in health care institutions.
120
When asked the work life balance practices that needed to be put in place to enhance
staff retention in their institutions the respondents said that staff should be provided
with comprehensive medical covers or access to free treatment and child care services
(onsite child care services). They also suggested that length of maternity leave should be
increased to 6 months so that the breastfeeding mothers can do so for at least 6 months
as is recommended. They said that paternity leave days should also be increased because
often the fathers reported back for duty when the mothers still needed their assistant
most. Others suggested that all employees should be given time to proceed for annual
leave as required and that the number of off days should be increased. Related to these
some felt that they should be granted off days during public holidays and the
management should source for part-timers to step in during such days. The interviewees
also concurred when they said that many times staff are usually recalled to duty even
when on leave or off-day and this makes it difficult for them to plan for their free time.
They also suggested that there should be flexi working arrangements such as
compressed week, flexible hours and part- time working to enable employees attend to
personal issues and have time to do locums which would enhance their financial well-
being. Others suggested that they should be deployed near their families for a number
felt that family bonds were seriously strained due to distances. They also said that there
should be family support in the event of death of staff member or a member of their
nuclear family that they should be provided with paid holidays, that there should be
provisions for retreats and group recreational opportunities and facilities such as social
clubs which will provide avenues for relaxation and also team building. The
respondents felt that if these practices were embraced, the staffs‘ morale would improve;
their commitment to the organization increased hence increased tendency stay.
121
4.6.5 Other Human Resource Management Practices that Influence Staff Retention
in Organizations
In the last question in this section the researcher sought to find out the other human
resource management practices that influence staff retention in organization. 80% of
those who responded identified the management style, 96% indicated job security,
95% identified staff involvement and participation in decision making and ownership of
the facilities ,90% talked of employee motivation. 85% identified communication
practices as key, 80% talked about performance management, another 75% enumerated
recruitment practices, while 70 % felt management of staff welfare was significant in
determining employee retention in organization. These factors could account for the
remaining 89.4% influence on retention.
4.6.6 Employee Commitment and Tendency to Stay (Retention)

In addition to exploring the human resource Management practices that influence
employee retention, the researcher also sought to find out the respondents‘ tendency to
be retained. To get insights into this issue the researcher formulated questions to
establish the respondents‘ levels of commitment to their organizations and also their
intentions to stay. The respondents were requested to react to various statements on
levels of commitment and intent to stay by ticking whichever was applicable to them on
a five point likert scale of Strongly Agree (SA), Agree (A), Undecided (UN), Disagree
(DA) and strongly disagree (SDA). The closer the responses are to five, the lower their
commitment and their intent to stay respectively. A score of 3 would indicate
indecisiveness while scores significantly below 3 imply higher level of commitment and
intent to stay longer in the organization. The responses obtained on organizational
122
commitment were quantified using frequencies and percentages and tabulated as shown
in table 4.28
Table 4.28: Employees’ Commitment
Response
Employees feel strong 0 0 0 0 0 0 163 73 59 27 222 100

sense of belonging to
their organizations
Employees agree with 0 0 0 0 0 0 180 80 44 20 224 100

this organization‘s
policies regarding
employee
Employees can gain 0 0 0 0 0 0 167 74 58 26 225 100

little by remaining in
this organization
Employees are willing 0 0 0 0 0 0 136 60 90 40 226 100

to put in more effort to
help the organizations to
succeed
Employees are proud to 0 0 0 0 0 0 153 68 73 32 226 100

tell others that they are
part of their
organizations
123
Employees care about 0 0 0 0 0 0 124 56 99 44 223 100
the fate of their
organizations
Employees are happy to 0 0 0 0 0 0 117 52 10 48 226 100

spend the rest of their 9
career with their
organizations
Table 4.28: Employees’ Commitment (cont)

The table shows that all the respondents either strongly disagreed or disagreed that they
Response
Employees feel as if 0 0 0 0 0 0 127 57 97 43 224 100

their organizations
problem are theirs
Employees feel that 33 15 63 2 4 2 57 25 27 12 224 100

they could easily be 8 4 0
attached to other
organizations as they
are attached to theirs
now
The organizations have 0 0 0 0 0 0 120 54 10 46 223 100

great deal of meaning to 3
the employees
124
felt a strong sense of belonging to their organizations, they agreed with this
organizations policies regarding employee, they were willing to put more efforts to help
the organization succeed, that they can gain little by remaining in the organizations, they
were proud to tell others they were part of their organizations and that they cared about
the fate of their organizations. They all representing 100% also either disagreed or
strongly disagreed that they were happy to spend the rest of their career life with their
organization, that they felt that the organizational problems were theirs and that the
organizations had a great deal of meaning to them. These responses show that the staff
are generally not committed to their organization
On their intention to stay, the other indicator of retention, the responses were as
tabulated in Table 4.29
125
Table 4.29: Employees’ Intend to Stay
Response
F % F % F % F % F % F %
Employees plan to work in this 0 0 0 0 0 0 12 5 10 4 22 10

organization for as long as 1 4 4 6 5 0
possible
Employees would certainly 0 0 0 0 5 25 10 4 68 3 22 10

look for new jobs in the near 6 2 5 0 6 0
future
Given opportunity, the 0 0 40 1 3 16 81 3 68 3 22 10

employees would look for a 8 5 6 0 4 0
transfer to other stations near
bigger towns
Given opportunities, 0 0 35 1 0 0 12 5 65 2 22 10
employees would rather work 6 4 5 9 4 0
in smaller facilities
Employees plan to stay on this 0 0 0 0 0 0 16 7 65 2 22 10

job for the shortest time 1 1 9 6 0
possible
Employees would hate to quit 0 0 0 0 3 17 12 5 57 2 22 10

