Theme: Perceived causes of the prolonged 2017 strikes | Theme: Overall perceived effects of the strikes | Theme: Efforts to keep services running |
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-Frustration with government’s failure to honour previous CBAs | Disruptions of service delivery -Decline in in-patient admissions -Reduction in outpatient service utilisation | Prioritization of specific services -Prioritization of emergency and chronic care services |
-Simmering discontent with human resource processes and poor working conditions | Households missed care with related health outcomes -Delays in accessing care due to uncertainty about which public facilities were open -Reported health related effects included: unwanted pregnancies, maternal complications and deaths, new-born deaths and long-term complications from delayed treatment | Minimising and managing conflict -Nurse managers tried to calm tensions and conflict between striking and non-striking nurses Drawing on NGO staff, other cadres and students -NGO staff continued to offer services in NGO supported areas such as TB/HIV -In some PHC facilities, support staff reportedly dispensed medications for minor ailments -Task-shifting to students and other non-striking cadres |
-Differences and unfairnesses across cadres of health workers | Alternative sources of care and increased costs of care: - Private facilities were an alternative source of care -Other reported alternatives include use of herbs or self-medication -Some households had to borrow or sell household assets to meet costs of care in private facilities | Links and interactions with private facilities: -Adoption of an informal system of transferring patients for post-operative care in private facilities during both strike periods. -Sub-county managers increased supervisory visits to private facilities and provided these facilities with supplies to ensure community members continued to receive services. |
Broader political context & activities -Politics reportedly took precedence over negotiation with nurses as politicians and government actors focused on national and county elections -Poor co-ordination between national and local governments impacted handling the strike | Demotivation among health system staff: -Health managers reported working long hours and feeling unsupported by their supervisors -Service provision was slower and more tasking for the non-striking staff leading to demotivation Loss of trust in the public health system: -Service disruption caused by high recurrence of strikes contributed to loss of trust in the public sector among community members | Support and action from the public: -Community members reportedly supported the health workers’ strikes. -However, after the death of two pregnant women during the nurses’ strike, some urban residents engaged the media to protest the continued strike. -Other community members almost burned down a private facility for demanding payment to remove the body of a woman who had been denied maternity care due to lack of funds |