It was a common situation for both Mary and Alice—they tried to visit the hospital, but couldn’t receive the care they needed. The health workers were on strike again.

Mary had traveled 4 kilometers and was pondering what to do with her sick child because no health workers were available at the hos­pital. Alice did not have the money to visit a private hospital and she wondered why she and Mary’s child were suffering—after all, they had nothing to do with the disagreement between health workers and the government.

Over the years, the health sector in Kenya has been characterized by persistent health worker unrest, which negatively affects health ser­vices. Between 2010 and 2020 there were eight nationwide strikes and many more county strikes. And in 2017 alone, there were over 250 days in which the health system was dysfunctional, with far-reaching impacts on access to and quality of essen­tial services.

Between 2010 and 2020 there were eight nationwide strikes in Kenya.

The reason for all these strikes? The government failed to implement collective bargain­ing agreements and return-to-work formulas. Health workers worked in poor conditions and experienced medical supply, equipment, and staff shortages. Promotions, salaries, and career progressions were delayed. There was a lack of training opportunities and comprehen­sive medical coverage.

During a pandemic, the impacts of health worker strikes are even greater and frontline health workers fear for their safety .

And while the health workers were fighting for their own rights, clients weren’t able to access the care they needed. The strikes caused decreases in women attending their fourth antenatal care visits, pregnant women starting antiretroviral treatment, viral load testing, short- and long-acting family planning method uptake, facility deliveries.

So, in 2018, IntraHealth International’s USAID-funded Human Resources for Health program supported the Council of Governors to con­vene a stakeholders’ meeting, bringing together key county leaders, national institutions, faith-based organiza­tions, health worker trade union representatives, private-sector partners, and other relevant stakeholders.

The meeting focused on the causes of the health worker strikes and identified strategies to improve employee/employer relations to avoid service disrup­tions. One of the main causes of the strikes was a lack of effective communication between employers and health worker trade unions. So, the group established national and county work councils for county leaders and health trade union leaders to proactively discuss and amicably seek solutions to health worker grievances.

Read: Averting Public Health Sector Industrial Unrest in Kenya: Establishing Stakeholder Work Councils to Foster Harmonious Labor Relations

To train the health management teams and trade union leaders on negotiation skills, labor dispute resolutions, and other relevant skills, IntraHealth brought together 96 health worker union leaders from four registered worker unions, 60 county health management teams, and 57 county human resources officers and trained them on leadership management and governance with a focus on human resources for health. The training pro­vided experiential learning and focused on how to manage trade unions within International Labour Organi­zation (ILO) conventions, and local labor laws as provided by the Labour Relations Act.

Many counties involve union leaders when they develop new policies, guidelines, and strategies.

Now, many counties involve union leaders when they develop new policies, guidelines, and strategies and union leaders use their training to participate. In Muranga County, union representatives were involved in developing health worker cadres. In Meru, Busia, Makueni, and Nyandarua counties, union representatives were involved in developing plans for human resources for health and the Ministry of Health’s Human Resources for Health Strategic Plan for 2019 to 2023.

Twenty-five counties have work councils who meet every quarter and as needed to discuss key issues affecting health workers, share prog­ress made in implementing their action plans to improve employer/employee relations for effective management of the health workforce, and engage with health worker unions to address looming health worker grievances.

For in­stance, Turkana County health worker trade unions issued a joint strike notice to the county leadership on October 23, 2020, over delayed promotions and redesignation of health workers, notifying them that a strike would go into effect on November 12, 2020. The county convened a work council meeting on November 11, 2020, in which the County Public Service Board committed to promoting all health workers who were due for promotion by November 30, 2020. As a result, the union resolved to call off the strike as the county worked on redesigna­ting 841 health workers.

“The engagement diffused a lot of suspicion between the county and the union and culti­vated some trust,” says Dr. Gilchrist Lokoel, a county director of health in Turkana County. “We all realized that we care about health workers and needed to harness our energies for the general good rather than tear each other apart in supremacy battles.”

Migori, Samburu, Kirin­yaga, Nyeri, Laikipia, Bomet, and Marsabit counties also negotiated with union leaders and agreed on an action plan, which prevented medical officers, nurses, and clinical officers from striking. Health workers in other counties eventually called off their strikes as a result of negotiations with the unions through the work councils.

On top of that, 3,303 health workers were recruited in six counties to address the health worker shortage and the work councils helped resolve issues around health worker promotions, provision of protective equipment, prompt salary payments, and designated COVID-19 isolation centers for affected health workers.

The work councils have helped limit the occurrence and length of the health workers strikes and are proving to be effective in not only averting health workers strikes but contributing to improved workplace environments and speedy reso­lution of labor disputes, which improves the availability and quality of health services for people like Mary and Alice, who need it the most.

The Human Resources for Health (HRH) Kenya Program is a five-year project funded by the US Agency for International Development (USAID) to strengthen health professional training programs and health workforce management systems throughout Kenya to help the country improve the health of its citizens.