Doctors and nurses in Kenya’s public hospitals downed their tools in the latest round of strikes to press for higher pay. Thousands of desperate patients have been left without care. Public hospitals are the easiest health service to access for the vast majority of Kenyans. They also offer the most affordable care. Health and Medicine Editor Joy Wanja Muraya spoke to Moses Masika about the reasons for the strike, and its impact.
What are the main reasons for the strike?
The current doctors’ strike is a result of the government failing to implement a collective bargaining agreement signed in June 2013. The agreement was based on negotiations between the government and the doctors’ union which started after another doctors’ strike in December 2011.
Over the last two years the union has reached out to several government organs to have the agreement implemented, but without success. These have included the Ministry of Health, the Salaries and Remuneration Commission, the National Assembly and the courts.
There have been more than two dozen strikes since the devolution of health services in 2013. At the end of 2013 most health services were decentralised from the central government to county governments in keeping with Kenya’s new constitution. The process was done hurriedly and the newly established county governments were faced with the responsibility of providing health services with no proper structures in place.
For example, the health bill – which was supposed to guide the health sector under the new dispensation – has not yet been passed into law.
Poor human resource management in the counties is another major problem. This has exposed medics to poor pay, salary delays, lack of a fair structure for career progression and training as well as discrimination and harassment.
The national government has the mandate to ensure Kenyans get the highest standard of health care as envisaged in the constitution. But it has done little to streamline the health sector after the devolution.
These issues – emanating from both national and county governments – have frustrated Kenya’s health workers and doctors. They have exhausted all other options except withdrawal of services which is a measure of last resort.
How do the pay and working conditions offered to public sector medical workers in Kenya compare with those in other African countries?
Working conditions for health care workers in Kenya are challenging. There are several issues.
Poor pay is the first on list. I made enquiries of the net salaries of newly employed doctor in several African countries and compared these salaries with the corresponding GDP per capita as listed by the World Bank. The net salary of a newly employed doctor in Kenya is 58% of the GDP per capita as compared to 86% in Malawi, 116% in Zimbabwe and 154% in the Democratic Republic of Congo. This means that a doctor in Kenya earns 58% the average income per person while a doctor in DRC earns 154% of the average income in the country. In hard figures, the net salary of a doctor in Kenya is US$ 800 as compared to US$ 1,000 in Zimbabwe and US$ 2,500 in South Africa.
In addition to poor pay, most health facilities are understaffed forcing workers to contend with long hours and inadequate facilities which leads to frustration and burn out.
In other African countries, especially those in southern Africa, doctors are offered better pay to attract and retain them. Better perks are offered to doctors who offer to work rural areas. But this is not the case in Kenya. Currently the country has about 10,000 doctors and less than half are in public service. A third of these are in Nairobi which has less than 10% of the total population.
Kenya, like many other countries on the continent, is suffering a brain drain as its highly-trained workforce – including doctors – moves south or to the developed world.
How do these disputes affect the morale of health workers?
The recurrent disputes have taken a toll on the morale of many health workers, forcing some to leave the counties to seek alternative employment.
Strikes in the health sector are never a good thing. Governments should do its best to avoid them yet the Kenyan government seems to have done very little.
We have no hard figures to quantify the effect of the strike. But the impact is likely to be felt in a number of ways. Even without a strike, many preventable deaths occur in hospitals because of inadequate investment in facilities, training and staff. A strike is likely to worsen this.
In addition, patients who access care late may suffer. The country has hundreds of thousands of patients on treatment for chronic conditions such as diabetes, hypertension and HIV. Many are likely to default on their treatment if the strike is prolonged. Interrupted care for the chronically ill will worsen their conditions.
Some patients may also turn to traditional healers. This could result in them needing more advanced care and longer hospital stays in the future. In turn this will increase the economic burden to patients, their relatives and the taxpayer.
How can governments and other employers avert industrial action?
The government and other employers in the health sector need to work proactively to promote harmony. They need to adopt fair labour practices by engaging unions continuously not only during industrial unrest.
This engagement should be on a platform of mutual respect among the three key partners: the government, employers and unions (employees). This would help address thorny issues promptly and reduce industrial unrest.
Employers, including the government, will find it easier to retain and motivate doctors if they offered decent wages, fair working hours and a clear path for career progression and training.
There should be a conducive working environment where doctors can work safely and in dignity. Doctors have often been harassed and sometimes attacked while executing their duties.
The collective bargaining agreement that the union is agitating for addresses these issues. If implemented it will restore order in the sector, retain more doctors in public service and boost their morale. This would be a good place to start.
Author’s note: This article has changed to clarify the methodology I used to calculate the earnings of doctors.