Insincerity, blame games, show of might and threats have been blamed for lack of progress in talks to resolve a four-month impasse between nurses and their employer.
Services have for the past couple of months ground to a halt in hospitals across the country, pushing patients, especially pregnant women, in some border counties to seek help in neighbouring countries.
Even so, nurses have remained adamant that county and national governments must first honour a collective bargaining agreement (CBA) before any of the caregivers can set foot in the public hospitals.
At the receiving end of this protracted tug-of-war are thousands of patients who have gone for months without services.
The number of mothers dying from complications of child birth has doubled.
Children have not been vaccinated and diseases that were once under control have begun to rear their ugly heads.
This year will go down in history as one that endured the worst public health crisis in Kenya’s history.
For most of this year, public health facilities across the country have been closed.
This is after the year opened with a doctors’ strike that paralysed activities in most public hospitals and, after this was resolved, nurses and other health workers started a series of work boycotts.
Following the devolution of health, the national government when approached to address the health workers’ dispute has always said “health is 100 per cent devolved”.
County governments have insisted that they be given full control over health.
Four years later, the health sector is in a shambles due to delays in procuring essential goods and services and misuse of funds allocated to healthcare.
But it is probably difficulties in payment of salaries leading to continued industrial unrest and under-performance across the board that has dealt the country’s health system its biggest blow.
Soon after doctors were able to finally resume duty following three months of holding a hard-line stance, nurses and clinical officers downed their tools, demanding that the government treats them equally.
The nurses said it was unfair to pay doctors “400 per cent of what they ask for” while downgrading them.
But no sooner had the clinical officers’ strike began gaining momentum than it was called off.
Always seen as the more humane of the 17 cadres of health professionals, the estimated 7,000 officers called off their two-week strike after signing a return-to-work formula with the Health Ministry and governors.
“We are not going back to work because we are happy, but because this is the beginning of having our issues addressed,” secretary general of the Kenya Union of Clinical Officers George Gibore said while signing the document.
But it has been the nurses’ strike, which has been going on for more than 130 days, that has seen most county health facilities deserted for lack of nursing services.
Through a protracted strike that has been laced with internal disputes within the nursing union leadership, thousands of Kenyans have missed essential hospital services.
Nurses first took to the streets on December 5, last year, the same time as doctors.
Almost nine days after this, they signed a return-to-work formula with governors after being offered a nursing allowance of between Sh15,000 and Sh20,000, to be implemented in two tranches, 60 per cent beginning January and the rest from July.
Two months later, nurses and the ministry as well as the Council of Governors began negotiations on the CBA, which became the genesis of the current stalemate.
On June 5, barely six months after calling off a nationwide strike, the Kenya National Union of Nurses (Knun) leaders asked their members to boycott work until such a time when the two levels of government would agree to sign and implement their CBA, which would cost taxpayers up to Sh7.8 billion annually.
Unlike their colleagues, they have stood their ground: “This time around we will not go back to work until our CBA is signed and registered in courts,” Knun Secretary-General Seth Panyako has persistently said.
And on this stance, close to 20,000 nurses across the 47 counties have stayed off work, unshaken by threats by governors to take action against those who are defiant.
PLEAS AND THREATS
Despite pleas and even sack threats from both levels of government, they have remained unshaken, claiming to have already ceded much ground.
“We have already written to them (CoG) and told them we are willing to give up the responsibility and call allowances, which reduces the annual cost of the CBA by 1.6 billion,” said Mr Maurice Opetu, the union’s deputy secretary-general.
“We are also willing to spread out the cost of other payments like uniform allowances in four years.”
But the ministry reads mischief on the part of nurses. While signing the clinical officers’ agreement, Health Cabinet Secretary Cleopa Mailu said meetings with nurses were not yielding fruit “because the union leadership is not sincere”.
“We invited the union, had good discussions and agreed on what we can and cannot deliver. The union leaders requested for time to seek guidance from members but they have not come back,” said Dr Mailu while signing a return-to-work agreement with clinical officers.
While denying the accusation, Mr Opetu said the meeting was informal as the CS just wanted to know how “our discussions with the Principal Secretary went”. “Let him show evidence or even minutes of the said meeting,” he said.
But why has the deadlock taken so long to resolve?
According to nurses, the lack of progress can be blamed on lack of sincerity by the involved parties.
“There is poor leadership within the ministry and the CoG. Instead of addressing us, they have resorted to sideshows, thinking that we will get tired and eventually go back to work without having our issues resolved,” said Mr Opetu.
Contacted to address the allegations, neither the CS nor the PS picked our calls.
But the union’s leadership has also been hit by infighting. Early into the strike, the union was divided into two factions, one led by the embattled chairman John Bii and the other by Mr Panyako.
This division saw the Bii-led team kicked out of a media briefing meant to call off the strike, as the other team remained adamant to date.
And now, Kenya is staring into a health crisis as hundreds of thousands of children are going without vaccination.
Even worse, is that there is no hope in sight as the latest planned meeting was called off at the last minute with both sides of the divide citing “unavoidable circumstances”.
Two weeks ago, the CoG sent out an invitation letter to the union’s representatives to a meeting to resolve the strike.
In the letter addressed to Mr Panyako and seen by the Nation, governors said they wished to “unlock the current nurses’ strike that has prolonged and caused suffering on Kenyan citizens”.
Two days later, the council through an email, notified nurses that the meeting “has been cancelled due to unavoidable circumstances.” “The inconveniences caused are highly regrettable,” the email added.
When contacted, the communication team for the council said a new date for the meeting will be communicated.
While politicians and technocrats have been haggling over budgets, promotions, salaries and their effects on government’s recurrent expenditure, few have paused to think about what the current impasse is doing to the country’s children, who are not receiving scheduled vaccines against some of the world’s most debilitating diseases, including polio, pneumonia, meningitis, measles, influenza, and hepatitis.
These diseases, long identified as among the biggest health threats in the region, could ravage the nation in the coming years if these hordes of vulnerable children are exposed to their vectors.
For health experts, it is hard to fathom the gravity of the situation.
Nurses worldwide may well be the unsung heroes of the medical field — they not only provide care to those hospitalised, but also execute tasks few others are willing to do under the immense pressure of the profession.
From giving injections, handling doctors’ prescriptions and dealing with psychotic patients.