‘It Was Hell in the Community’: A Qualitative Study of Maternal and Child Health Care During Health Care Worker Strikes in Kenya

Abstract

Background: Health care workers in Kenya have launched major strikes in the public health sector in recent years but how strikes by health care workers affect health systems and services is under-explored. We conducted a qualitative study to explore maternal and child health care and services during nationwide strikes by health care workers in 2017 from the perspective of pregnant women, community health volunteers (CHVS), and health facility managers. Methods:We conducted interviews and focus group discussions (FGDs) with three populations: women who were pregnant in 2017, CHVs, and health facility managers. Participants were part of a previous study and recruited using convenience sampling from a single County in western Kenya. Interviews and FGDs were conducted in English or Kiswahili using semi-structured guides that probed women’s pregnancy experiences and maternal and child health services in 2017. Interviews and FGDs were audio-recorded, translated, and transcribed. Content analysis followed a thematic framework approach using deductive and inductive approaches. Data were collected March to July 2019. All participants provided written informed consent.Results:Forty-three women (mean age 28) and 22 CHVs (mean age 47) participated in 4 FGDs and 3 FGDs, respectively, and 8 health facility managers (mean age 38) participated in interviews. CHVs and health facility managers were majority female (80%). Participants reported that strikes by health care workers significantly impacted the availability and quality of maternal and child health services in 2017 and led to indirect economic effects due to households paying for services in the private sector. Participants overwhelmingly felt it was the poor, particularly poor women, who were most affected since they were more likely to rely on public services, while CHVs highlighted their own poor working conditions in response to strikes by other health care workers. Strikes strained relationships and trust between communities and the health system that were identified as particularly important to maternal and child health care. Conclusion: The impacts of strikes by health care workers extend beyond negative health and economic effects and exacerbate fundamental inequities in the health system with important implications for health systems strengthening and universal health coverage in Kenya and other countries.

The impact of strike action by Ghana registered nurses and midwives on the access to and utilization of healthcare services

“…However, the proportion of immunizations in Faith-based hospitals increased by 252%. Scanlon, Maldonado [12] also established a robust link between strike action by healthcare workers and poor maternity and health care utilization, including ANC and delivery at a health facility among pregnant women, and delays in a child's first oral polio vaccination in Kenya. In a related Kenyan study, outpatient attendance declined by 64.4%, special clinics attendance by 74.2%, deliveries by 53.5% and inpatient admissions by 57.8% when nurses and other healthcare professionals embarked on strike [11].…”