Nairobi, Kenya - A health workers' strike in Kenya last month highlighted what many Kenyans say is a broken public healthcare system.
The nationwide strike was a protest against the devolution of health services in Kenya from the auspices of central government to the county administrations, as required under the country's 2010 constitution. Doctors and nurses also demanded a national health commission be established to manage the devolution process, should it go forward, and requested that parliament enact a health bill.
The strike continued, despite the government agreeing to delay the devolution plan to February 2014. "The protest was the last resort, the culmination of several botched meetings and negotiations," said Dr Nelly Bosire, the Nairobi chairwoman for the Kenya Medical Practitioners, Pharmacists and Dentists Union. "We should note here that Kenya has never taken healthcare services seriously. There are a lot of issues that need to be addressed here."
The 12-day strike was called off by the secretary general of the Medical Practitioners and Dentists Union after meeting with government officials, sparking a wave of speculation over what transpired in the meeting.
Kenyan doctors and nurses have often complained of shortages of equipment and drugs in hospitals, which they say is a major obstacle to saving patients' lives. Similar medical workers' protests, which have occurred over each of the past three years, have also called for higher wages for the country’s doctors.
Healthcare workers complain that the government has been indifferent to their demands. For instance, in March 2012 the Kenyan government decided to fire 25,000 public health workers for striking, and asked all "unemployed or retired" health workers to apply for their jobs.
During the most recent strike, Kenyan President Uhuru Kenyatta urged doctors and nurses to return to work, saying that Kenyans "have a right to receive essential services and this is not a matter to be negotiated".
The government has tried to put in place measures to make healthcare affordable and more accessible, deciding last year to waive maternity fees charged at public hospitals. But Kenya's medical practitioners challenged the move, arguing that government-run hospitals do not have the capacity or the necessary equipment to provide such care.
The Pumwani Maternity Hospital in Nairobi, largely considered to be the biggest such hospital in East and Central Africa, also serves as an obstetric and referral hospital for areas outside of the capital. Here, 60 to 80 mothers give birth every day, about one-third of them undergoing caesarian sections. But the hospital only has two functioning operating rooms and 10 incubators to care for babies born prematurely.
In September 2013, Kenyans were shocked when video footage surfaced online showing a woman delivering a baby on the floor of the Bungoma District Hospital. The nurses in attendance were slapping the woman and ordering her to walk to a ward to finish the delivery. Another pregnant woman who had come to the hospital to deliver caught the incident on her phone.
At the heart of the healthcare debate in Kenya is the lack of concrete data on the need for health services. Analysts familiar with the process say the planned county health budgets were drawn up in three days in order to speed up the allocation of funds.
It is all about consultation and getting the right data to influence policy making. After all, what gets measured gets managed.
"This was supposed to be a process, a process that essentially links real demands at the county level to the budgets that are available," said Dr Jason Lakin, a research fellow with the International Budget Partnership (IBP), an organisation that analyses public budgets around the world to improve governance. "Clearly the Transition Authority [responsible for devolution] didn't complete the process."
According to the IBP, none of Kenya's 47 counties meet the country's targets for doctor-population ratios, which the government has set at 36 doctors for every 100,000 people. Kenya has a little more than 8,600 registered medical doctors - of a population of more than 40 million people - and only 4,500 of those doctors are currently working, according to the Medical Practitioners and Dentists Board.
Sick at 50
The December 2013 protests came as Kenya geared up to celebrate 50 years of independence from British colonial rule. Many in the healthcare sector took to social media to complain about the situation, using the hashtag #SickAt50.
Although the strike has ended, many in the medical industry remain concerned about the government's devolution plan. "The disappointment is palpable. But we live to fight another day. We lost the battle but not the war. Aluta Continua!" the union wrote on its Twitter account when the strike ended.
To avert similar crises - dozens of babies died in hospitals during the strike, and mothers and patients told horror stories of being turned away from medical facilities - advocates say Kenya's government must do a better job of managing the health sector.
"It all boils down to management," said Crystal Simeoni, a programme officer at Hivos, an international non-governmental organisation monitoring Kenya's primary schools and health clinics. "It is all about consultation and getting the right data to influence policy making. After all, what gets measured gets managed."
Follow Abdi Latif Dahir on Twitter: @Lattif