Dance with death: A health crisis nobody wants to address

The dance with death has become an annual ritual. 

Since the advent of devolution in 2013, at least one county witnesses a healthcare workers strike every month. 

And with that, many Kenyans have had to pay the ultimate price, leaving floods of tears behind.

Health has remained in the intensive care unit – never fixed but always on life support.

Health workers in 10 counties are on strike, with several deaths already reported.

It is the patients who suffer as the devolved governments and workers unions fight.

From Kenyatta National Hospital in Nairobi to Mombasa, Bungoma, Turkana and several other counties, it has been a tale of death, despair, and pain.

Kenya witnessed its longest strike by doctors, which began on December 5, 2016 and ended on March 14, 2017 - a record 100 days. 

As if that pain was not enough, the doctors’ action was followed by a 150-day nurses strike that began three months later.

It was a record 250 days of healthcare workers’ strikes in just 11 months.

They were complaining of poor pay and failure to implement the 2012 CBA.

Emergency measures

The government took emergency measures that saw consultants and military doctors deployed to public hospitals.

Basic services were restricted to emergencies while elective procedures were deferred or referred to private hospitals, for those who could afford.

Clinical officers took over operations and cases they could manage.

Later, the public was led to believe there would be no more strikes by health workers.

The national and county governments promised to act. Alas! It was not to be.

On Monday, doctors, and nurses at KNH began a strike to push for better remuneration, paralysing services at a time the nation is battling a global pandemic.

The workers want the government to implement a new organisational structure and adjust pay as agreed when KNH was upgraded to a top-tier parastatal eight years ago.

Their action came barely a week after the Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) issued a strike notice if its grievances are not addressed.

Nurses and doctors have boycotted work in several counties. 

“We have issued the strike notice because of persistent failure and lacklustre approach to address the challenges endemic in the health sector,” KMPDU acting Secretary General Chibanzi Mwachonda said.

“The CBA is in its final year of implementation but many issues remain unresolved. Failure to make the CBA operational has directly been linked to the scattered approaches that individual counties and the national government have taken.”

He said the health workers’ strikes and court cases tell a lot.

“County governments are not willing to end this CBA issue, resulting in doctors being denied of the gains of on-call and risk allowances,” he said.

The solution? A new agency

The solution to all the above issues, as Dr Mwachonda argued, was the creation of a Health Services Commission.

Kenya Medical Association President Dr Were Onyino agrees, adding that the government must centralise the management of the human resource, adding that the Health Services Commission would be best placed to do this.  

“The decisions with regard to health care human resources needs a competent authority well briefed on the matter,” he said.

So, will the government finally head and push for a Commission to avert the persistent disruption to critical healthcare services by these industrial actions?

The Building Bridges Initiative (BBI) report supports the formation of this Commission, and could just be the magic bullet required to save Kenyans from this annual ritual of pain and suffering.

The BBI, in its report proposed that a commission be established to take charge of the management of staff in the public health sector. This will remove the health human resource from the counties control. 

“A transfer of transfer of the health sector personnel element from county governments to an independent Health Service Commission to enable sharing of the very limited health experts,” it said.

According to the BBI proposal, once established, the Commission will register all trained health workers and develop job groups in accordance with the various cadres in the health sector. 

It will also develop a promotion criteria, work out compensation allowance in accordance with hours offered, while also managing transfers of health workers across counties.

This, if passed, will be a win for health workers, but also offer permanent relief to the public as it will guarantee the transfer of Health functions from county governments to an independent Commission.