Abstract:
Background: Studies of the impact of health care workers’ strikes tend to look at facility-level activity rather than
populations, with evidence from low and middle-income countries relatively sparse. This study explored the effect
of national strikes on maternal and child health. It looked at the impact on health system activity in both public and
non-public sectors (e.g. private, faith-based), on health promotion investments like immunisation, and on disease
detection like post-partum haemorrhage (PPH). A 100 day doctors’ strike started in December 2016, a 150 day nurses
strike from June 2017 and then the clinical officers for 21 days that September.
Methods: Time series descriptive analysis of attendance data from the Kenyan Health Management Information
System (public, non-public sector facilities). The setting was Kilifi, a coastal county in Kenya with a population of about
1.5 million.
Results: Along the care pathway from antenatal, postnatal and out-patient child health clinics, activity levels
dropped markedly in the public sector with only partial compensatory increases in non-public sector activity. The
number of fully immunised children fell during the nurses strike as did women seen with PPH during all strikes. These
health care strikes caused significant adverse health impacts at the time and potentially inter-generationally as exem-
plified by the fall in antenatal haematinics supplementation and syphilis testing. Some post-strike ‘’catch-up” activity
occurred, however this may have been too late in some instances.
Conclusions: Policy-makers at national and county level need to ensure population health is protected at times of
strikes and ideally resolve disputes without such action. Not to do so risks major negative effects on maternal and
child health. Increased use of the non-public health sector could be done by the authorities in mitigation should
strikes occur again.