Our nurses are on strike once again. The sorry images of
abandoned patients are looming big on our screens one more time. It is barely
two years since the last major strikes and here we are. What is it about our
human resources for health that we just can’t seem to get right?
There have been multiple debates about healthcare in Kenya.
The biggest yet, has been on the devolution of health as a function. That boat
sailed many years ago but despite so much focus on healthcare in Kenya in this
duration, the sector is still bleeding miserably.
How is it that our frontline health workers are so unhappy? How
is it that we cannot seem to get solutions that last in such a sensitive sector?
So much investment has gone into health infrastructure with billions’ worth of
medical equipment being launched weekly, restructuring in key state health
corporations such as the Kenya Medical Supplies Agency (KEMSA), building and
expansion of hospitals, but there has not been any convincing investment in
human resources for health.
How is it that such a key building block in the provision of
such an integral service remains so disorganized? I would be very wary if the
nurse changing my bedpan was so dissatisfied with her work environment that she
would have to down her tools every other year, just to be heard. Do our
decision makers ever realize just how hard they fail the taxpayer?
Nurses go on strike for the most basic of things. They do not
demand for luxuries. Allowances to be able to afford the uniforms they must
wear to work, failure to which, they would be in contravention of their code of
conduct. They demand that they should be compensated for the high risks they
are exposed to when serving the patients. This is not even remotely luxurious.
Nurses have contracted diseases and died in the line of duty.
How is it possible that after all these years of having a
formal health system, we cannot seem to figure out just how important these
nurses are to all of us and just handle their matters conclusively and put an
end to these unnecessary strikes?
It is pretentious to look at this matter from the financial
angle only. The deep dissatisfaction presented here is beyond money issues.
They stem from a deep feeling of being unappreciated as a service provider and
not having space to have your opinion heard and considered.
It cannot be that in the same country, there is a county that
has been able to keep their word and implement the collective bargaining
agreement while another claims to have no budget for it. Does this not point to
an unresponsive and irresponsible leadership?
These are the failures that keep building the case for a
centralized health service commission. There is no guarantee that it will
resolve all pending problems but it will definitely make it easier to hold one
office accountable for the mess happening countrywide and get answers. It will
definitely be much easier to replace non-performing office holders.
With sterling examples such as Makueni County, it is obvious
that devolution can work well when those tasked with implementation do their
job. It is unfortunate that the oversight function in health does not seem to
exist. It is incredible that a function that is directly determinant of life
and death is left unattended to the point that we keep creating mini-holocausts
that cause death to hundreds of patients.
What exactly is the definition of a shared function? Who will
crack the whip on counties going rogue in health care, resulting in unnecessary
deaths? Who will hold counties accountable when they do not pay their debts to
KEMSA, resulting in suspended provision of essential drugs to hospitals? Who
will demand answers when expensive equipment goes to waste because there is no
county budgetary allocation for servicing and provision of reagents in the
laboratory yet the leases are faithfully serviced.
This predictable circus of strike notices, unconvincing
responses, actual strikes, court orders declaring the strikes illegal,
intimidations, arrests and eventual sit-downs is getting really old. How can
any leader worth their salt fail so miserably to the point that workers can go
on strike to demand implementation of agreements jointly agreed upon, even when
they have specific timelines?
It is time to take stock and make tough decisions. We cannot
be advocating for universal health coverage with interruptions of such
magnitude. The joke is on us. There must be a comprehensive review of how
health workers will be managed, to realize this basic right. We are destroying
donor confidence in the entire project.
In addition, as we continue to view this as a devolved
problem, we forget that key national functions are also compromised.
Immunization programmes are effected through these very same cadre of staff. We
are exposing the entire population by compromising public health interventions.
As we advocate for recognition and remuneration of community
health workers, we must first sort out the workers we already have. It does not
matter how many machines are procured if there is no one to utilize them for
the betterment of the patient’s health.
Nursing care is the mainstay of hospital care for patients.
Once the nurse exits the equation, everything else collapses. We cannot continue
being this casual about the negative impact of the industrial unrest to the
health of our country. Could we stop paying lip service to this problem and
resolve it once and for all?
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