The many unfortunate strikes by both doctors and nurses in Kenya since the devolution of health services in 2013 have largely been caused by lack of proper leadership and mechanisms for dispute resolution and prevention at the devolved level. In 2013, most health services were decentralised from the national government to county governments in keeping with Kenya’s new constitution, which was done to ensure that people can access health services with more ease.
The process of decentralisation of services was done hurriedly and the newly established county governments were faced with a myriad of challenges emanating from increased responsibility in the provision of health services. The failure by the different government organs to coordinate the human resource functions has been an eminent discrepancy that requires harmonisation.
These recurring prolonged health workers strikes cause preventable deaths and avoidable economic strain to patients and affected families. The interrupted care of the chronically ill (diabetic, hypertensive, HIV+) worsens their health conditions when they default accessing medicines. Pregnant women and children are denied access to life saving interventions resulting in premature deaths, disability or other health complications. The strikes cripple health services in public health facilities which is a violation of the constitutional provision that every person has the right to health.
Insincerity, blame games, show of might and threats have always been the main reason for lack of progress in talks to resolve impasses between health workers and their employer. This in most instances leads to halting of services in public health facilities across the country. Bringing every stakeholder to the negotiating table can go a long way in ensuring harmonious deliberations between the parties.
The communities that receive these services are the greatest stakeholder and their involvement in health matters could yield positive results since they have great influence on the leadership and providers of services. A good example where this strategy has worked efficiently is in Turkana County where the County government and Amref Health Africa through the USAID funded Afya Timiza project facilitated the establishment of a round table forum to facilitate dialogue meetings between the Turkana County Department of Health and health worker unions.
This roundtable forum was convened by the Turkana County Department of Health and attended by all the leaders of the health worker unions in the county. The issues raised by union officials were on promotions and re-designation of health workers, staffing shortages and burn out, implementation of Collective Bargaining Agreements (CBAs), handling of disciplinary cases, allowances, trainings and administrative support to facilitate work.
The Afya Timiza project facilitated the dialogue process by providing technical support for labour relations to the county health department and logistical support to both parties. This provided an opportunity for the county and health worker union leaders to have an open meeting of equals to discuss issues raised by union leaders and examine responses by the county leadership. Consequently, they were able to build consensus, agree on the resolutions and developed an incremental formula to address the issues raised as the the health workers resume work.
Both levels of government should ensure that strategies that work in different counties are used to ensure better conflict resolution mechanisms; every county has its own dynamics that would aid in yielding good results. The County Public Service Boards, (CPSB), Salaries and Remuneration Commission and county departments of health should have a common point of convergence in managing human capital
Admittedly, there has been better and positive results in the recently called off strike with some counties being able to resolve the impasse with their health workers through deliberations and constant negotiations. This will offer a good platform for future resolutions. It is also a clear indication that solutions can be found within, rather than having to escalate to the national level which takes a lot of time due to vested interests and increased bureaucracy.
The national government has the mandate to ensure Kenyans get the highest standard of health care as envisaged in the constitution; it should therefore be the mandate of government to initiate conversations that can lead to amicable solutions.
Devolution of the health sector was the right thing for the country, many facilities have been established and better medical services recorded across the country than before.
For instance, specialised treatment previously associated with big hospitals is now available at county-based health facilities. Counties such as Makueni have become shining examples of universal health coverage where people can access primary health care close to their location.
But the converse is also true. Management of personnel and equipment has proved problematic. Many counties still have a challenge with staff management, particularly remuneration, training and promotion.