Nurses Strike: Is health care at the primary level in Kenya collapsing?

Health services in Kenya’s public health facilities remain paralyzed that is now entering into its 100th day due to the ongoing nurse strike.

The nurses have paralyzed health services demanding the full implementation of the Collective Bargaining Agreement (CBA).

26,000-member union has issued a peaceful demonstration notice beginning Monday ‘until the solutions to the CBA dispute is found or the strike is called of’ according to Seth Panyako, Kenya National Union of Nurses (KNUN).

According to the CBA, the union wants the least pay for a nurse to be KSh52, 000, up from KSh38,000 while the highest paid will receive KSh130,000 from KSh70, 000.

In contrast, the union’s National Chairman of the union John Bii however, has been reported to state that the strike is illegal citing that the nurses have to go back to the negotiating table before eventually signing the CBA.

“It is not in dispute that nurses in the public sector were awarded nursing service allowance of KSh20,000 last year during the negotiated return-to-work formula, which was paid in January and February in most counties and national facilities. This was, however, stopped after the nurses, through the Secretary-General demanded health service allowance, which was the preserve of other health care cadres.”

Further, the Council of Governors has termed the ongoing nurses’ strike illegal as the right procedure was not followed for industrial action as stipulated in law.

According to the Council of Governors, the financial implications of the current draft CBA stands at KSh40 billion over a period of four years which translates to KSh10 billion annually which they term as unsustainable.

In the current financial year, the County Governments have made increments of KSh3.4 billion to nurses to be paid every financial year.

As a result, both governments, national and county have urged them to take the offer and resume work to avoid disciplinary action.

President Uhuru Kenyatta during the launch of a cancer treatment center at the Kenyatta National Hospital  asked the nurses to go to work. “He said public servants should know that they work for the public and should not disrupt services that benefit citizens,” according to the PSCU statement.

Besides, nurses have remained steadfast. All they seek is  better public health care for the public.

The Kenya National Union of Nurses called the strike on June 5 and efforts by the Council of Governors and the government to resolve the impasse have hit a dead end.

In Kenya, access to quality health care is a constitutional right, however, millions cannot afford to pay for health services at public or private clinics.

The Constitution incorporated economic, social and cultural rights in the Bill of the Rights Article 43. The article provides that every person has the right to the highest attainable standard of health, which includes the right to health care services, including reproductive health care; to accessible housing, and to reasonable standards of sanitation; to be free from hunger and to have adequate food of acceptable quality; to clean and safe water in adequate quantities; to social security and to education.

A person shall not be denied emergency medical treatment.

The State shall provide appropriate social security to persons who are unable to support themselves and their dependents.

As the strike goes on with no one addressing it, the poor and indigent are the most affected when it comes access to healthcare because one needs money to receive medical services.

But healthcare is a  devolved fun action in Kenya. However, certain health service remain the role of the national government and these include; health policy, financing, national referral hospitals, quality assurance and standards, health information, communication and technology, national public health laboratories, public-private partnerships, monitoring and evaluation, planning and budgeting for national health service and maintenance of services provided by Kenya Medical Supplies Agency, National hospital Insurance Fund, Kenya Medical Training College and Kenya Medical Research Institute.

In the devolved government, the Kenya Health Policy 2014-2030 provides guidance to the health sector in terms of identifying and outlining the requisite activities in achieving the government’s health goals.

It provides an institutional framework and structure that specifies the new institutional and management arrangements required under the devolved system.

It also acknowledges the need for new governance and management arrangements at both levels of government and outlines governance objectives as delivery of efficient, cost effective and equitable health services, devolution of health service delivery, administration and management to the community level, stakeholder participation and accountability in health service delivery.

However, it has proven difficult to smoothly devolve these functions.

This has led to debates on whether to the functions of health services provision should be devolved.

The challenges facing the sector indeed have affected  health care at the primary level which in most cases is the first , if not the only level of health services subject to devolution.

Kenya can only realise the right to health through a consultative process that will incorporate both party’s ideas to avoid future crises and strikes as it is the case that has paralysed health services and put many lives at risk.

The government should realise that enjoyment of the right by the poor and marginalised will depend on what measures are implemented to improve access to healthcare services.