this job 9 9 7 6 5 0
One of the major reasons 0 0 0 0 0 0 15 7 68 3 22 10

employee will continue to 6 0 0 4 0
work for the organization is
that another organization may
not match the overall benefits
gain
126
From the table it clear that all the respondents either strongly disagreed or disagreed that
they planned to work for the organization as long as possible, that they planned to stay
on the job for the shortest time possible, and that the reason they would continue to work
for the organization is that another organization may not match the overall benefits
gained. (84%), (83%), (75%) and (66%) respectively either strongly disagreed or
disagreed that given an opportunity they would rather work in smaller towns, they
would hate to quite the job that they would certainly look for another job in the near
future and that they would look for transfer to stations near bigger towns.
These responses indicate that despite the poor HRM practices and the low level of
commitment to the organizations, the employees‘ tendency to leave was still low. This
could have been due to a number of reasons. First the fact that they are already trained in
a particular field in this case health care makes it difficult to fit in jobs in other fields.
Secondly, with devolution of health care services, transfers to other counties is difficult
hence they have to either bear or quite altogether. Thirdly the level of unemployment is
high with a number of health care trained personnel still out in the job market and
looking for employment. Quitting would thus be treated cautiously. Fourth some of the
staff has worked for a long period of time thus they wouldn‘t like to lose their benefits.
Fifth, a number of them had dependents some of whom were in school hence they would
be hesitant to disrupt their schedules.
However given a better chance in the same field like in NGO‘s they would consider
quitting. This is in line with responses from interviews where the interviewees indicated
that those who got job opportunities with good paying NGOs readily left and that
majority of those who left either went for private practice or got job with better paying
organizations such as the NGOs.
127
4%
6%
undecided
disagree
strongly disgree
90%
Fig 4.14: Employees’ commitment and intent to stay
4.7 Presentation of Interview Findings.
There were a total of 12 interviewees. These consisted of the four medical superintends
in charge of the referral hospitals; the three level four and one level five hospital while
the remaining 8 were in charge of the health institutions mainly health care centers and
dispensaries in the eight sub counties. The interviewees were requested to state if
turnover was a challenge in their institutions. Out of the 12 interviewees, 8 said that it
was not a problem while the other four said it was a major problem. The four were the
medical superintends. Related to this question, they were asked how they would rate
retention in the facilities in the institutions in their sub counties or the hospitals. The
sub-county health officers said that retention was very good because almost all
employees remained in service while those in the level five and level four facilities said
it was fairly good. Asked to account for the trend in the retention rate, those who said it
128
was high said that retention was high because the staff did not have options hence had to
stick with their current job, because inter county transfers were difficult, possibility of
government scholarship, availability of staff houses in some incidences, proximity to
their homes due to job security in public sector and also because of assurance of pension
on retirement. It‘s also worth noting that the staff in these facilities is mainly clinical
officers and nurses. Those who said it was fair cited the same reasons but also indicated
that high workloads in the busy facilities coupled with poor salaries and lack of
incentives and opportunities in private sector due to their experiences were responsible
for the departure of some of them.
When asked where those who left went, their responses included transfer to smaller
facilities where there is less workload or to larger towns especially Machakos town
where they would get locums in the private facilities, others joined the forces (army),
others changed career and opted to do farming, majority got jobs with NGOs and private
sectors that are considered to pay better while others went abroad to advance their
careers. Related question was the category of staff who were most affected. It was
revealed that the doctors and pharmacists were most affected followed by the clinical
officers. A few of the other were affected. On the reasons advanced for leaving the
interviewees cited poor pay and uncompetitive pay, lack of career advancement
opportunities, poor working conditions including lack of working tools and equipment
and high workloads. Others included lack of staff motivation, work-life balance issues
such as to get nearer families and personal issues.
When asked to rank the practices in order of priority, work environment was ranked
first, followed by career advancement, then work-life balance and finally remuneration
practices. Other factors that influence retention of staff according to the interviewees
are good pay, recognition through provision of incentives, provision of necessary
supplies, adequate staffing/ manageable workload, good leadership/ management, career
advancement opportunities, teamwork, desire to gain experience, physical security,
provision of housing facilities and good infrastructure especially transportation.
129
Majority of the interviewees said that they wouldn‘t mind leaving if given the
opportunity. When asked why they wouldn‘t mind leaving or what would prompt them
to leave they cited poor pay, salary delays, non-remittance of dues that were deducted at
times even attracting penalties from the relevant institutions like banks, poor working
conditions and too much work load including night shifts which were often laborious as
some of the reasons for their dissatisfaction hence desire to leave. Others were lack of
pay increment even after career advancement, corruption, absence of hardship and night
duty allowances, lack of career advancement opportunities and lack of free time to
attend to personal issues.
Finally the interviewees were asked to suggest what they thought should be done to
enhance retention. They suggested that pay should be increased, employees should be
paid according to their competences, that pay increase should be implemented
immediately upon attainment of higher qualification, employees should be promoted to
avoid stagnation, employees should be given incentives and that allowances such as
hardships, responsibility and night duty should be given. Others said that employees
should be sponsored to advance their careers, medical supplies should be improved,
staffing should also be improved to reduce workload and reduce burnouts and other
working conditions also be improved. Lastly majority felt that health care should be
centralized and managed by county government citing the inability of most counties to
manage the same. Majority said that conditions in some of the facilities were now worse
than they were when they were managed centrally.
130
CHAPTER FIVE
SUMMARY OF MAJOR RESEARCH FINDINGS, CONCLUSIONS AND
RECOMMENDATIONS
5.1. Introduction
This chapter presents a summary of the major findings from the study as presented in the
previous chapter. Conclusions are then drawn based on the findings of the study and
recommendations made based on the findings and conclusions of the study. The chapter
ends with suggested areas in which further research can be undertaken.
5.2. Summary of Major Findings
This study aimed at establishing the role of remuneration practices, career advancement
practices, work environment management practices and work-life balance practices on
the retention of staff in public health care institutions in Machakos County in Kenya.
Mixed research design was employed and questionnaires and interviews were used to
collect primary data. The target population was all technical staff in all the public health
care institutions in the county and the respondents were doctors, dentists, clinical
officers, physiotherapists, nurses, pharmacists, radiographers and laboratory technicians
who were selected through purposive sampling and stratified random sampling. 251
questionnaires were distributed out of which 227 were duly filled and returned giving a
response rate of about 90%. 12 interviews were also conducted. Majority of the staff
were young people aged below forty years and were mostly females .
5.2.1. Remuneration Practices and Retention

