Table 7.

Summary of thematic issues emanating from focus group discussions (FDGs) in the three regions

	Kibera	Machakos	Turkana
1. Positive issues about the current work environment	General satisfaction with salary, and job security	Positive response from patients	Good connections, relations with the community
2. Limitations	Discrimination in training, Poor communication from superiors on job assignments; Tribalism.	Low/substandard housing, quality of accommodation.	Limited choices for education facilities for children of staff; language barrier especially for non-locals, unreliable transport to work and lack of electricity.
3. Reasons for leaving job	Stagnation on current job, rivalry between different job cadres especially between Clinical Officers and Nurses	Poor commuter allowance, Huge workload; Government bureaucracy (lack of commodities and other supplies)	Harsh geographical and climatic conditions
4. Retention: What would keep you in your job?	Regular training; good supervision	Better salaries, on-the-job training; more staff to support high workload	Hardship allowances; better accommodation and infrastructure.
5. Compensation factors	Increase allowances (medical, house, overtime and leave allowances)	Need to increase salaries and to pay salaries on time;	Lack of National Social Security Fund (NSSF) and retirement benefits (For private facilities);
6. Gender issues at work	Increase duration of maternity leave	Not very vocal on gender issues, though a few muted voices of females felt that need to increase duration of maternity leave	Men require paternity leave
7. Cultural issues	Men control family planning and especially reproductive health issues sometimes to the detriment of women	A significant number of people believe in witchcraft and use herbs and charms to treat diseases	Women do not easily allow male nurses to attend to them; Women are encouraged to give birth in standing position; New mothers do not breastfeed for a while if they give birth at night.
8. Organizational support	Multiple reporting lines and supervision make it difficult to coordinate work	In-charges are often significantly older than those they supervise and do not fully appreciate their younger colleagues.	Staff are committed to work in hardship conditions