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The impact of the nurses', doctors' and clinical officer strikes on mortality in four health facilities in Kenya.

ABSTRACT: BACKGROUND:Health worker strikes are a significant threat to universal access to care globally and especially in sub Saharan Africa. Kenya's health sector has seen an increase in such industrial action. Globally there is limited data that has examined mortality related to such strikes in countries where emergency services were preserved. We sought to assess the mortality impact of an 100?day physician strike which was followed by 151?day nurses' strike and 20 day clinical officer strike in Kenya. METHODS:Monthly mortality data was abstracted from four public hospitals, Kenyatta National Referral Hospital, AIC Kijabe Hospital, Mbagathi Hospital and Siaya Hospital between December 2016 and March 2018. Differences in mortality were assessed using t-tests and multiple linear regression adjusting for facility, numbers of patients utilizing the hospital and department. RESULTS:There was a significant decline in the numbers of patients seen, comparing the non-strike and strike periods; beta (ß) coefficient?-?649 (95% CI -950, -?347) p?

SUBMITTER: Kaguthi GK

PROVIDER: S-EPMC7249343 | biostudies-literature | 2020 May

REPOSITORIES: biostudies-literature

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The impact of the nurses', doctors' and clinical officer strikes on mortality in four health facilities in Kenya.

Kaguthi Grace Kiringa GK Nduba Videlis V Adam Mary Beth MB

BMC health services research 20200526 1

<h4>Background</h4>Health worker strikes are a significant threat to universal access to care globally and especially in sub Saharan Africa. Kenya's health sector has seen an increase in such industrial action. Globally there is limited data that has examined mortality related to such strikes in countries where emergency services were preserved. We sought to assess the mortality impact of an 100 day physician strike which was followed by 151 day nurses' strike and 20 day clinical officer strike ...[more]

PMID: 32456634

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Project description:BACKGROUND:While health worker strikes are experienced globally, the effects can be worst in countries with infrastructural and resource challenges, weak institutional arrangements, underdeveloped organizational ethics codes, and unaffordable alternative options for the poor. In Kenya, there have been a series of public health worker strikes in the post devolution period. We explored the perceptions and experiences of frontline health managers and community members of the 2017 prolonged health workers' strikes. METHODS:We employed an embedded research approach in one county in the Kenyan Coast. We collected in-depth qualitative data through informal observations, reflective meetings, individual and group interviews and document reviews (n =?5), and analysed the data using a thematic approach. Individual interviews were held with frontline health managers (n?=?26), and group interviews with community representatives (4 health facility committee member groups, and 4 broader community representative groups). Interviews were held during and immediately after the nurses' strike. FINDINGS:In the face of major health facility and service closures and disruptions, frontline health managers enacted a range of strategies to keep key services open, but many strategies were piecemeal, inconsistent and difficult to sustain. Interviewees reported huge negative health and financial strike impacts on local communities, and especially the poor. There is limited evidence of improved health system preparedness to cope with any future strikes. CONCLUSION:Strikes cannot be seen in isolation of the prevailing policy and health systems context. The 2017 prolonged strikes highlight the underlying and longer-term frustration amongst public sector health workers in Kenya. The health system exhibited properties of complex adaptive systems that are interdependent and interactive. Reactive responses within the public system and the use of private healthcare led to limited continued activity through the strike, but were not sufficient to confer resilience to the shock of the prolonged strikes. To minimise the negative effects of strikes when they occur, careful monitoring and advanced planning is needed. Planning should aim to ensure that emergency and other essential services are maintained, threats between staff are minimized, health worker demands are reasonable, and that governments respect and honor agreements.

Project description:ObjectiveNurses' and doctors' health at work is crucial for their overall performance and the quality of care they provide. The Jobs Demands Resources (JD-R) model offers a framework for health at work, encompassing 'job demands', 'job resources', 'personal resources', 'leadership', 'well-being' and 'outcomes'. While various instruments exist to measure health, an overview of instruments specifically designed for assessing nurses and doctors health is currently missing. This study provides a comprehensive overview of available health instruments specifically developed and validated for healthcare professionals in hospital care.DesignScoping review.Data sourcesMEDLINE, Embase and CINAHL.Eligibility criteriaStudies assessing the health of nurses and/or doctors in hospitals using or evaluating instruments based on the JD-R model, published between January 2011 and January 2024, excluding student-exclusive samples.Data extraction and synthesisWe extracted data on study and sample characteristics, as well as details of the measurement instruments, including main and subconstructs. Instruments were categorised based on the JD-R model domains. Descriptive analysis and data visualisation were performed using Excel and Python.ResultsWe included 1204 studies, reporting 986 unique instruments. We identified 32 comprehensive instruments suitable for broad health screening, measuring four or more of the JD-R model domains. Additionally, we identified instruments focusing on specific domains for targeted screening needs. Furthermore, we present frequently reported instruments assumed to be extensively evaluated, user-friendly, accessible and available in multiple languages.ConclusionsHealth at work cannot be determined by a single instrument alone, underscoring the multidimensional nature of workplace health. Alternatively, organisations should select instruments based on domains most relevant and applicable to their context. This approach ensures a more comprehensive assessment of health at work.