From the results there it was evident that there was a weak but statistically significant
positive relationships between remuneration practices and retention of health care staff
in Machakos County (F (9.847, df=1, and p<0.05). Thus remuneration practices play a
131
critical role in employee retention. Majority of the respondents felt that remuneration
practices affect staff motivation hence retention in organizations. This is consistent with
the findings of (Bergiel et al. 2009) who noted that research findings suggest that there
is a significant and positive relationship between compensation and job embededness
However, despite the high value attached to remuneration practices, most of the
respondents were dissatisfied with the remuneration practices in place. Indeed majority
said that benefits such as car allowances and group incentives were not provided while
the salaries and benefits provided were inadequate and there weren‘t periodic salary
reviews. A great number also felt that the salary systems were uncompetitive, unfair and
inequitable and that staff were not paid for their excellence. Additionally, performance
related pay and competency based strategies were not embraced neither were salaries
and benefits paid promptly. These sentiments were confirmed by recent strikes by nurses
from various counties including nurses from Machakos, Meru, Mombasa, and of late
Bugoma and Embu The reward practices in place had little though positive impact on
the retention of staff in public health care institutions in the county as indicated by the
low value of adjusted r squared of 0.038 meaning that only 3.8% of the change in
retention can be explained by a unit change in the remuneration practices.
5.2.2 Career Advancement Practices and Retention
Most respondents felt that career advancement practices affect staff retention in public
health care institutions in the county. These practices include a progressive scheme of
service, the promotion criteria in place, provision of wide career opportunities,
opportunities for internal growth, internal promotion, merit based promotion , position
movement, fair distribution of training and development opportunities, provision of paid
study leaves, mentoring and formal and informal networks. Indeed the results of the
study showed a significant relationship between these career advancement practices
and retention of staff in the health care institutions in the county (F (15.260, DF=1, and
132
P<0.05). These findings are consistent with findings from a research by Chay and
Norman (2003) on creating value for employees which shows that perception of
investment in development can improve nurses‘ morale and dedication to the level that
emotionally binds them to the organization and encourages them to stay on.
However despite the high regard for career advancement practices most of the
respondents felt that the career advancement practices in place were not good, career
advancement opportunities were not equitably provided while sponsorship in the form of
scholarships or tuition reimbursements was not done. Even cheaper career advancement
practices such as position movement and internal promotion to facilitate career
advancement were limited. This observation is confirmed by the low value of r squared
(0.059) which means that career advancement practices in the institutions contribute
only 5.9% of the change in staff retention.
5.2.3 Work Environment Management Practices
The results showed that majority of the respondents said that work environment
management practices such as provision of adequate work tools, proper design of the
workplace to ensure privacy, provision of protective gear and risk allowances,
involvement indecision making, stress management, manageable workloads and
supervisor support among others enhance retention of staff in public health care
institutions. The results showed a significant positive relationship between the work
environment management practices and retention of staff in the public health care
facilities in the county (F 16.612, df =1, and P<0.05) . The findings are in line with
those of Milory (2004) who reported that people enjoy working, and strive to work in
those organizations that provide positive work environment where they feel they are
making difference and where most people in the organization are proficient and pulling
together to move the organization forward. Indeed workspace designs have a profound
133
impact on workers and they tend to live with job as long as satisfied (Brill, Weidemann,
Olsen, Keable & Bosti, 2001).
However, majority of the respondents were dissatisfied with the work environment
management practices in place. For instance they said that work tools were insufficient,
offices were poorly furnished, and risk allowance was insufficient, employees were not
involved in decision making and that there weren‘t support to manage work stress. The
coefficient of determination r squared of 0.065 confirms this for it shows that work
environment management practices account for only 6.5% of a unit change in retention
of staff in public health institutions in the county.
5.2.4 Work-Life Balance Practices
The study revealed that most respondents felt that work-life balance practices affect staff
motivation hence their retention in the public health care institutions. These practices
include among others provision of onsite childcare services, flexible work schedules,
social and family events, gym and mental relaxation programmes, children education
schemes, leave (maternity, compassionate, maternity, study, paternity, annual etc.), off
days and time away when necessary. Indeed there was a significant positive relationship
between these work-life balance practices and retention of staff in the public health care
institutions in the county ( F (18.224, df =1, and P<0.05). This is in line with the
findings of Lockwood, 2003 and Landaur, 1997 who asserted that work-life balance
programmes have the potential to significantly improve employee morale, reduce
absenteeism and retain organizational knowledge, particularly during difficult economic
times. Indeed Rahman and Nas (2013) assert that obtaining a balance between work and
life has a great role in employee‘s decision to remain with the organization.
The high value attached to work life balance practices notwithstanding the staff was
dissatisfied because some of the work- life balance practices such as onsite childcare
134
services, flexible schedules (e.g. compressed week and flexi hours), provision of social
and family events, mental relaxation programmes and child education schemes were not
in place. The low r squared= 0.071 meaning that only 7.1% of the change in retention
can be explained by change in work-life balance practices index confirms these
observation. However some of the work life balance practices such off day, sick leave,
annual leave, maternity and paternity leave and compassionate leaves were said to be in
place and were partly attributed to the observed retention level.
5.2.5 Employee Commitment and Intent to Stay
The research revealed that the employees‘ level of commitment was low. Indeed all the
respondents indicated that they didn‘t have a strong sense of belonging to their
organizations, didn‘t agree with most of their organizations employee policies, were not
willing to put more efforts to help the organization succeed, felt they could gain little by
remaining in the organizations, were not proud to tell others they were part of their
organizations and never cared about the fate of their organizations. Majority were also
not willing to spend the rest of their career life with their organization given an
alternative, felt that the organizational problems were not theirs and that the
organizations didn‘t have a great meaning to them.
Although their level of commitment was low due to the poor HRM practices, their intent
to leave was also low. In fact most of the respondents disagreed that they planned to stay
on the job for the shortest time possible, that the reason they would continue to work for
the organization is that another organization may not match the overall benefits gained,
that given an opportunity they would rather work in smaller towns, that they would
certainly look for another job in the near future and that they would look for transfer to
stations near bigger towns. These findings are consistent with the responses from the
135
interviewees where retention in the health care centers was said to be very good while it
was fairly good in the level four and level five hospitals.
The reasons advanced for the good retention were among others that the staff did not
have options hence had to stick with their current job, because inter county transfers
were difficult, possibility of government scholarship, availability of staff houses in some
incidences, proximity to their homes, due to job security in public sector and also
because of assurance of pension on retirement. In the level four and five hospital where
retention was rated as fairly good, high workloads in the busy facilities coupled with
poor salaries and lack of incentives and availability of opportunities in private sector
due to their experiences were responsible for the departure of some of staff. It was noted
that those who left transferred to smaller facilities where there is less workload or to
larger towns especially Machakos town where they would get locums in the private
facilities. Others joined the forces (army), others changed career and opted to do
farming, and majority got jobs with NGOs and private sectors that are considered to pay
better while others went abroad for further studies.
To enhance commitment hence retention, majority of the respondents and interviewees

