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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 strikesTheme: Overall perceived effects of the strikesTheme: Efforts to keep services running
-Frustration with government’s failure to honour previous CBAsDisruptions 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 conditionsHouseholds 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 workersAlternative 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