A vicious cycle of crippling strikes and endless pay disputes has severely affected the ability of public hospitals to deliver much-needed health services to Kenyans.
The constant conflict between county governments and health workers has pushed patients to seek health services in private hospitals and clinics despite the prohibitive costs.
There appears to be no hope in sight that the current nurses’ strike, which started in June will end any time soon.
Indeed nurses have said that they are tired of being undermined by governors who they accuse of ignoring their interests.
“They never honour their word,” Mr Seth Panyako, the Secretary-General of the Kenya National Union of Nurses, said.
“It does not matter how many meetings we have with them. They will simply not respect it.”
In February, barely two months after calling off an earlier nationwide strike that coincided with that of doctors, the nurses were back on the streets again, demanding better working conditions.
Their main grievance was that although they had signed a Collective Bargaining Agreement (CBA) with governors and the Ministry of Health in December, the county bosses had failed to honour their part of the bargain.
The December strike had been called off after the Ministry of Health and the union signed a Sh7 billion agreement.
The deal between Kenya National Union of Nurses (KNUN) and the ministry would have seen nurses receive monthly allowances of between Sh15,000 to Sh20,000, depending on their job group.
Despite the two parties agreeing that county governments would not punish or intimidate any of the officials for participating in the boycott, some of the employers failed to keep their part of the bargain.
So, this time round, the close to 26,000 nurses across the country are standing their ground.
The strike to push for recognition and implementation of their CBA has entered its 109th day.
In their new CBA, they are demanding monthly allowances of between Sh15,000 to Sh35,000, depending on their job group.
They also want an additional Sh5,000 as extraneous allowance over and above what is currently being paid to nurses across all job groups.
They also want a call allowance of Sh10,000 for anaesthetist nurses and nurses working in dispensaries and health centres.
They are also demanding responsibility and house allowances among others.
In all, the average amount of money needed by counties to settle this expenditure is estimated at Sh8 billion annually, money which the Salaries and Remuneration Commission (SRC) says governors do not have.
Although nurses provide the bulk of direct patient care at all levels of health services delivery in the country, the public sector seems to have ground to a halt since June 5 when the nurses downed their tools.
They are now threatening to take legal action against governors who will replace any of the nurses currently on strike.
This is after the governors advertised for the positions left vacant by the striking health workers.
Mr Panyako told the Saturday Nation that the advertisements were misguided.
“They (governors) cannot afford to have nurses replaced. Already there is a huge shortage of nurses so what they should advertise instead are for position meant to employ more nurses,” he said.
Government spending on health care is approximately six per cent of GDP, a relatively low figure compared to other countries in the region.
About one in four Kenyans are covered by public and private insurance schemes, leaving three out four without any form of insurance.
As such, they have to depend on out of pocket cash reserves when they fall ill.
A public health expert and University of Nairobi academic, Prof James Mbaria, says the strike’s biggest losers have been patients.
“In cases of illness, prompt diagnosis gives the prescribed treatment regimen higher chances of succeeding.
“Delays in the diagnosis and treatment of patients can lead to a worsening of their health complications and even death in some cases,” the head of the university’s Pharmacology and Toxicology Department says.
Prof Mbaria also notes that the strike is bad for the economy due to the man hours already lost by patients involved in businesses and other forms of gainful employment taking longer periods to recover as they lack access to specialised, affordable medical care.
“Our economic well-being has been affected by the strike since patients who were previously clients of the public health care system are taking longer periods and spending more in private hospitals to recover from their illnesses,” he said.
The impasse has degenerated into an alternating chorus of accusations, threats and displays of brinkmanship between the Ministry of Health, the Council of Governors and the nurses’ union.
The fault, however, does not entirely lie with the county governments. The nurses’ officials cannot also stop squabbling.
To end the impasse, Prof Mbaria proposed the immediate harmonisation of salaries payable to the various health sector workers sharing the same grades and designations to avert “mass discontent caused by pay disparities”.
“It is not practical to have staff from the same sector on different salary scales when their qualifications are the same simply because they were employed at different times or by different levels of government.
“As long as we fail to harmonise the salaries and these pay disparities exist, the endless cycle of strikes will never end,” he said.
Following the promulgation of the Constitution in 2010, primary and secondary level public health services moved in 2013 from the national government and the Ministry of Health to county governments.
Since then, the ministry is limited to providing support and technical guidance to the counties and is responsible for regulating the health sector with the counties providing the health services.
The ministry is guided by the Kenya Health Sector Strategic Plan 2013-2017, which is prepared for every election cycle.
Prof Mbaria sees a comprehensive review of the laws and policies governing the national and devolved health sectors as another possible solution.
“Devolution of health was a brilliant idea whose implementation was not well thought-out and what we are witnessing are the teething problems of implementation which can be resolved by comprehensive consultations and review of related laws and policies,” he said.
“The health sector is a priority area and the reforms will eliminate grey areas and conflicts of scope and interpretation in service delivery between the two government levels.”
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