Abstract
BackgroundHealth care workers in Kenya have launched major strikes in the public health sector in the past decade but the impact of strikes on health systems is under-explored. We conducted a qualitative study to investigate maternal and child health care and services during nationwide strikes by health care workers in 2017 from the perspective of pregnant women, community health volunteers (CHVs), and health facility managers.MethodsWe conducted in-depth interviews and focus group discussions (FGDs) with three populations: women who were pregnant in 2017, CHVs, and health facility managers. Women who were pregnant in 2017 were part of a previous study. All participants were recruited using convenience sampling from a single County in western Kenya. Interviews and FGDs were conducted in English or Kiswahili using semi-structured guides that probed women’s pregnancy experiences and maternal and child health services in 2017. Interviews and FGDs were audio-recorded, translated, and transcribed. Content analysis followed a thematic framework approach using deductive and inductive approaches.ResultsForty-three women and 22 CHVs participated in 4 FGDs and 3 FGDs, respectively, and 8 health facility managers participated in interviews. CHVs and health facility managers were majority female (80%). Participants reported that strikes by health care workers significantly impacted the availability and quality of maternal and child health services in 2017 and had indirect economic effects due to households paying for services in the private sector. Participants felt it was the poor, particularly poor women, who were most affected since they were more likely to rely on public services, while CHVs highlighted their own poor working conditions in response to strikes by physicians and nurses. Strikes strained relationships and trust between communities and the health system that were identified as essential to maternal and child health care.ConclusionWe found that the impacts of strikes by health care workers in 2017 extended beyond negative health and economic effects and exacerbated fundamental inequities in the health system. While this study was conducted in one County, our findings suggest several potential avenues for strengthening maternal and child health care in Kenya that were highlighted by nationwide strikes in 2017.
Highlights
Health care workers in Kenya have launched major strikes in the public health sector in the past decade but the impact of strikes on health systems is under-explored
Five health facility managers were nurses, two were public health officers, and one was a community health extension worker, with five working in public facilities and three working in private facilities in 2017
community health volunteers (CHVs) had a median of 11 years of experience while health facility managers had a median of four years of experience in their position
Summary
Health care workers in Kenya have launched major strikes in the public health sector in the past decade but the impact of strikes on health systems is under-explored. Recent government initiatives have aimed to improve access to and utilization of maternity services [5], including a new scheme launched in 2017 called Linda Mama that covers maternity services, including antenatal care (ANC), delivery, and postnatal care, under the national health insurer, the National Hospital Insurance Fund [6] These policies have been associated with moderate increases in ANC coverage and delivery with a skilled birth attendant, but significant demand- and supply-side barriers remain, for women who are poorer and reside in more rural communities [7,8,9,10,11]. Clinical officers, who are mid-level physician-assistant clinicians in Kenya [14], launched their own 20-day strike led by their union in the midst of the nurses’ strike
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
