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Table 3 Summary of identified themes and subthemes

From: Prolonged health worker strikes in Kenya- perspectives and experiences of frontline health managers and local communities in Kilifi County

Theme: Perceived causes of the prolonged 2017 strikes

Theme: Overall perceived effects of the strikes

Theme: Efforts to keep services running

-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

  1. CBA Collective Bargaining Agreement, HIV Human Immuno-Deficiency Virus, NGO Non-Governmental Organisation, PHC Primary Health Care, TB Tuberculosis