The five-month strike by nurses, which ended in November, was one of the longest and deadliest in Kenya.
The images out of the various health facilities were grim— mainly capturing the deep suffering of patients and their relatives.
The medical personnel attending to the patients during this period of strain were seldom heard as they worked in the background to save lives despite the massive shortage of staff due to the boycott.
Health workers at the only operating facilities during the strike such as the Kenyatta National Hospital (KNH) and Moi Teaching and Referral Hospital lived to tell a tale.
The KNH, for example, delivers between 1,200 and 1,500 babies a month but the number doubled during the nurses’ strike to between 2,400 and 3,000, said Orora Maranga, head of reproductive health at the facility during an interview.
“Around 40 to 50 per cent of the patients were in need of Caesarean section at any given moment,” he says, and added that only six doctors were present every 24 hours, attending to the huge number of patients at the labour and obstetric unit — most affected by the industrial dispute.
The hospital has a 30-bed labour ward unit. However, during the strike, there were 80 deliveries a day, says Dr Maranga.
This meant that doctors and other health workers were overwhelmed.
This definitely affected the quality of healthcare service delivery and probably increased pain and stress to not only the patients but also the medical professionals who had to work longer hours due to the increased number of patients.
With the limited number of personnel, the quality of service delivery may have gone down as the professionals opted to handle the most severe and urgent cases, he says.
“We tried, we took measures, and the figures in terms of maternal and newborn deaths did not unjustifiably increase at the hospital,” says Dr Maranga.
However, due to the increased number of patients in need of Caesarean section, the hospital had to increase the number of theatres to four, he adds.
This also meant that some of the patients requiring other forms of surgeries that were not urgent had to be displaced to create room for increased Caesarean deliveries, he says.
“There was a lot of pressure and strain at the hospital. We had to increase the number of workers, both professional and support staff, but still the numbers were overwhelming,” says Dr Maranga.
The number of pending Caesarean sections was too high during the strike, said John Ong’ech, deputy director, surgical services at KNH.
“There were increased numbers of mothers and preterm babies. Preterm babies doubled during the said period at the hospital,” he says.
Maternal, neonatal deaths
As a result, there were increased maternal and neonatal deaths at the hospital, especially due to late referrals, he explained.
“It was not easy, the strike definitely resulted in increased maternal and neonatal deaths. We could not turn away the mothers who came to the hospital to seek our services,” he says.
Dr Ong’ech added that some of the deaths, especially of newborns, were due to congestion and cross-infection,
“Mothers and newborns were dying every day at the hospital because the medical staff and the nurses were overwhelmed,” he says.
At least six preterm babies would share an incubator, he added, a situation that increased the rate of cross-infections amongst the infants.
“It was a painful situation, to say the least, to watch helplessly as lives drifted away,” says Dr Ong’ech.
More mothers, newborns and children could have died at home, especially in far-flung areas, those who could not afford to go to private hospitals or did not have the means to get to the KNH or Moi Teaching and Referral Hospital, said the doctors.
“Though we do not have definite data, the number of mothers and children who died was very high. The strike affected mostly those who could not afford medical services in private hospitals. The situation was very bad amongst poor families, it was a double tragedy,” said Louisa Muteti, Midwives Association of Kenya chairperson who is also a midwife at Makueni County and Referral Hospital in Wote.
“Outpatient sections in public hospitals were closed, there was no way we could help mothers, the situation was grim and painful,” she says.
This is in addition to the fact that famine in most parts of the country during the five-month period exacerbated the already bad situation, said the healthcare practitioner.
Dr Patrick Amoth, standing in for the director of medical services at the Ministry of Health, says the government was compiling and analysing data from the counties on the actual numbers of maternal, neonatal and child deaths as well as the impact of the strike had on maternal and child health.
One of the most affected regions was Nairobi. According to a senior county government official who declined to be named, the situation was grim.
Nairobi has three major hospitals — Mama Lucy Kibaki Hospital, Mbagathi and Pumwani Maternity, and at least 78 health centres and satellite clinics, all of which were closed, forcing city residents to flock to the KNH.
At a time when the country is recovering from the debilitating effects of the strike which started only two months after the 100-day doctors’ strike ended in March, the fact remains that thousands of women and babies die every year during or after childbirth in Kenya.
As the government strives to reduce maternal and neonatal deaths in accordance with goal number four and five of the Millennium Development Goals 2015, incessant strikes make it difficult to achieve the goals.
These goals sought to reduce under five years’ child mortality and to improve maternal health around the world.
However, by the time the UN Sustainable Development Goals replaced the MDGs in 2015, a World Bank and United Nations report shows an average of 510 mothers out of 100,000 live births died during delivery in Kenya, with a lower estimate of 344 and a high of 754 deaths in the same year.
In total, 8,000 mothers died in Kenya in 2015 during childbirth, according to the report titled: ‘Trends in Maternal Mortality: 1990 to 2015’, one of the highest death rates in the world.
Kenya was ranked among 18 sub-Saharan Africa countries that had the highest maternal mortality rate with Sierra Leone leading the pack with an average of 1,360 deaths per 100,000 live births.
During the same year, 22.2 children per 1,000 live births died in Kenya, according to the report.
However, according to the Kenya Demographic Health Survey 2014 report, the maternal mortality rate was 362 out of 100,000 live births, way above the projected 147 out of 100,000 live births at the moment.
Erode healthcare gains
Strikes in the health sector may be slowing down, or even eroding the gains the country has attained over the years, Dr Maranga told the Business Daily.
And the situation has been worsened due to the fact that healthcare service delivery is a devolved function, he said and added that frequent strikes in the sector not only affect mothers and children but also the public.
“Maternal, neonatal and child mortality are affected more by what happens in the society rather than what happens in the hospitals. However, there is a decrease in the momentum towards achieving the MDGs because of the strikes,” he says.
In addition to strikes, maternal and neonatal healthcare are dogged by various hurdles.
“Kenya did not reach the MDG number five target of 147 per 100,000 live births maternal mortality rate due to various reasons. For example, there is only a small number of staff with core midwifery competencies in the country,” says Ms Muteti.
She added that ill-equipped facilities have affected healthcare service delivery.
“The last time midwives were trained in Kenya was in 2005. Currently, there are 100 midwives only, and, 71 are in management level,” she said.
It is unfortunate that mothers share beds due to congestion in many public health facilities, she added.
Despite Kenya being a signatory to the Abuja Declaration 2001, it has not achieved the 15 per cent target in budget allocation to the health sector.
As a result, healthcare services remain poor and incessant strikes have made it worse and bring unending pain and sorrow.
Catherine Ongeti, healthcare practitioner at the Jacaranda Maternity in Ruiru, Nairobi, says there is a difference between being able to access healthcare and getting quality medical services.
“Institutional deliveries are increasing among all income groups around the world, especially in Africa, yet increased access to care does not often result to improvement in the quality of healthcare or better health outcomes,” she said during an earlier interview.
According to Ms Ongeti, most maternal deaths occur due to preventable causes. Many mothers become sick before or after childbirth due to poor handling, all which boil down to poor quality health services.