suggested that pay should be increased, employees should be paid according to their
competences, that pay increase should be implemented immediately upon attainment of
higher qualification, employees should be promoted to avoid stagnation, employees
should be given incentives and that allowances such as hardship, responsibility and night
duty should be given. Others said that employees should be sponsored to advance their
careers, medical supplies should be improved, staffing should also be improved to
reduce workload and reduce burnouts and other working conditions also be improved.
They also suggested that duration for maternity and paternity leaves should be increased,
onsite childcare facilities provided and paid holidays and avenues for relaxation and
bonding be provided among others. Lastly majority felt that health care should be
136
centralized and managed by county government citing the inability of most counties to
manage the same.
5.3 Conclusion
Human resources are one of the most critical components for strategic success across all
organizations. Effective human resources management practices should be able to satisfy
and retain this most critical asset. The role of HRM is generally seen in ensuring that
firms are able to attract, retain, motivate and develop human resources according to
current and future requirements according to Som, 2008.
In this study the role of remuneration, career advancement, work environment

management and work life balance practices on the retention of staff in public health
care institutions in Machakos County was investigated. From the findings its concluded
that that these human resource management practices play a significant role in the
retention of staff in public health care institutions in Machakos County as evidenced by
the positive correlation values between these variables and retention( see appendix VII) .
It is however concluded that the practices in place were unsatisfactory. For instance
remuneration practices were not good; career advancement was not undertaken
appropriately, work environment management practices were not effective with the
working conditions in most cases being deplorable and requiring urgent attention while
work-life balance practices were either absent or inadequate.
Despite this, the findings show that retention in the facilities was either good or fairly
good. From this study it is concluded that a set of HRM practices will not necessarily
have a direct impact on the retention of staff in public health institutions in the county.
For instance, if remuneration practices were not good, the retention of the staff was
found to be either be unchanged or in some cases it was affected negatively. However,
137
commitment of the staff which is a critical factor in the performance of staff was
negatively affected.
From the results, it is also concluded that besides remuneration practices, career
advancement practices, work environment management practices and work-life balance
practices, other organizational and human resource management practices such as
leadership, employee involvement and participation, recruitment, performance
management practices and employee motivation also play significant role in enhancing
employee loyalty and commitment to organizations hence their retention and should
therefore not be ignored.
These findings thus suggest that there is need for the Machakos county government to
look into the aspects of remuneration, career advancement, work environment and
working life balance practices and other human and organizational practices such as
leadership, participation, performance management and recruitment among others and
put in place mechanisms that would address these practices and thus minimize their
negative effects on staff satisfaction and commitment hence performance and retention
in the health care institutions in the county.
5.4. Recommendations
The study explored the role of some HR practices on the retention of staff in the public
health institutions in Machakos County. Based on the findings, the following
recommendations were made which the county government of Machakos, other county
governments and even the national government should put in place to address these
issues if Kenya is to achieve its vision 2030 plans on the health sector.
To enhance staff commitment hence retention through remuneration practices, the

county government ensure timely payment of salaries and remittance of any dues
138
deducted to the relevant institutions to avoid penalties and enable staff get their benefits
accordingly. The salaries and benefit should be increased and made competitive to
minimize turnover to private sector. The government should also adopt performance
related pay policy and competency based pay policy in order to motivate the hard
working staff and also those who advance their qualification. Given that these staff at
times work under extremely difficult and risk conditions and sometimes at odd times and
for long hours in a day, risk allowances should be improved, overtime pay and night
call/duty allowances be introduced and staff efforts be recognized through periodic
rewards especially at the end of the year by being given gift or shopping vouchers. Lack
of equity in the remunerations of county staff was expressed as one of the dissatisfiers
among the staff. The salaries and allowances of staff in public service should be
harmonized with those of county employed officers of equivalent qualification and
experience who most of the health staff felt had been engaged and placed on higher job
grades. Staff employed on contract should also be put on permanent terms while those in
hardship areas are given hardship allowance for these would increase financial and job
security hence commitment to the organizations.
Career advancement prospects are one of the intrinsic motivators in the work place. Now
that health care is a devolved function; the county government should establish a staff
development kitty which should fairly be administered through granting of scholarships
to its officers including the health care staff. Promotion should be done equitably and
should be based on merit while those who attain higher qualification should be promoted
promptly for delays tend to discourage the staff. Opportunities for continuous training
including on the job training/ internal training should be provided and these together
with practical assessment should be part of the recognized career advancement practices.
Seminars, refresher training mentorship programmes, position movement and regular
capacity building should also be embraced as career advancement practices to enhance
retention. Importantly, the criteria for promotion and career advancement should made
139
clear and information on advancement opportunities should be provided such as on
seminars and courses available. Lastly exchange programmes with other countries and
counties and networking should be used as career advancement practices.
To improve the work environment, a conducive working environment characterized by

clear channels of communication should be established. In particular, upward
communication should be encouraged so that the staff can be able to express their views,
give feedback on performance and express their dissatisfactions. Involvement in
decision making, a conducive organizational climate and work place civility should also
be embraced. The county government should also allocate some funds for expansion of
facilities to provide for the medical needs of the ever increasing population. Physical
and mental health is paramount as outlined in the Occupation Safety and Health Act,
2007 part VI on health general provisions. Therefore operational spaces should be well
cleaned, ventilated, lit and furnished. Safety in the work place should be enhanced
through staff housing and provision of protective gears as some of the respondents
indicated they were prone to insecurity incidences especially during night shifts while
others felt that protective gears and equipment were not readily available predisposing
them to health hazards while on duty. Facilities be equipped with working tools, drugs
and other facilities necessary for efficient operations.
It was noted that most areas in the county have acute water shortages and therefore the
county government needs to look for alternative water sources such as boreholes for the
facilities to improve hygiene and reduce exposure of the staff and patients to health
hazards. The staff should be housed within the institutions and disability friendly
facilities such as ramps, walk-ways, wash rooms and sitting facilities be provided as
almost all facilities did not have a provision for this which poses lots of challenges to the
physically challenged staff. Staffing levels should be improved to make workloads
manageable, technology embraced and team work improved through team building
140
exercise. The staff on contract should be engaged permanently as this would enhance
their commitment hence retention.
To provide work-life balance, provide staff with comprehensive medical covers or

access to free treatment and child care services (onsite child care services). Flexi
working arrangements such as compressed week, flexible hours and part- time working
be introduced to enable employees attend to personal issues. There should be family
support in the event of death of staff member or a member of their nuclear family.
Occasionally the staff should be taken for retreats and group recreation to provide
avenues for relaxation and also bonding.
The issue of devolution of health care sector should also be looked into. Majority of the
staff felt that the county governments seem not to have been prepared enough to manage
this very important sector. The central government should therefore consider
centralizing some of the roles such as management of the payrolls and provision of
essentials such as drugs to the facilities. If these practices are embraced, the staffs‘
morale will improve, their commitment to the organization will increase and hence there
will be an increased tendency to stay.
5.5 Suggestion for Further Research

