We need better managers to run the health sector

It has been four months since nurses in Kenya downed their tools due to disagreements with the Council of Governors over their Collective Bargaining Agreement.

The impact of the prolonged strike on the healthcare sector has been adverse and has been felt in all corners of our nation.

To understand the gravity of the situation, imagine a pregnant woman who goes into labour at night, but the nearest health centre is closed because there are no nurses.

Feel the pain the expectant mother is going through. Visualise her being in labour for 22 hours. The next night, she delivers under the care of her relatives or a traditional birth attendant.

A number of things go wrong. She almost bleeds to death. Her newborn has breathing difficulties. There is no nurse to help the baby breathe normally. Her baby dies.

You can now stop imagining, because this is the reality many Kenyans have faced in the last four months.  

Based on status reports that we are receiving from our programme officers in the field, the strike has greatly reduced access to quality health services, especially for mothers.

HOME DELIVERIES

In Siaya, for instance, mothers have resorted to delivering at home, with the exception of the few who are able to get services at private health facilities, where they have to pay. Meanwhile in Bungoma, there is a decline in skilled delivery and antenatal care.

This dangerous situation is replicated throughout many other counties.

As Amref, we are doing all we can to plug the gaps in counties where we have programmes.

We recognise and appreciate the efforts that NGOs, faith-based organisations, and private hospitals have taken to ensure continuity of services in the health facilities that they manage.

However, considering that 60 per cent of health facilities in Kenya are public – managed by the county or national governments –  a huge percentage of Kenyans lack much needed healthcare.

And this is happening against the backdrop of health being a right as gallantly proclaimed in Article 43 of our Constitution and reaffirmed in the Health Act 2015.

We need nurses to resume work. This, however, is where the challenge lies.

The tangent that the strike negotiations have taken heightens the possibility that stakeholders may not come to an agreement soon.

This points to the real issue: there are serious leadership, management and governance gaps in the healthcare sector.

This is coming to the fore now that health is a devolved function and leaders’ change management skills have been put to the test.

The current crisis with nurses could have been averted if there was a proper change management strategy that involved healthcare professionals and gave them sufficient time to understand and adopt the new system.

Communication between different stakeholders has also been poor, and conflicting news reports about the strike corroborate this.

Similarly, basic tenets of human resource management that underpin conflict resolution and negotiation are being overlooked. Some counties, for instance, threatened to sack nurses, despite the proven ineffectiveness of threats in positively influencing employee behaviour in the long run.

In a nutshell, the leadership of our healthcare system needs to improve its managerial skills.

They need to deploy requisite planning and organisational skills to ensure that things run as expected.

It has been commonly assumed that a good health professional is also a good manager.

While health professionals can excel in their field, it does not necessarily mean that they are automatically good in management or leadership. 

Management skills not only take years to perfect, but also demand professional and systematic training, including coaching and mentorship.

That is why Amref has partnered with various agencies to roll out a leadership, management and governance training programme for the health sector in Africa.

All parties who need to play a role in resolving this dispute should get to the negotiating table and end the strike and the suffering of millions of Kenyans. The national and county governments should also ruthlessly prioritise strengthening leadership and governance capabilities of managers in the health sector.

Dr Ndirangu is the Country Director for Amref Health Africa in Kenya