Prolonged health worker strikes in Kenya- perspectives and experiences of frontline health managers and local communities in Kilifi County

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dc.contributor.authorWaithaka, Dennis
dc.contributor.authorKagwanja, Nancy
dc.contributor.authorNzinga, Jacinta
dc.contributor.authorTsofa, Benjamin
dc.contributor.authorLeli, Hassan
dc.contributor.authorMataza, Christine
dc.contributor.authorNyaguara, Amek
dc.contributor.authorBejon, Philip
dc.contributor.authorGilson, Lucy
dc.contributor.authorBarasa, Edwine
dc.contributor.authorMolyneux, Sassy
dc.date.accessioned2020-03-02T12:11:39Z
dc.date.available2020-03-02T12:11:39Z
dc.date.issued2020-02-10
dc.date.updated2020-02-18T10:55:09Z
dc.description.abstractAbstract Background While health worker strikes are experienced globally, the effects can be worst in countries with infrastructural and resource challenges, weak institutional arrangements, underdeveloped organizational ethics codes, and unaffordable alternative options for the poor. In Kenya, there have been a series of public health worker strikes in the post devolution period. We explored the perceptions and experiences of frontline health managers and community members of the 2017 prolonged health workers’ strikes. Methods We employed an embedded research approach in one county in the Kenyan Coast. We collected in-depth qualitative data through informal observations, reflective meetings, individual and group interviews and document reviews (n = 5), and analysed the data using a thematic approach. Individual interviews were held with frontline health managers (n = 26), and group interviews with community representatives (4 health facility committee member groups, and 4 broader community representative groups). Interviews were held during and immediately after the nurses’ strike. Findings In the face of major health facility and service closures and disruptions, frontline health managers enacted a range of strategies to keep key services open, but many strategies were piecemeal, inconsistent and difficult to sustain. Interviewees reported huge negative health and financial strike impacts on local communities, and especially the poor. There is limited evidence of improved health system preparedness to cope with any future strikes. Conclusion Strikes cannot be seen in isolation of the prevailing policy and health systems context. The 2017 prolonged strikes highlight the underlying and longer-term frustration amongst public sector health workers in Kenya. The health system exhibited properties of complex adaptive systems that are interdependent and interactive. Reactive responses within the public system and the use of private healthcare led to limited continued activity through the strike, but were not sufficient to confer resilience to the shock of the prolonged strikes. To minimise the negative effects of strikes when they occur, careful monitoring and advanced planning is needed. Planning should aim to ensure that emergency and other essential services are maintained, threats between staff are minimized, health worker demands are reasonable, and that governments respect and honor agreements.
dc.identifier.apacitationWaithaka, D., Kagwanja, N., Nzinga, J., Tsofa, B., Leli, H., Mataza, C., ... Molyneux, S. (2020). Prolonged health worker strikes in Kenya- perspectives and experiences of frontline health managers and local communities in Kilifi County. <i>International Journal for Equity</i>, 19(1), http://hdl.handle.net/11427/31440en_ZA
dc.identifier.chicagocitationWaithaka, Dennis, Nancy Kagwanja, Jacinta Nzinga, Benjamin Tsofa, Hassan Leli, Christine Mataza, Amek Nyaguara, et al "Prolonged health worker strikes in Kenya- perspectives and experiences of frontline health managers and local communities in Kilifi County." <i>International Journal for Equity</i> 19, 1. (2020) http://hdl.handle.net/11427/31440en_ZA
dc.identifier.citationWaithaka, D., Kagwanja, N., Nzinga, J., Tsofa, B., Leli, H., Mataza, C., Nyaguara, A. & Bejon, P. et al. 2020. Prolonged health worker strikes in Kenya- perspectives and experiences of frontline health managers and local communities in Kilifi County. <i>International Journal for Equity.</i> 19(1) http://hdl.handle.net/11427/31440en_ZA
dc.identifier.risTY - AU - Waithaka, Dennis AU - Kagwanja, Nancy AU - Nzinga, Jacinta AU - Tsofa, Benjamin AU - Leli, Hassan AU - Mataza, Christine AU - Nyaguara, Amek AU - Bejon, Philip AU - Gilson, Lucy AU - Barasa, Edwine AU - Molyneux, Sassy AB - Abstract Background While health worker strikes are experienced globally, the effects can be worst in countries with infrastructural and resource challenges, weak institutional arrangements, underdeveloped organizational ethics codes, and unaffordable alternative options for the poor. In Kenya, there have been a series of public health worker strikes in the post devolution period. We explored the perceptions and experiences of frontline health managers and community members of the 2017 prolonged health workers’ strikes. Methods We employed an embedded research approach in one county in the Kenyan Coast. We collected in-depth qualitative data through informal observations, reflective meetings, individual and group interviews and document reviews (n = 5), and analysed the data using a thematic approach. Individual interviews were held with frontline health managers (n = 26), and group interviews with community representatives (4 health facility committee member groups, and 4 broader community representative groups). Interviews were held during and immediately after the nurses’ strike. Findings In the face of major health facility and service closures and disruptions, frontline health managers enacted a range of strategies to keep key services open, but many strategies were piecemeal, inconsistent and difficult to sustain. Interviewees reported huge negative health and financial strike impacts on local communities, and especially the poor. There is limited evidence of improved health system preparedness to cope with any future strikes. Conclusion Strikes cannot be seen in isolation of the prevailing policy and health systems context. The 2017 prolonged strikes highlight the underlying and longer-term frustration amongst public sector health workers in Kenya. The health system exhibited properties of complex adaptive systems that are interdependent and interactive. Reactive responses within the public system and the use of private healthcare led to limited continued activity through the strike, but were not sufficient to confer resilience to the shock of the prolonged strikes. To minimise the negative effects of strikes when they occur, careful monitoring and advanced planning is needed. Planning should aim to ensure that emergency and other essential services are maintained, threats between staff are minimized, health worker demands are reasonable, and that governments respect and honor agreements. DA - 2020-02-10 DB - OpenUCT DP - University of Cape Town KW - Strike KW - Stressor KW - Conflict KW - Strategy KW - Frontline health managers KW - Community KW - Kenya LK - https://open.uct.ac.za PY - 2020 T1 - Prolonged health worker strikes in Kenya- perspectives and experiences of frontline health managers and local communities in Kilifi County TI - Prolonged health worker strikes in Kenya- perspectives and experiences of frontline health managers and local communities in Kilifi County UR - http://hdl.handle.net/11427/31440 ER -en_ZA
dc.identifier.urihttps://doi.org/10.1186/s12939-020-1131-y
dc.identifier.urihttp://hdl.handle.net/11427/31440
dc.identifier.vancouvercitationWaithaka D, Kagwanja N, Nzinga J, Tsofa B, Leli H, Mataza C, et al. Prolonged health worker strikes in Kenya- perspectives and experiences of frontline health managers and local communities in Kilifi County. International Journal for Equity. 2020;19(1) http://hdl.handle.net/11427/31440.en_ZA
dc.language.rfc3066en
dc.rights.holderThe Author(s).
dc.sourceInternational Journal for Equity
dc.source.journalissue1
dc.source.journalvolume19
dc.source.journalvolume1-15
dc.source.urihttps://equityhealthj.biomedcentral.com/
dc.subjectStrike
dc.subjectStressor
dc.subjectConflict
dc.subjectStrategy
dc.subjectFrontline health managers
dc.subjectCommunity
dc.subjectKenya
dc.titleProlonged health worker strikes in Kenya- perspectives and experiences of frontline health managers and local communities in Kilifi County
dc.typeJournal Article
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