This study was done in public health care facilities in Machakos County in Kenya over a
period of two months (December 2014 and January, 2015). A longitudinal study should
should be carried out to monitor the relationship between demographic factors such as
the age, marital status, family status, educational level and experience of employees and
their intention to stay with the organization.
Secondly the study only explored the role of remuneration practices, career
advancement practices, work environment management practices and work-life balance
practices in the retention of staff in public health institutions in Machakos County. For
141
better insight into the role of these human resource management practices in the public
sector health, similar studies should also be done in public health care institutions in
other counties in order to generalize the findings to all public health care institutions in
the Country. Further research in this area should focus on the role of management style,
employee motivation, recruitment practices, employee participation and involvement,
communication and performance management among others on retention of staff in
public health care institutions in the County.
The findings of the study were that most of the staff that left went to work for NGOs and
private health care institutions. Similar studies should also be done in the private health
care institutions and NGOs to establish the retention strategies developed and adopted
and how these strategies are embedded within the organizations‘ dynamic environment.
The study looked at the role of human resource management practices on the retention
of staff in health care institutions, studies should also be done to establish the
relationship between employee retention and employee performance in organizations.
142
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179
APPENDIX I: AUTHORITY LETTER
180
APPENDIX II: AUTHORITY LETTER FROM THE COUNTY
181
APPENDIX III INTRODUCTION LETTER
JKUAT
P. O. Box 62000
Nairobi.
Mobile No. 0721 512293
December, 2014.
Dear Respondent,
RE: ROLE OF HUMAN RESOURCE PRACTICES ON RETENTION OF STAFF
IN PUBLIC HEALTH INSTITUTIONS IN MACHAKOS COUNTY.
I am a post graduate student at JKUAT pursuing a PhD in Human Resource
Management. In this regard, I am carrying out a research on the above topic, in partial
fulfillment for the requirement for the award of the degree.
I kindly request you to assist me by filling the attached questionnaire to the best of your
knowledge. The information provided will be treated with utmost confidentiality and
will only be used for the above indicated purpose.
Yours sincerely,
Jacinta Kinyili.
182
APPENDIX IV: QUESTIONNAIRE
ROLE OF HRM PRACTICES ON THE RETENTION OF STAFF IN PUBLIC

HEALTH INSTITUTIONS QUESTIONNAIRE FOR THE PUBLIC HEALTH
INSTITUTION STAFF.
PART A
Background information
Please tick (√) the appropriate response where applicable.
1. Gender
a) Female [ ] b) Male [ ]
2. Age in years :
a) 20-30 [ ] d) 51-60 [ ]
b) 31-40 [ ] e) 61-70 [ ]
c) 41-50 [ ] f) above 70 [ ]
3. Marital status :
a) Married [ ] b) Unmarried [ ]
4. Family status:
a) With children [ ] b) Without children [ ]
5. If with children state if:
a) Dependents [ ] b) Not dependents [ ]
6. Level of education :
a) Certificate [ ] d) Masters [ ]
b) Diploma [ ] e) Doctorate [ ]
c) Bachelors [ ]
183
7. State the Department in which you work_____________________
8. Designation
a) Doctor [ ] (e) Pharmacist [ ]
b) Radiographer [ ] f) Dentist [ ]
c) Clinical officer [ ] (g) Lab technician [ ]
d) Nurse [ ] h) Physiotherapist [ ]
i) Any other (specify)… ……………………………………
9. Year of attainment of qualification …………………………………….
PART B
Section I: Reward and Compensation Practices
1. In your own opinion, do you think reward and compensation practices affect
employee retention?
a) Yes [ ] b) No [ ]
2. The following are statements about rewards and compensation practices that
enhance retention in organizations. Please react to them on a five point scale in
the levels of Strongly Agree (SA)-1, Agree (A)-2, Undecided (UN)-3, Disagree
(DA)-4 or Strongly Disagree (SDA)-5 regarding their applicability in your
organization.
Statement Response
Retention is enhanced due to/because: SA A UN DA SDA

1 2 3 4 5
Salaries and benefits provided are adequate
There are periodic salary reviews
Salaries and benefits are paid promptly
Provision of incentives such as risk allowances
184
,overtime pay, strenuous allowances, pension
Pay system provided is competitive, fair and
equitable
The salary and benefit policy is fairly and
equitably administered
There exists employee benefits such as car
loans , mortgage , paid holidays and other
fridge benefits
Adoption of competency based pay strategy
Implementation of performance related pay
strategy
Employees are fairly rewarded for their
performance ,
Employees are rewarded for excellence
Provision of group incentives such as profit
sharing,
Implementation of skill/knowledge based pay
system
3. Please mention other aspects of the reward and compensation practices not
mentioned above that influence retention in your organization
i. ………………………………………………………………………………
ii. ………………………………………………………………………………
Suggest other aspects of reward and compensation practices that you feel should be put
in place to enhance employees‘ retention
i. ………………………………………………………………………………
ii. ………………………………………………………………………………
185
Section III: Career Advancement Practices
1. In your own opinion, do you career advancement practices affect employee

retention?
a) Yes [ ] b) No [ ]
2. The following are statements about the career advancement practices that
enhance retention in organizations. Please react to them on a five point scale in
organization.
Statement Response

