Paediatric and obstetric outcomes at a faith-based hospital during the 100-day public sector physician strike in Kenya

Abstract

Published reviews of national physician strikes have shown a reduction in patient mortality. From 5 December 2016 until 14 March 2017, Kenyan physicians in the public sector went on strike leaving only private (not-for-profit and for-profit) hospitals able to offer physician care. We report on our experience at AIC-Kijabe Hospital, a not-for-profit, faith-based Kenyan hospital, before, during and after the 100-day strike was completed by examining patient admissions and deaths in the time periods before, during and after the strike. The volume of patients increased and exceeded the hospital’s ability to respond to needs. There were substantial increases in sick newborn admissions during this time frame and an additional ward was opened to respond to this need. Increased need occurred across all services but staffing and space limited ability to respond to increased demand. There were increases in deaths during the strike period across the paediatric medical, newborn, paediatric surgical and obstetric units with an OR (95% CI) of death of 3.9 (95% CI 2.3 to 6.4), 4.1 (95% CI 2.4 to 7.1), 7.9 (95% CI 3.2 to 20) and 3.2 (95% CI 0.39 to 27), respectively. Increased mortality across paediatric and obstetrical services at AIC-Kijabe Hospital correlated with the crippling of healthcare delivery in the public sector during the national physicians’ strike in Kenya.

Effect of strikes by health workers on mortality between 2010 and 2016 in Kilifi, Kenya: a population-based cohort analysis

“…Assuming an equal distribution of strikes over time, this number would translate to each country having a strike about once every 18 months. Most published work on the effects of health workers' strikes on mortality are from high-income settings, with three reports identified from sub-Saharan Africa 6, 11, 12. The Kenyan health sector has had more than 40 regional and national strikes by health workers since 1998 (Friedman WH and Keats A, personal communication), with the most recent entailing a 100-day doctors' strike followed by a 5-month nurses' strike, during which time services in all public hospitals in the country were disrupted 11, 13.…”

“…Most published work on the effects of health workers' strikes on mortality are from high-income settings, with three reports identified from sub-Saharan Africa 6, 11, 12. The Kenyan health sector has had more than 40 regional and national strikes by health workers since 1998 (Friedman WH and Keats A, personal communication), with the most recent entailing a 100-day doctors' strike followed by a 5-month nurses' strike, during which time services in all public hospitals in the country were disrupted 11, 13. Although it is evident that strikes by health workers reduce provision of and access to medical services,6, 12, 14, 15 the reported effect on mortality has been varied.…”

“…Although it is evident that strikes by health workers reduce provision of and access to medical services,6, 12, 14, 15 the reported effect on mortality has been varied. Some studies have reported no change in mortality,15, 16, 17 others an increase in deaths,6, 11, 18 yet other studies have shown an unexpected decrease in mortality 4, 19. Findings of no change in mortality have been attributed largely to continued access to emergency services,1, 20 partial involvement of striking staff, and continued service provision by other cadres of medical staff 14, 15, 17.…”

‘We just look at the well-being of the baby and not the money required’: a qualitative study exploring experiences of quality of maternity care among women in Nairobi’s informal settlements in Kenya

“…Recent evidence investigating the impact of medical strikes suggests that they can lead to a crippling of healthcare delivery in the public sector. 36 Hence, the private sector that absorbs the capacity needs to be competent and capable of providing the necessary services to avert the potential morbidity and mortality that come with a medical worker strike.…”

Health worker strikes: are we asking the right questions?

“…Longer strikes that took place during 2017-the 100-day doctor strike and the 151-day nurse strike-make the question all the more important to address. 3,4 How can Kenyan health workers trust a government health system that leaves them so under-resourced? How does the Kenyan public trust health workers who are willing to put down their tools?…”