Hospitals in Kenya are increasingly investing in advanced medical fellowship programmes to train specialised doctors also known as subspecialists, a strategic shift aimed at addressing the shortage of medical experts in the country.
Fellowship programmes are the highest level of clinical training after medical school and residency. Medical residency refers to a session of postgraduate training in a specific medical specialty and builds upon a doctor's medical school education.
The advanced training sessions aim to ensure that expert care is available where it is needed, contributing to a more resilient and equitable health system that can effectively address evolving health challenges.
Subspecialists are medical professionals with advanced training in specific areas such as neurology, oncology, and interventional cardiology. Their expertise is critical to improving outcomes for patients with complex medical conditions.
This trend represents a major step forward in Kenya's efforts to address the growing burden of non-communicable diseases (NCDs) and provide high-quality, specialised care that is accessible to communities across the country.
At the forefront of this transformation is the Aga Khan University Hospital (AKUH) in Nairobi, which has become a regional leader in subspecialty training.
"Today, we have close to 14 or 15 advanced fellowship programmes," said Rashid Khalani, AKUH's chief executive officer. "By 2028, we hope to add nine more programmes. The idea is to train as many subspecialists as possible for the country, not just for Nairobi, not just for the Aga Khan, but for all corners of Kenya."
In Kenya, the path to becoming a doctor typically begins with a five-year MBChB (Bachelor of Medicine and Bachelor of Surgery) degree, followed by a four-year residency in a broad specialty such as internal medicine, paediatrics, or surgery.
For those who wish to become subspecialists - doctors with advanced expertise in specific areas of medicine - the next step is an advanced fellowship programme. These programmes last two to three years and provide intensive, hands-on clinical training, mentorship, and academic instruction.
The cost of training a fellow is between Sh45,000 and Sh50,000 per year. For longer programmes, the total investment in a doctor can exceed Sh150,000.
Kenyatta National Hospital (KNH), in partnership with the University of Nairobi, fellowship programmes in nephrology, neonatal, cardiothoracic surgery, and intensive care are training the next generation of clinical leaders in public health. These specialists are essential for staffing national and regional referral centres.
“The fellowship in neonatal medicine is a clinical fellowship programme is designed to provide the learner with advanced knowledge and understanding of principles of evidence-based care, clinical skills, as well as professional and ethical behaviour essential for the practice of neonatal medicine,” said Dr Brian Maugo, a neonatologist at the department of paediatrics and child health at UoN.
Moi Teaching and Referral Hospital (MTRH) has established a strong fellowship training programme through its Academic Model Providing Access to Healthcare (AMPATH) partnership and collaboration with Moi University.
Programmes at MTRH cover specialties such as medical oncology, neonatal medicine, endocrinology, paediatric neurology, and gynecological oncology which is the first fellowship in any medical field approved by Moi University, with several graduates now practicing across Kenya and Uganda.
Faith-based hospitals also play an important role. Gertrude's Children's Hospital, for example, trains paediatric subspecialists in neurology and cardiology. Tenwek and AIC Kijabe Hospitals, known for their excellence in surgery and family medicine, are developing robust fellowship programmes that support not only Kenyan counties but also patients from across East Africa.
Tenwek offers a fully accredited Cardiothoracic Fellowship to surgical consultants who have done their masters and have been certified. This is a five-year training program where fellows undergo rigorous training schedule that combines both classroom, clinical, and theatre experience.
The fellowship programme focuses on providing professional education and state-of-the-art care for a broad spectrum of cardiothoracic and foregut diseases, producing fully trained, competent, innovative, and compassionate CT surgeons. Offering hands-on training, as well as research opportunities. The research represents an important component of our fellowship programme,” the hospital said.
This momentum reflects a significant turning point in Kenya's health strategy. As infectious diseases are better controlled, the focus has shifted to non-communicable diseases as the leading causes of death and disability. These include heart disease, stroke, cancer, diabetes, and chronic respiratory diseases.
"Effective treatment of these diseases requires more than general practitioners; it requires specialists with advanced knowledge, state-of-the-art diagnostic tools, and well-resourced clinical environments. In addition to technical skills, many fellowship programmes provide doctors with leadership training and exposure to health system management, preparing them not only to treat patients but also to strengthen local health systems," said Khalani.
"When countries fund their fellows, it's a win-win. They get qualified specialists back, and we help decentralise expertise. The ripple effect is already visible. Counties that once had to refer almost all complex cases to Nairobi are now doing more at the local or regional level. This shift is relieving pressure on national referral hospitals and improving access for patients, who can now get quality care closer to home,” he added.