1 2 3 4 5
Existence of a comprehensive progression
scheme of service
The scheme of service is very clear on the
criteria for promotion and career progression
The policy on employee promotion is
equitably applied among all the employee
Provision of wide career expectations
advancement opportunities
Existence of opportunities to grow internally
in this institution
Internal promotion is encouraged
Promotions in this organization are based on
merit
186
Existence of position movement which
enhances learning
Provision of training and development
opportunities enhancing employability
Training and development opportunities are
equitably and fairly distributed
Tuition payment/ reimbursement is done
Provision of scholarships
Provision of paid study leaves or time- off in
the evening to participate in development
programmes.
Mentoring is embraced as a career
advancement strategy
Formal and informal networks strategy for
career advancement are embraced
Position movement is used as career
progression strategy
3. Please mention other career advancement practices not mentioned above that
enhance retention in your organization
i. ………………………………………………………………………………
ii. ………………………………………………………………………………
4. In your opinion how can career advancement and development practices be
improved to enhance employees‘ retention
i. ………………………………………………………………………………
ii. ………………………………………………………………………………
Section III: working environment
Please indicate with a tick () where possible
187
1. In your opinion, does working environment affect the retention of employees?
a) Yes [ ] b) No [ ]
4. Below are some statements about work environment based practices that enhance
employee retention in organizations. Please react to them on a five point scale in
organization.
Statement Response
1 2 3 4 5
There are sufficient working tools
Working tools are provided as and when
needed.
Office space is sufficient
Offices are well furnished
Offices and working rooms are well ventilated
Offices and rooms are well lit
Working area is free of noise pollution and dust
pollution
Workspace is well designed to provide privacy
Protective gear is provided where necessary
Risk allowances is sufficient
Offices are well furnished
Workload is manageable
Assurance of job security of job
Employees are involved in decision making
Existence of teamwork
Support by colleagues supervisors and
188
administrators
Conflicts in the workplace are minimal
Provision of support to handle work stress e.g
existence of psychologist.
2. Please mention other aspects of working environment not mentioned above that
affect employee retention
(i) ……………………………………………………………………
(ii) ………………………………………………………………………
3. In your opinion, what aspects of working environment should be put in place to
enhance employee retention?
i. ………………………………………………………………………………
ii. ………………………………………………………………………………
Section IV: work-life balance

1. In your own opinion, do you think work-life balance affect employee retention?
a) Yes [ ] b) No [ ]
2 .The following are statements about work-life balance practices that enhance
employee retention in organizations. Please react to them on a five point scale in
organization.
189
Statement Response

1 2 3 4 5
Annual leave is given
There is provision of sick leave
Compassionate leave is granted
Sabbatical leave is provided
Employees are given study leaves
Staff are given their off-days as required
Whenever an employee has a personal issue to
attend do they are given time away
Availability of part-time working arrangements
Provision of onsite childcare services
Work schedules are flexible enough to allow
employees attend to personal issues
The supervisors are supportive and caring
whenever someone is needs such support
Counseling services are provided to employees
whenever needed.
There is provision for social and family events
Availability of gyms and mental relaxation
programmes
Provision of children education schemes
Availability of health and well-being
programmes like health insurance for self and
defendants
190
3. Please mention other aspects of the work-life balance practices not mentioned above
that enhance employee retention in your organization
i. ………………………………………………………………………….
ii. ……………………………………………………………...…………..
iii. ………………………………………………………………………….
4. Suggest work-life balance practices that you feel should be put in place to enhance
employees‘ retention
i. ……………………………………………………………………………
ii. ……………………………………………………………………………
iii. ……………………………………………………………………………
5. Other than remuneration practices, career advancement practices, work environment
management practices and work-life balance practices please state in the spaces below
other human resource management practices that you think influence the retention of
employees in organizations.
……………………………………………………………………………………………
……………………………………………………………………………………………
……………………………………………………………………………………………
……..
191
Section V: organizational commitment
Statement Response
SA A UN DA SDA
1 2 3 4 5
I feel a strong sense of belonging to this organization
I often find it difficult to agree with this

organization‘s policies regarding employee.
There is little I can gained by remaining in this
organization
I am willing to put in greater more effort to help this
organization be successful
I am proud to tell others I am part of this
organization
I really care about the fate of this organization.
.
I would be very happy to spend the rest of my career
with this organization
I really feel as if this organization‘s problems are my

own.
I think that I could easily become attached to another

organization as I am to this one.
This organization has a great deal of personal
meaning for me
Section VI: Intention to stay
192
Statement Response
SA A UN DA SDA
1 2 3 4 5
I plan to work in this organization for as long
as possible
I will most certainly look for a new job in the
near future
Given an opportunity I would look for a
transfer to another station near bigger town.
Given an opportunity I would rather be
working in a smaller facility
I plan to stay on this job for the shortest time
possible
I would hate to quite this job
One of the major reasons I continue to work for
this organization is that another organization
may not match the overall benefits I have here.
I sincerely appreciate your time and cooperation. Please check to make sure that you
have not skipped any questions inadvertently
Thank you.
193
APPENDIX V: INTERVIEW SCHEDULE
ROLE OF HRM PRACTICES ON THE RETENTION OF STAFF IN PUBLIC

HEALTH INSTITUTIONS INTERVIEW SCHEDULE FOR THE PUBLIC
HEALTH INSTITUTION STAFF.
.
PART A
Background information
Please state.
1. Gender
2. Age in years :
3. Marital status :
4. Family status:
a) With children [ ]
b) Without children [ ]
5. If with children state if:
a) Dependents [ ]
b) Not dependents [ ]
6. Level of education:
a) Certificate [ ] d) Masters [ ]
b) Diploma [ ] e) Doctorate [ ]
c) Bachelors [ ]
7. Please state the department in which you work

8. Designation
9. Year of attainment of qualification
SECTION B
194
10 .In your opinion is turn over a challenge facing this organization?
11. In your own assessment, how would you rate the level of employee commitment to
this organization?
12. How would you rate the retention rate in this organization?
13. Why?
14. What reasons do employees give for staying in this organization?
15. Where do those who leave go?
16 .Which category of employee is most affected?
17. For those who leave the organization; what reasons do they advance for their
departure?
18. Compensation, career advancement, working environment and work-life balance
practices are human resource management practices that have been cited as influencing
employees‘ decision to stay in an organization. Name them in order of priority starting
with the one with the greatest effect in your organization.
19. What other factors do you think influence retention of employees in an organization?
20. Given an opportunity else where would you mind leaving this organization?
21. Please explain why.
22. If you left this organization where would you go?
23. What factors would prompt you to leave this organization?
24. What do you think should be done to enhance the retention of employees in this
sector?
I sincerely appreciate your time and cooperation.
Thank you.
195
APPENDIX VII: MEANS AND STANDARD DEVIATION
Variable Percentage [%] N Mean SD
SA A UN DA SDA
[1] [2] [3] [4] [5]
Reward practices 0 1 9 66 24 227 4.12 .592
Career advancement 1 0 34 42 25 227 3.85 .793

practices
Work environment 0 0 29 61 10 219 3.79 .604
Work life balance 1 0 1 78 21 227 4.17 .479
Retention(commitment 0 0 6 89 4 227 3.96 .396

