Abstract
BackgroundHealth worker strikes are a significant threat to universal access to care globally and especially in sub Saharan Africa. Kenya’s health sector has seen an increase in such industrial action. Globally there is limited data that has examined mortality related to such strikes in countries where emergency services were preserved. We sought to assess the mortality impact of an 100 day physician strike which was followed by 151 day nurses’ strike and 20 day clinical officer strike in Kenya.MethodsMonthly mortality data was abstracted from four public hospitals, Kenyatta National Referral Hospital, AIC Kijabe Hospital, Mbagathi Hospital and Siaya Hospital between December 2016 and March 2018. Differences in mortality were assessed using t-tests and multiple linear regression adjusting for facility, numbers of patients utilizing the hospital and department.ResultsThere was a significant decline in the numbers of patients seen, comparing the non-strike and strike periods; beta (ß) coefficient − 649 (95% CI -950, − 347) p < 0.0001. The physicians’ strike saw a significant decline in mortality (ß) coefficient − 19.0 (95%CI -29.2, − 8.87) p < 0.0001. Nurses and Clinical Officer strikes’ did not significantly impact mortality. There was no mortality increase in the post-strike period beta (ß) coefficient 7.42 (95%CI -16.7, 1.85) p = 0.12.ConclusionDeclines in facility-based mortality during strike months was noted when compared to a non-striking facility, where mortality increased. The decline is possibly associated with the reduced patient volumes, and a possible change in quality of care. Public health facilities are congested and over-utilized by the local population majority of whom cannot afford even low cost private care. Health worker strikes in Kenya where the public health system is the only financially accessible option for 80% of the population pose a significant threat to universal access to care. Judicious investment in the health infrastructure and staffing may decrease congestion and improve quality of care with attendant mortality decline.
Highlights
Health worker strikes are a significant threat to universal access to care globally and especially in sub Saharan Africa
Settings We selected four hospitals that represent a spectrum of health facilities available in Kenya [1]; Kenyatta National referral hospital (KNH), which operates as a parastatal organization and whose nurses were not on strike during the 151 day nursing strike, [2] a private mission hospital, Kijabe Hospital (AICKH) whose health workers did not participate in any of the national unionized health worker industrial action, [3] a level 4 urban hospital (Mbagathi Hospital-MH) and, [4] a level 4 rural hospital (Siaya Hospital-SH)
It has been reported that the nurses’ at AICKH went on strike for 1 week in February in the midst of the doctors’ strike
Summary
Health worker strikes are a significant threat to universal access to care globally and especially in sub Saharan Africa. There is limited data that has examined mortality related to such strikes in countries where emergency services were preserved. We sought to assess the mortality impact of an 100 day physician strike which was followed by 151 day nurses’ strike and 20 day clinical officer strike in Kenya. The formal assessment of the impact of health workers’ strikes on mortality has demonstrated counterintuitive outcomes [1] contrary to mass media reports and reported health worker concerns [2, 3]. The nurses’ and doctors’ strikes in Kenya generated perceptions of unmet health needs [3]. Poor and disadvantaged persons report higher unmet needs for health care when there are strikes [5]. Suspension of health services may have unknown effects based on the organization of the health systems in that setting, health seeking behavior, morbidity patterns and the cadre of health professionals on strike as well as level of participation
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