Post script: when all is said and done about Kenya’s healthcare crisis

When all is said and done concerning Kenya’s healthcare crisis: My two cents are – there is more to consider than the need to call for an industrial action, most critical being -Timing!

On 10th July SRC released new guidelines for allowances, job grading and salary  structures, remuneration of state officers and public servants (2017-2022) that would in effect see some earn less than before http://www.nation.co.ke › News.

These were in line with job review and just concluded job evaluation. It would ensure among others fairness and harmony in remunerations of benefits. It took account job performance, the economy and earnings adjusted to the cost of living etc. This hopefully captures the aspirations and hopes of Kenyans in the constitution to reduce the public wage bill. It would be unfortunate if the SRC decision was going to throw the country into another quagmire of further industrial unrest, but it did.

These drastic measures would save the country Ksh 8 billion in the first year. But then, was this a saving in a true sense since the budget was a projection of the fiscal year? We know saving = money earned but not spent. The already striking nurses (as expressed on day 38) wanted the saved Ksh 8b to be allocated to them. What an uplifting thing that would be? But then did it matter that some of the money was going to be subtracted from them too?

There was uncertainty over the transition effect in the period towards and after the 2017 general election, the myriad election petitions (the highest in Kenya’s history), majorly the repeat presidential election have ravaged the country’s economy in a very negative way. Kenya’s election was slated as one of the most expensive in the world. The electoral body alone would use more than Kshs 52b [~5.2m US$] for the two elections which were only 97-days apart. The by-elections were likely to cost more since they would be spread out on a case by case basis.

The government had to review economic growth projections downwards owing to the prolonged electioneering period, cut down on unnecessary expenditure like out of the country travels by public officers. There was very little money in circulation, stock exchange almost flopping or literally closing business more than once on the day of the ruling reports indicated that Ksh 128 billion was wiped from the stock exchange in 2 days as investors panic sold and exited the market. There were rising fuel prices, food shortages.

There was a lot of consumption with little income generation, few goods and services, few to no foreign investors or tourists were coming, delayed to no payments were being made to suppliers and service providers. There was relaxed to no services in some public offices some of it due to workers’ strikes, breaks and public holidays. Stocks outs were the order in terms of surgical consumables and pharmaceuticals, especially in the health sector.

This author remembers how this had become an easy excuse for shelving and even postponing events, commitments, and decisions. Some of these were communicated in the following format … as you are aware we are in an unprecedented political situation that requires our response. A time to exercise our civic duty. In this respect, we have decided to postpone by one month… We regret any inconvenience caused.

The Chair CoG during a governor’s retreat in September 2017 reiterated ‘…the resources are not sufficient to increase the wage bill. Nurses should be patient until the economy improves’. He added that the precedent set by the striking health workers posed a major threat to other sectors of the economy. Further that matters CBA were now going to dealt with at county level. In this respect, it would be farfetched to imagine that parliament could be recalled from recess to pass a supplementary budget to benefit health care in this country!

Kenyans were sharply divided along political lines, this percolated professional lines and shook the defense ‘forces’ in union matters. The momentous opportunity also meant that Kenyans were more polarized than any other period. There was potential volatility in traditionally hotspot regions whichever way the election goes.

There was a near news blackout on the state of health as everyone else was focused on their political survival or otherwise  what they have made us believe was the State of the Nation.

Lastly, there was the perception of an ‘evil eye’ around the months of August/September as disaster-prone.

There was a vicious cycle of having to rebuild the nation every 5 years. This had become a reality, almost a tradition. Demographic health statistics usually took a nose dive as several gains were lost.

The timing of an industrial action around such a time whether it might have been anticipated or not needs to take into account the above modifiers. These were not facts a union leader could afford to assume. In future, this ought to form a critical lesson for trade unionists as to whether to call for a strike at such a season. But more opportune was when to change strategy if they found themselves in such a crisis.

It should be remembered by all and sundry that in resource-constrained settings (that Kenya is), a life long career at the hospital bedside can suck the life right out of a person (My 2 cents). These people need to be paid well and be given a good working environment if at all we are to expect them to deliver quality health care. It is not a grandiose idea to build and amplify the dreams of healthcare workers. Really we need not wait until they are forced to resort to the industrial action. Why, because this is one group that no society anywhere can afford to be at war with. In the best of societies they cerebrate them. A strong health work force and resilient health systems are the hall mark of social development. We can only hope to invest in them.

Well, these were all issues for our weighing and considerations because our circumstances were unique. See a related post http://www.compleathealthsystems.com/nursing-news/kenyan-nurses-strike-linked-general-elections/

[Simon Kamau alias Compleat Nurse has an MS in Nursing Leadership & Health Systems Administration University of Colorado Denver]

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