& intend to stay)
196
APPENDIX VIII: LIST OF HEALTHCARE FACILITIES
Facility
Code Facility Name Subcounty Division Type
1 Katani Dispensary Athi River Athi River Dispensary
2
Mlolongo Wellness Centre Athi River Athiriver Dispensary
3
KMC Staff Clinic Athi River Athi River Dispensary
4
Athi River Health Centre Athi River Athi River Health Centre
5
Kinanie Dispensary Athi River Athi River Dispensary
6
Kivaani Health Centre Kangundo Kakuyuni Health Centre
7
Mukunike Dispensary Kangundo Kakuyuni Dispensary
8
Kakuyuni Health Centre Kangundo Kakuyuni Health Centre
Kangundo Community
9
Clinic Kangundo Kangundo Health Centre
SubCounty
10
Kangundo District Hospital Kangundo Kangundo Hospital
11
Kathaana Dispensary Kangundo Kakuyuni Dispensary
12
Kawauni Dispensary Kangundo Kangundo Dispensary
13
Kyevaluki Dispensary Kangundo Kakuyuni Dispensary
14
Ithaeni Dispensary Kathiani Kathiani Dispensary
15
Kaani Dispensary Kathiani Kathiani Dispensary
16
Kalunga Dispensary Kathiani Kathiani Dispensary
197
17
Miumbuni Dispensary Kathiani Kathiani Dispensary
18
Mitaboni Health Centre Kathiani Kathiani Health Centre
SubCounty
19
Kathiani District Hospital Kathiani Kathiani Hospital
28
Kaviani Health Centre Kathiani Kathiani Health Centre
29
Mutitu Dispensary Kathiani Kathiani Dispensary
30
Ngoleni Dispensary Kathiani Kathiani Dispensary
APDK Dispensary
31
(Machakos) Machakos Central Dispensary
32
Kititu Dispensary Machakos Kalama Dispensary
33
Mua Hills Dispensary Machakos Central Dispensary
34
Nzaini Dispensary Machakos Kalama Dispensary
School for the Deaf
35
GK Prison Dispensary
36
37
Kalama Dispensary Machakos Kalama Dispensary
38
Kamuthanga Dispensary Machakos Central Dispensary
Level 5
39
Machakos Level 5 Hospital Machakos Central Hospital
40
Makyau Machakos Central Dispensary
41
Kola Health Centre Machakos Kalama Health Centre
198
Approved School
46
Dispensary (Machakos) Machakos Central Dispensary
47
Mutituni Dispensary Machakos Central Dispensary
48
Muumandu Dispensary Machakos Kalama Dispensary
49
Muvuti Dispensary Machakos Central Dispensary
50
Katumani Dispensary Machakos Central Dispensary
51
Kiitini Dispensary Machakos Kalama Dispensary
52
Kimutwa Dispensary Machakos Central Dispensary
53
Kyawalia Dispensary Machakos Kalama Dispensary
54
Kiseuni Dispensary (Yatta) Masinga Masinga Dispensary
55
Mukusu Dispensary Masinga Masinga Dispensary
56
Kitangani Dispensary Masinga Masinga Dispensary
57
Kivaa Health Centre Masinga Masinga Health Centre
58
Milaani Dispensary Masinga Ndithini Dispensary
59
Kithyoko Dispensary Masinga Masinga Dispensary
60
Endei Dispensary Masinga Masinga Dispensary
61
Ikaatini Dispensary Masinga Masinga Dispensary
62
Itunduimuni Dispensary Masinga Masinga Dispensary
63
Iuuma Dispensary Masinga Masinga Dispensary
199
69
Kaewa Dispensary Masinga Masinga Dispensary
70
Kakongo Dispensary Masinga Masinga Dispensary
71
Kangode Dispensary Masinga Masinga Dispensary
72
Kangonde Dispensary Masinga Masinga Dispensary
73
Kaonyweni Dispensary Masinga Masinga Dispensary
74
Kikumini Dispensary Masinga Masinga Dispensary
75
Kathukini Dispensary Masinga Ndithini Dispensary
76
Katothya Dispensary Masinga Masinga Dispensary
77
Manaja Dispensary Masinga Ndithini Dispensary
78
Masinga Health Centre Masinga Masinga Health Centre
79
Katulye Dispensary Masinga Masinga Dispensary
80
Ndela Dispensary Masinga Mananja Dispensary
81
Ndithini Dispensary Masinga Ndithini Dispensary
82
Ngetani Dispensary Masinga Masinga Dispensary
83
Muthesya Dispensary Masinga Ndithini Dispensary
84
Kyondoni Dispensary Masinga Masinga Dispensary
85
Wamboo Dispensary Masinga Masinga Dispensary
SubCounty
86
Matuu District Hospital Masinga Yatta Hospital
200
87
Kituluni Dispensary Matungulu Kyanzavi Dispensary
88
Matungulu Health Centre Matungulu Matungulu Health Centre
89
Sengani Dispensary Matungulu Matungulu Dispensary
90
Kwa Nguu Dispensary Matungulu Kyanzavi Dispensary
91
Kalandini Dispensary Matungulu Matungulu Dispensary
92
Kambusu Dispensary Matungulu Matungulu Dispensary
93
Kikuyuni Dispensary Matungulu Kyanzavi Dispensary
94
Katheka Dispensary Matungulu Matungulu Dispensary
95
Kayatta Dispensary Matungulu Kyanzavi Dispensary
96
Kiliku Dispensary Matungulu Matungulu Dispensary
104
Kimiti Dispensary Matungulu Matungulu Dispensary
105
Kyeleni Health Centre Matungulu Kyanzavi Health Centre
106
Ndunduni Dispensary Matungulu Kangundo Dispensary
107
Nduu Dispensary Matungulu Matungulu Dispensary
108
Nguluni Health Centre Matungulu Matungulu Health Centre
109
Uamani Dispensary Matungulu Kyanzavi Dispensary
110
Kwakala Dispensary Mwala Yathui Dispensary
111
Mathima Dispensary Mwala Mwala Dispensary
201
112
Kathama Dispensary Mwala Mwala Dispensary
113
Muusini Dispensary Mwala Masii Dispensary
114
Maweli Dispensary Mwala Mwala Dispensary
115
Mbiuni Health Centre Mwala Mwala Health Centre
116
Miu Sub-Health Centre Mwala Yathui Health Centre
117
Nthwanguu Dispensary Mwala Kibauni Dispensary
Mumbuni Dispensary
118
(Mwala) Mwala Mwala Dispensary
119
Wamunyu Health Centre Mwala Yathui Health Centre
120
Yathui Dispensary Mwala Yathui Dispensary
121
Ikalaasa Dispensary Mwala Kibauni Dispensary
Kavumbu Dispensary
122
(Mwala) Mwala Masii Dispensary
123
Kaiani Dispensary Mwala Yathui Dispensary
124
Kalala Dispensary Mwala Kibauni Dispensary
125
Mango Dispensary Mwala Masii Dispensary
126
Masii Health Centre Mwala Masii Health Centre
127
Katulani Dispensary Mwala Kibauni Health Centre
128
Kilembwa Dispensary Mwala Yathui Dispensary
129
Tulila Dispensary Mwala Kibauni Dispensary
202
130
Kyawango Dispensary Mwala Mwala Dispensary
SubCounty
131
Mwala District Hospital Mwala Mwala Hospital
132
Muthetheni Health Centre Mwala Masii Health Centre
133
Ngulini Dispensary Mwala Mwala Dispensary
134
Vyulya Dispensary Mwala Masii Dispensary
135
Miu dispensary Mwala Kivaani Dispensary
136
Kitheuni Dispensary Yatta Katangi Dispensary
137
Kisiiki Dispensary Yatta yatta Dispensary
NYS Dispensary
138
(Mavoloni) Yatta Yatta Dispensary
139
Kithimani Dispensary Yatta Yatta Dispensary
140
Kwa Mwatu Dispensary Yatta Yatta Dispensary
141
Mbembani Dispensary Yatta Masinga Dispensary
142
Nthungululu Dispensary Yatta Yatta Dispensary
143
Ikombe Disp Yatta Katangi Dispensary
144
Katangi Health Centre Yatta Katangi Health Centre
145
Kisesini Dispensary Yatta Katangi Dispensary
146
Kinyaata Dispensary Yatta Katangi Dispensary
147
Kyasioni Dispensary Yatta Yatta Dispensary
203
148
Kauthulini Dispensary Yatta Kithimani Dispensary
149
Kikesa Dispensary Yatta Katangi Dispensary
150
Mamba Dispensary (Yatta) Yatta Yatta Dispensary
151
Musingini Dispensary Yatta Yatta Dispensary
152
Ndalani Dispensary Yatta Yatta Dispensary
204
APPENDIX IX: MAPS
191