Project description:BackgroundRegulation can improve professional practice and patient care, but is often weakly implemented and enforced in health systems in low- and middle-income countries (LMICs). Taking a de-centred and frontline perspective, we examine national regulatory actors' and health professionals' views and experiences of health professional regulation in Kenya and Uganda and discuss how it might be improved in LMICs more generally.MethodsWe conducted large-scale research on professional regulation for doctors and nurses (including midwives) in Uganda and Kenya during 2019-2021. We interviewed 29 national regulatory stakeholders and 47 subnational regulatory actors, doctors, and nurses. We then ran a national survey of Kenyan and Ugandan doctors and nurses, which received 3466 responses. We thematically analysed qualitative data, conducted an exploratory factor analysis of survey data, and validated findings in four focus group discussions.ResultsKenyan and Ugandan regulators were generally perceived as resource-constrained, remote, and out of touch with health professionals. This resulted in weak regulation that did little to prevent malpractice and inadequate professional education and training. However, interviewees were positive about online licencing and regulation where they had relationships with accessible regulators. Building on these positive findings, we propose an ambidextrous approach to improving regulation in LMIC health systems, which we term deconcentrating regulation. This involves developing online licencing and streamlining regulatory administration to make efficiency savings, freeing regulatory resources. These resources should then be used to develop connected subnational regulatory offices, enhance relations between regulators and health professionals, and address problems at local level.ConclusionProfessional regulation for doctors and nurses in Kenya and Uganda is generally perceived as weak. Yet these professionals are more positive about online licencing and regulation where they have relationships with regulators. Building on these positive findings, we propose deconcentrating regulation as a solution to regulatory problems in LMICs. However, we note resource, cultural and political barriers to its effective implementation.

Project description:Human brucellosis is considered to be an important but typically under-diagnosed cause of febrile illness in many low and middle-income countries. In Kenya, and throughout East Africa, laboratory diagnosis for the disease is based primarily on the febrile antigen Brucella agglutination test (FBAT), yet few studies of the diagnostic accuracy of this test exist. Assessment of the performance of the FBAT is essential for its appropriate clinical use, as well as for evaluating surveillance data reported by public health systems. To assess FBAT performance, we collected sera from people with symptoms compatible with brucellosis attending two health facilities in Busia County, Kenya. Sera were tested using the FBAT and results compared with those from the Rose Bengal Test (RBT), an assay with well-known performance characteristics. Positives on either test were confirmed using the classical serum agglutination test (SAT)-Coombs test combination and a rapid IgM/IgG lateral flow immunochromatography assay (LFA). A questionnaire focussing on known risk factors for exposure to Brucella spp. was also conducted, and relationships with FBAT positivity examined using logistic regression. Out of 825 recruited individuals, 162 (19.6%) were classified as positive using the FBAT. In contrast, only eight (1.0%) were positive using the RBT. Of the 162 FBAT positives, one (0.62%) had an atypical agglutination in SAT and three (1.9%) showed low Coombs titres. Out of 148 FBAT positive individuals tested using the LFA, five (3.4%) were IgM positive and none were IgG positive. Poor or no correlation was observed between FBAT results and most established risk factors for Brucella infection. We observed substantial disagreement between the FBAT and a number of well-known serological tests, with the majority of reactive FBAT results appearing to be false positives. Poor FBAT specificity, combined with a lack of confirmatory testing, strongly suggests overdiagnosis of brucellosis is common in this low prevalence setting. This is expected to have important economic impacts on affected patients subjected to the long and likely unnecessary courses of multiple antibiotics required for treatment of the disease.

Dataset Information

The impact of the nurses', doctors' and clinical officer strikes on mortality in four health facilities in Kenya.

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The impact of the nurses', doctors' and clinical officer strikes on mortality in four health facilities in Kenya.

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