We have billions for MCA car grants, no money for medics

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 besides unfair pay, delayed salaries and unpaid dues.

It is noteworthy that Kenya has lost several health workers to Covid-19 including 39 nurses, 17 medical doctors and 10 clinical officers as of March 2021.

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-which amplified the need to care for, and support our health workers even as they serve the public.

Health worker strikes are a perennial feature of the Kenyan public health system. In 2017, for instance, 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.

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 above. 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 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 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 taxpayers’ money was being used by the political elite to advance initiatives like Building Bridges Initiative, as well as awarding Members of County Assemblies car grants to the tune of Sh4.5 billion. 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 and mitigate the impact of strikes. 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 need to carefully consider compensation packages for health workers to ensure fairness within and across cadres including regular and timely pay and conducive working conditions besides prioritizing the wellbeing of health workers during the Covid-19 pandemic.

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, a 2021 Aspen New Voices Fellow, is a senior gender and health systems research fellow at KEMRI-Wellcome Trust Research Programme