When Doctors strike: Making Sense of Professional Organizing in Kenya

Abstract

Little is known about how the health professions organize in low- and middle-income countries (LMICs). Recent strikes among health workers in many LMICs have directed interest toward measuring their impacts and understanding their causes. Yet, much of this literature belies a technical understanding of a social problem. By drawing on theoretical developments in organizational studies, this article proposes health sector movements be understood through attendant social processes of sensemaking as organizations seek to expand pragmatic, moral, and cognitive forms of legitimacy. Kenya, a lower middle-income country in sub-Saharan Africa, is an interesting case for such research. The intersubjective construction of meaning among medical doctors fashions narratives to order institutional change in the Kenyan health sector. This analysis shows how the strong legacy of colonial biomedicine shaped medical professionalism and inherent tensions with a deteriorating state following independence. In 2010, a new constitution and devolution of health services caused a fractured medical community to divide and pursue industrial action in its quest for organizational legitimacy. In this way, strike behavior, as a form of legitimation among union doctors in Kenya, is a risky path to universal health coverage.

Framing health taxes: a scoping review

“…This is somewhat surprising as ministry/department of health officials were central actors in framing health taxes. One explanation for the absence of health professional associations, and the medical profession in particular, is that this simply reflects broader trends of declining political legitimacy for the medical profession in the USA49 (which accounted for 43% of articles), though the opposite may be true elsewhere 50. More research is needed to understand the limited role of health professional associations in framing health taxes and whether this can/should change…”

Political economy analysis of sub-national health sector planning and budgeting: A case study of three counties in Kenya

“…Moreover, the growing influence of political appointees / representatives could be seen as displacing the voice of healthcare providers in health sector planning [34]. This could be an underlying contributor to the well-documented strikes in the health sector [35] and renewed efforts by providers to extend their influence into non-clinical policy arenas [36]. The contrasting views on the value and effects of public participation in governance of resources has been reported by Mitchel and Bossert, who in their 2010 analysis argued that the stakeholders views on the value of decentralisation normally depends on their positionality within the public sector service delivery [37].…”

Associations, unions and everything in between: contextualising the role of representative health worker organisations in policy

“…Historical trajectories also help explain the ideas espoused by certain representative organisations, and as such, are useful in understanding their role in policy processes. For example, the history of the Kenyan Medical Association, from its origins as an East African chapter of the British Medical Association to its postcolonial role, provides important context for understanding its leadership, membership base and policy stances 11. Historical context may also provide a sense of shared ‘traits’ across associations, such as the evolution of profession-specific associations in former colonies.…”

“…In recent years, a more complex picture regarding RHWOs has begun to emerge with researchers attending to the multifarious policy goals of RHWOs and in a wider array of contexts, particularly low and middle-income countries (LMICs). Examples of actions by RHWOs to actualise principial commitments regarding health systems include RHWOs’ roles in shaping access to health services or health rights,3 influencing regulatory policy pertaining to the health sector to protect their financial or professional interests9 or advocating for improved remuneration, safety and working conditions 10 11. COVID-19 further amplified the role of RHWOs in health policy processes as platforms and channels for health worker discontent and frustrations during the pandemic 12.…”

“…In the context of LMICs, attention to the political economy of health policy processes is growing,17 with scholars highlighting context-specific dynamics and interactions between governments, domestic actors (eg, business, civil society, labour), international actors (eg, aid agencies, multinational corporations, philanthropy) and other stakeholders in shaping policy processes and outcomes. With some key exceptions,3 9 11 18 there is very limited research on groups representing health workers’ associations, unions and other organised groups serving as policy actors in LMIC contexts as well as the interactions of RHWOs globally and their influence on national and subnational policy. Existing research in global health often assumes—rather than investigates—the role variously played by RHWOs in policy processes and lacks analytical specificity regarding the definitional characteristics of RHWOs 19.…”