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ROLE OF HUMAN RESOURCE MANAGEMENT

PRACTICES ON RETENTION OF STAFF IN PUBLIC

JACINTA MUNYIVA KINYILI

(Human Resource Management)

JOMO KENYATTA UNIVERSITY OF

Jacinta Munyiva Kinyili

A thesis submitted in partial fulfilment for the degree of doctor

Signature: ________________ Date: _________________

Jacinta Munyiva Kinyili

Signature: _____________________ Date: ___________________

Dr. Kabare Karanja

Signature: ___________________ Date: _____________________

Prof. Gregory S Namusonge

Table 3.2. Sample Size .................................................................................................. 56

Table 4.2: Graduation Period ..................................................................................... 78

Table 4.3: Anova results on role of remuneration practices on retention of health

Table 4.4: Model Summary ...................................................................................... 80

Table 4.5: Coefficientsa ............................................................................................. 81

Table 4.6: Anova results on role of career advancement practices on retention of

Table 4.7 Linear regression analysis model summary.............................................. 83

Table 4.8 Regression analysis correlation coefficient .............................................. 84

Table 4.9: Anova results on role of work environment management practices on

Table 4.10 Model Summary ....................................................................................... 86

Table 4.11: A Simple Regression Analysis Correlation Coefficients ........................ 86

Table 4.14: Simple regression analysis correlation Coefficients ................................ 89

Table 4.15: Correlation analysis between the HRM practices .................................... 90

Table 4.16: Summary of the correlation analysis of the bivariate relationship of

Table 4.17 Multiple linear regression analysis Model Summary ............................... 92

Table 4.19 : Multiple regression analysis correlation coefficients. ............................. 94

Table 4.20: Remuneration Practices Influence Staff Retention .................................. 95

Table 4.22 Career Advancement Practices Affect Retention ................................... 101

Table 4.25: Role of Work Environment Management Practices on Retention of Health

Table 4.28: Employees‘ Commitment ....................................................................... 123

Table 4.28: Employees‘ Commitment (cont) ............................................................ 124

Table 4.29: Employees‘ Intend to Stay ...................................................................... 126

Figure: 2.1 Conceptual frame work. ........................................................................... 21

Figure 4.1: Response Rate........................................................................................... 67

Figure 4.2. Response rate by designation ................................................................... 68

Figure 4.3: Gender ...................................................................................................... 69

Figure 4.4: Age in Years ............................................................................................. 70

Figure 4.5: Marital Status ........................................................................................... 72

Figure 4.7: Status of Children .................................................................................... 74

Figure 4.10: Level of Agreement with Reward Practices ............................................ 99

Figure 4.14: Employees‘ commitment and intent to stay ........................................... 128

Appendix i: Authorityletter .......................................................................................... 180

Brain Drain - The movement of health personnel in search of a better

Retention - Retention is a voluntary move by an organization to create

BOSTI The Buffallo Organization for Social and Technological Innovation

GOK- Government of Kenya

1.1 Background of the Study

Accelerating product and technological changes, global competition, deregulation and

Branham (2005) drawing on a research undertaken by the Saratoga Institute as cited in

In terms of access to health care, Approximately 78 percent of Kenyans live in rural

The devolution of health care in Kenya is also likely to complicate management of

1.3.1 General Objective

1.3.2 Specific Objectives

i. To explore the role of remuneration practices on the retention of staff in public

iii. To establish the role of work- environment management practices on the

1.4 Research Questions

Signature: Date: _

Signature: ___ Date: _

Signature: _ Date: ___