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Commentary
Tackling health professionals’ strikes: an essential part of health system strengthening in Kenya
  1. Grace Irimu1,
  2. Morris Ogero2,
  3. George Mbevi2,
  4. Celia Kariuki3,
  5. David Gathara2,
  6. Samuel Akech2,
  7. Edwine Barasa2,
  8. Benjamin Tsofa2,
  9. Mike English2
  1. 1Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
  2. 2Kenya Medical Research Institute (KEMRI), Wellcome Trust Research Programme, Nairobi, Kenya
  3. 3Department of Paediatrics Mama Lucy Kibaki Hospital, Nairobi City County, Nairobi, Kenya
  1. Correspondence to Professor Grace Irimu; GIrimu{at}kemri-wellcome.org

https://doi.org/10.1136/bmjgh-2018-001136

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    Summary box

    • Since 2013, Kenya's public health sector has been affected by frequent short strikes, culminating in nationwide strikes lasting a total of 250 days by doctors and nurses in a span of 11 months in 2016/17.

    • Health professionals have the right to go on strike, but their strikes crippled health services with almost no public hospital inpatient services being provided, thus violating people’s right to healthcare.

    • To avoid similar instances in the future, mechanisms should be established for dispute resolution, anticipating and pre-empting changes within the health system that result to conflict between parties.

    • There are no ‘magic bullets’ to avert all problems due to these strikes in what are complex, politically managed and highly professionalised health-sector organisations.

    • Reactive solutions such as sacking striking workers, jailing trade union officials neither address the underlying problems nor build resilience of the health system.

    Introduction

    Since devolution of healthcare services in 2013, the Kenyan public health sector has been affected by frequent short and often localised strikes.1 These were followed by a public-sector nationwide doctors’ strike lasting 100 days (from 5 December 2016 to 14 March 2017) and then the nurses’ strike lasting 150 days (from 5 June to 1 November 2017), a total of 250 strike days in a span of 11 months, referred to hereafter as the 2017 strikes. The strikes resulted from a complex chain of events briefly outlined below.

    A new 2010 Kenya Constitution gave every worker (with some exceptions for disciplined armed forces) the rights to join a union, engage in collective bargaining and the freedom to strike, linked to supporting rights to fair remuneration and reasonable working conditions.2 This constitution also devolved all primary and secondary health services to 47 new semiautonomous county governments. Initial plans were to progressively transfer functions over a 3-year transition period from …

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