As project managers and organizational leaders, many of us oversee programs that strengthen the public sector to deliver high quality maternal and newborn health (MNH) services. Our efforts depend heavily on the functionality of the health workforce in the countries where we work.
But what happens when public sector health workers are on strike? Health facilities in low-income countries often close down completely during industrial action, disrupting what can be the only health system accessible to poor individuals. This can have especially severe consequences for pregnant women and their newborns. When the public health workforce is not operating, many women and their families must choose between having a risky home delivery with an unskilled provider, going to an unaffordable private hospital or crossing the border into a neighboring territory.
Public sector health workers go on strike for many reasons, usually as a last resort. In resource-poor settings, major staffing shortages are widespread, making individual workloads unsustainable. Supervision is often poor with limited access to training and development. Robust management systems are rarely in place, and health workers miss opportunities for career progression and salary adjustments over many years. Under these circumstances, doctors, nurses and other health professionals pursue collective bargaining not only for themselves, but in the long-term interests of the communities they serve.
Over the past year, Kenya’s public health system has faced numerous strikes of multiple cadres, including nurses and clinical officers, sometimes for several months at a time. The latest national nurses’ strike lasted from June to October 2017. During these extended periods, most public dispensaries and health centers close their doors. Some hospitals remain open on a limited basis, but even when they do, service uptake drops dramatically and mortality rises. Recent media coverage in Kenya has indicated a potential doubling of maternal deaths during the recent nurses’ strike.
While political action is underway, what can health program managers do to prevent maternal and newborn deaths? MNH programs in Bungoma, Kenya have revealed effective strategies for safeguarding the health of pregnant women and newborns under challenging circumstances.
Supporting the faith-based sector
For most poor families, the faith-based sector is the only option for facility delivery when the public sector closes because other private sector facilities tend to be too expensive. This trend is exemplified by shifts in where cesarean sections take place during and after strike periods in Bungoma, Kenya:
This influx of patients creates an unmanageable workload for health workers and affects the quality of care they are able to provide.
Programs can provide targeted support to health facilities in the faith-based sector in several areas:
- Procurement of essential drugs, supplies and equipment to ensure that over-crowded facilities can maintain high quality services during surges in patient volume.
- Mentorship programs for emergency obstetric and newborn care can be implemented so that nurses from public facilities on strike can practice their skills while assisting with staffing needs.
- Financial support to help offset higher operating costs.
When health workers go on strike, health programs must adapt in the following ways:
- Fail fast. Learn from failure and move on quickly. Regular reviews of routine data will quickly point to a health system that is not working during a health worker strike and can offer clues for adjustment.
- Support decentralized decision-making. The staff who are closest to the ground are the ones who see the problems and the solutions most clearly—but they are often too far away from decision-making authority to change a programming approach without extensive consultation. Breaking down these barriers speeds up the change process.
- Be ready. After one strike ends, another one might be on the horizon. With each cycle, learn and adapt for the future.
In the long term, health system reforms are needed to support the health workforce and equip it with sufficient resources to provide high quality care. In the meantime, program managers can play a critical role in ensuring quality MNH services are available during health worker strikes. Women are counting on us to roll up our sleeves, think creatively and work together to keep essential services available.
Read other posts from the Maternal Health Task Force (MHTF)’s Global Maternal Health Workforce blog series.
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