Kenya’s healthcare system may stumble yet again if nurses go ahead with their strike next month. Nurses have issued a 21-day strike notice stating the government’s failure to implement the agreement made in 2017.
President Uhuru Kenyatta has a dream that by the end of his second term in 2022, every Kenyan will have access to critical healthcare services without denting their pockets. However, this may be difficult to achieve if issues persist with the quality of healthcare and presence of adequate workforce.
All governments need to invest in and develop their nursing and midwifery workforce to achieve a rapid, cost-effective expansion of high-quality Universal Health Coverage (UHC). According to a recently launched report which I had the privilege to assist in c-authoring, ‘‘Nursing and Midwifery. The Key to the Rapid and Cost-Effective Expansion of High-Quality Universal Health Coverage,’’ nurses play a big role in health services and are central to effectively managing the defining health challenges of modern times. Current global policy on UHC can be strengthened through greater focus on health workforce, particularly nursing and midwifery.
There would be a profound effect on how quickly UHC could be achieved if a nurses and midwives were enabled to work more effectively to the full scope of their license class or to take on new roles in expanded and speciality practice. Our report shows that by redesigning health services at a national level to make better use of nurses and midwives, countries like Kenya can achieve high-quality, cost-effective UHC.
There are three simple ways Kenya can build on the existing workforce and achieve its goal of UHC: Kenya could usefully adopt a strategy that combines investment in the workforce with changes in service delivery and practice.
In practice, this means enabling nurses and midwives to work to their full potential through the creation of more nurse-led clinics, more specialist nurses and more midwifery services. Evidence in the report shows that cost-effective expansion of Universal Health Coverage will heavily depend on enabling and training the existing workforce, including nurses and midwives, to work more effectively.
In addition to the examples listed in Rapid Expansion, there is enormous potential for nurses to expand their scope of practice through task-sharing. One study cited in the report estimates that advanced-practice nurses can complete approximately 70 percent of a general practitioner’s workload thus freeing up doctors to attend to patients with higher levels of acuity.
There is evidence of the positive impact that nurses and a patient-centred, holistic approach have on the quality of care, including studies showing nurses generally achieve equivalent health outcomes for long-term non-communicable diseases management and nurses often score higher for patient satisfaction and for treatment adherence.
Nurses are well positioned to provide simultaneous health-promotion and disease-prevention advice and take on roles in coordinating and supporting teams of primary health care workers.
Sharon Brownie, Dean of Nursing and Midwifery in East Africa, Aga Khan University Hospital.