WHAT PRECIPITATED THE NURSES STRIKE AND HOW TO END IT

Since the devolution of health service provision, we were assured of a better organized public health system responding to the needs of the citizens at the grassroots. But with untested and improperly structured measures of management the role of health service delivery was taken over by the county governments. This was the start of an unfortunate experiment in failure. Healthcare delivery requires a competent and innovative management of the limited resources allocated in the counties for that vital function. But most counties have had to cope with first -term governors who did not ensure proper focus on planning and thought all the resources in their counties were to be reallocated to other functions at their whim. They also surrounded themselves with yes-men who sung their praises and never once questioned any misadventures in allocation of resources. This myopia affected service delivery and can only be corrected through a better recruitment process in the second term of county governance in this country if we are not to witness the same.

One of the essential pillars to a smoothly working health system is a workforce that is competent, committed, content, confident, compassionate and united. This function of health system takes up over 50% of recurrent expenditure in both the private and public sectors. Healthcare human resources is also the single most important factor that affects all pillars of the health system including health service delivery, supply chain management and management and leadership. Therefore one would think ensuring proper staffing and continent of this important resource would have been the first order of business for any administration. But alas, we were mistaken.

Some of the problems affecting this component of health system include

LACK OF UNITY OF HEALTHWORKERS

Healthworkers cadres in Kenya have become disjoint, individual silos working almost to antagonistic goals and with mutual petty rivalries hindering their unity to ensure an improved health system. In the midst of all the doctors rights and #LipaKamaTender there was hope that the nurses and clinical officers would be on board to ensure a permanent resolution of the problem, but that was not to be. The nursing union officials and membership were mum and busy toiling in the overcrowded hospitals while doctors were busy agitating and holding demos and sit-ins to press for a negotiated settlement. Rumour mills not to be believed insinuated that there was a tiff in the different unions and it led to lack of support for the doctors strike hence the long 100day strike we witnessed. Now the roles have been reversed and #NursesStrikeKe is a fight for the survival of one of the cogs in the wheel of the health system, the care givers. The Clinical officers briefly made a cameo entrance to the thriller with a few hours of industrial action that was immediately hushed by the national and county governments. Maybe it was just short-term expedience to swipe the problem under the carper but sooner or later the clinical officers are bound to come back to the scene with a strike and a hashtag of their own.

The fragmented union activities of the doctors, nurses and clinical officers makes it difficult to have a conclusive and lasting solution to the healthworkers grievances. The different cadres of healthcare have had an ongoing tuff wars that make them not see each other as a team but instead an amalgamation of different and opposing teams. Doctors in general will not have high regard for nurses and nurses seem to be content to harassing new doctors posted at their stations in order to fulfil their dominatrix fantasies. Clinical officers, despite being a fist line care giver in primary healthcare are looked down upon by doctors and this back and forth only yields a messy outcome of scorn, backstabbing and lack of unity.

The current impasse between the nurses and county governments is just a weird sequel of a Quentin Tarantino thriller. Now it’s more than 120 days in and there is no resolution in sight.

A federation of Kenyan health workers unions would be a welcome idea as it would give a forum through which each union would air their grievance towards the other union and ensure a united healthcare workforce representation in all matters related to their interests. All health unions need to realize that the loss of one cadre of health staff is a loss for the whole health system and should ensure their unity of purpose reigns over any other interests so that there is improvement in the health service delivery and terms of their services.

FLAWED JOB EVALUATION

I do know that nurses and other health workers are not demented souls to leave patients dying on the floors of their wards to engage in strikes. There are grievances that led to these acts. Among issues on the table are the recent Salaries and Remuneration Commission(SRC) Job Evaluation that classified  nurses as semi-skilled workers and with starting salaries far below those of other diploma holders in other sectors. The recent SRC job evaluation failed to take into consideration the unique nature of health workers roles and job evaluation resulted in downgrading of cadres of staff. For example a Diploma nurse being equated to a Diploma sales and purchasing graduate on the basis of each being a diploma graduate.

Another flaw in most job evaluations including I presume the SRC one is the classification of staff depending on the number of staff they supervise. These guidelines have not taken into consideration the unique structure of healthcare where a nurse may not necessarily supervise any of her colleagues but the value of her work is measured even in the economic and human development indices of the country based on lives saved, children immunized and mothers attended to in childbirth. Using this simple formula there is no way a nurse or any health worker with Diplomas would be ranked in the same category as clerks in the procurement departments. Furthermore nurses are involved in front line lifesaving tasks fraught with risks including life altering ones such as infection with deadly multidrug resistant diseases and needle pricks that can infect them with HIV in the cause of carrying out their calling.

It’s time the government and the SRC relooked at the health workers classification in the Job Evaluation and include a category of knowledge workers whose contribution to the society is just unquantifiable and very important for human development of the country. Maybe one day we can finally see a nurse or any other health worker not having to do double-shifts just to make ends meet and to have proper family life like the rest of the Kenya workers.

In the meantime all I hope is that that the slogan of solidarity is not mere rhetoric for the other health worker union and that they can bury the hatchet with the nurses union and help them realize their goal of proper job classification and recognition. Dr Oluga, can you hear me?