By Kui Muraya (@KuiMuraya)
The World Health Assembly designated 2020 as the International Year of the Nurse and the Midwife, to honour their work and advance their vital role in transforming health care around the world.
In Kenya however, nurses spent the better part of 2020 on strike, protesting poor working conditions, including failure by the government to provide them with adequate personal protective kits and medical insurance, particularly in the context of COVID-19. They were also protesting unfair pay, delayed salaries and unpaid dues. It is noteworthy that the country has lost several health workers to COVID-19. Based on personal communication from respected Kenyan health journalist Dr. Mercy Korir, as of March 2021, the country had lost 39 nurses, 17 medical doctors and 10 clinical officers to COVID-19. One of them, Dr. Stephen Mogusu is said to have sent out a message to his colleagues a few hours before his death, telling them to save themselves and get out while they still could. Health workers lost in the line of duty, and Dr. Mogusu’s despondent message amplify the need to care for, and support, our health workers even as they care for us and serve the public.
Health worker strikes are a perennial feature of the Kenyan public health system. In 2017 for example, nurses were on strike for 150 days, paralyzing healthcare service delivery countrywide. This was preceded a few months earlier by a doctors’ strike that lasted 105 days.
The debates on the moral ethics of health worker strikes are valid. In September 2020 for example, there was outrage in Kenya when a pregnant woman gave birth outside the largest public maternity hospital. Despite their pleas and the woman’s advanced labour, she and her husband were denied entry due to an ongoing health workers’ strike. She gave birth right outside the hospital gate with the assistance of passersby. In ‘typical’ Kenyan fashion, there was public outcry. Both citizens and the political elite were shocked, with some women leaders led by the Kenya Women Parliamentary Association holding a protest at the hospital. I understand this outcry: I, too, was outraged. Yet, not much has been done to improve the situation since.
Health worker strikes in Kenya often affect those who are furthest from the centre of power and privilege, the most vulnerable who cannot afford to pay for private healthcare like the woman in this story. But as a country, we need to do better at supporting our healthcare workers if they are to continue supporting us. It is unreasonable to expect that healthcare workers, many of whom have family and other personal obligations, should continue serving the public without having been paid salaries for several months or without adequate protections, thereby exposing themselves and their families to undue risks.
Some critics say that when healthcare workers go on strike, they are being unfair to citizens and that they should exercise patience with the ‘financially-constrained’ government. However, healthcare workers have often unsuccessfully tried other means of engagement with the government before going on strike, including giving public notification of their intention to strike. In April 2020 for example, various health professionals issued a seven-day industrial strike notice to the government if their demands for equitable compensation and COVID-19 related protections were not met. These notifications are seemingly never taken seriously – until the strikes happen – and then everything comes to a standstill.
At the centre of the 2017 nurses’ strike, was a dispute related to a prior collective bargaining agreement that had not been honoured because county governors subsequently deemed it ‘too costly’. Yet, while we often hear that there are insufficient funds to fully support Kenya’s healthcare sector, other sectors seem to be kept afloat without problems. In 2020 for example, while a section of healthcare workers was still on strike, billions of Kenya shillings in taxpayer money was being used by the political elite to advance political agendas and initiatives such as the Building Bridges Initiative, as well as awarding Members of County Assemblies car grants to the tune of 4.5 billion Kenya Shillings. This suggests that the issue has little to do with availability of state resources.
The short and long-term solutions to Kenya’s recurrent healthcare worker strikes are already known and documented. A recently published policy brief outlines how we can prevent such strikes and mitigate their impact when they do happen. Key strategies include long-term monitoring, planning and strengthening of the health system, supporting health workers to make ‘reasonable demands’ and for government to respect and honour agreements made.
The demands made by healthcare workers over the years, and the solutions outlined in this policy brief, point at a human resources management problem. As a first step, county governments which are primarily responsible for human resources for health in Kenya’s devolved system of governance need to carefully consider compensation packages for health workers to ensure fairness within and across cadres. They need to ensure that health workers are paid regularly and in a timely manner, and that working environments are conducive and sufficient. Finally, they need to prioritize the health and wellbeing of health workers, particularly in the current COVID-19 climate.
The year 2021 has been designated by the World Health Organisation as the International Year of Health and Care Workers, in recognition of their dedication to providing care during and despite the COVID-19 pandemic, that has challenged health systems worldwide. It is my hope that in Kenya, 2021 will not be remembered for its strikes, but as the year when we did better for our healthcare workers.
Dr. Kui Muraya is a 2021 Aspen New Voices Fellow who is passionate about advocating for gender equity, rights, and social justice more broadly. Professionally she works as a senior gender and health systems research fellow at the KEMRI-Wellcome Trust Research Programme.