Health Care in Kenya: A Viable Currency for Political Negotiation

Much as health care in Kenya was a viable currency for political negotiation it was a vulnerable service industry. Ever dangerously close to the precipice of collapse, destroying the gains made every 5 years. Strikes by health care workers in Kenya somehow coincided with general elections (1997, 2013, 2017 among others). May be the stakes seem to get higher as the trade unions sought for sympathy from political players.

Pic: Nurses protest outside Afya House on September 11, 2017. The strike has been a huge blow for the public health sector. [Courtesy of NATION MEDIA GROUP]

Some studies reported on this relationship namely Sisaye PEV Sisaye_ETD-2013.pdf  (2009), and Shikanga et al., (2009)  observed that that gains painstakingly made in areas like: health infrastructure, health literacy, family planning, fight against HIV/AIDS, ARV adherence, gender based violence, nutrition, sanitation etc. got eroded during periods of instability, yet every other election was a potential flashpoint for violence.

Vulnerable populations: children, adolescent, the aged, the sick and women suffered the the most. Violence or perceptions of it was usually signaled by allegations of election fraud which led to dislocation, forcible transfer of populations, internally displaced persons (including profiling and intimidation of health care workers not indigenous of the area they were deployed). Create a fear of the unknown narrative so that these people would not vote at all or ‘vote and go upcountry/out of the country’.

Neighbours turned against each other and it was not unusual for public officers to take sides. Crowded living situations, lowered levels of personal hygiene and inadequate sanitation due to large geographic shifts of the population meant that disease outbreaks became a big challenge to contain during periods of political instability.

Quoting Shikanga et al., (2009, p.1088):

“lack of public transportation, multiple work stoppage “mass action” days, and impromptu roadblocks on rural roads, greatly complicating access to health facilities…Many staff in health facilities…who had left their posts to go to their home areas to vote and celebrate Christmas were unable to return. Health facility staff of rival ethnic backgrounds also fled their posts…out of concern for their personal safety. Health facilities experienced shortages in critical supplies during the months after the election…Staff and supply shortages were most acute in January and February during the height of the post-election violence, but persisted into March and April….”

The likely scenario was also brought out  by Obbo ‘Hiding under the beds trembling, lights off as election violence rages down the streets due to old politics of horse trading, back stabbing and ethnic baiting as they rally and circle the wagons to protect their turfs’. http://mobile.nation.co.ke/blogs/Wake-me-up-when-the-voting-is-finally-done/1949942-4042720-kqib27/index.html (Obbo is a popular  columnist – Daily Nation on 3rd August 2017).

A good number of displaced persons never came back. Many patients especially on ARVs were found to have not returned to their routine health facility after the conflict. Achieving the optimal pre-election staff numbers became an uphill task for a couple of years later. Some regions reported more than 45% deficit compared to pre-conflict levels.  Communities and care providers that did come back struggled to rebuild, pre-existing ethnic cleavages that had deepened. Please view a short script below:

 https://youtu.be/bQFGpek0ExM

Shared by a health care provider affected by post-election violence in January 2008. [Caption from file 2008. Location, Kimumu Eldoret. Kenya].

Kenya was not an ideal economy; there is often deep polarization of systems by politics. It was unfortunate that Kenya’s social order was an ‘all-time electioneering’ mood country characterized by anxiety and unpredictability around each election cycle. In a way not letting go to allow Kenyans move forward with their lives. Pointers to these otherwise referred as mihemko na mirindimo ya kisiasa, [See www.MyMemory.net] direct translation from Swahili for emotions and thunderings of politics. Gains made in health care suffered some degree of setback with every general election.

See a related post: A Kenyan nurse fear of post election violence- my tell tale.

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