Kenyan medical practitioners announced that they would down their tools on 5 December, following the failure of the national government to honour a collective bargaining agreement (CBA) that it had signed with the Kenya Medical Practitioners and Dentists' Union. The strike commenced two days later, leading to the closure of the country's public medical facilities.
46 days into the doctors strike today. Medical students from all public and private universities are on the streets of Nairobi demonstrating— kmpdu (@kmpdu) January 19, 2017
For the last two weeks, the #LipaKamaTender hashtag has been especially visible as the KMPDU has taken to social media to explain the current state of affairs. Using the hashtag, the union is calling on the Government to honour the CBA that they signed with the doctors' union in 2013, which saw the end of a strike that had seen a similar shutdown of medical facilities.
13. That CBA is what will redeem the healthcare of this country for it has the interest of every kenyan in it pic.twitter.com/hEh5EJmlLc— kmpdu (@kmpdu) January 14, 2017
The hashtag calls on the Government to honour its obligations to the doctors just as it does with tenders, which are often paid in full even though the terms are not met.
The strike, which has persisted for the last two and a half months, has thrown an already rickety health system into chaos and contributed to the deaths of several patients and heartbreaking scenes of desperate suffering at health centers.
In response, the Government deployed military doctors to Kenyatta National Hospital, the country's largest public health facility, as a stopgap measure. They also offered the doctors a pay rise, which the doctors' union has since rejected.
Doctors have also adopted the #MyBadDoctorExperience hashtag to describe some of the problems they have faced in the course of doing their jobs. Stories of lack of oxygen for patients, recycling gloves meant for single use, and extending already long shifts in order to make sure that patients are treated, for example, only serve to highlight that the grievances that the doctors want to be addressed extend beyond increasing their pay. They also want the facilities where they work to be improved.
Got pricked in casualty,patient hiv+, no PEP in the hospital, had to travel to nairobi at 1am to get it #MyBadDoctorExperience— Nasirumbi Magero (@nena00200) January 16, 2017
I had to use my bare hands to stop bleeding in a HIV positive mama due to lack of gloves instead I had to take ARV's #MyBadDoctorExperience— Health Transformer (@bin_abeid) January 16, 2017
#MyBadDoctorExperience referring patients from western to knh for chemo and radiotherapy but deep down you know they'll never afford it.— Tim Kanyeki (@tkanyeki) January 16, 2017
#MyBadDoctorExperience Donors channel billions to fight malaria yet for a whole week we had no antimalarial drugs in a level 5 hospital!!— Nic mos mog (@Mosmog) January 16, 2017
The health crisis is made worse by instances of corruption and outright theft of funds meant for healthcare at the Ministry of Health.
Doctors through their union are also challenging healthcare funding across Kenya, with the government’s allocation amounting to 2.7 per cent of total expenditure, far below the 15 percent recommended in the Abuja Declaration.
By using social media, the striking medics have located their industrial action within a broader national debate. Doctors are making it clear that their demands are not misplaced. They argue; if the ruling government can afford to overpay tenders and fail to seal loopholes leading to corruption, they definitely can afford to pay the doctors.
One criticism of the health workers' strike has been that doctors are bound to a set of responsibilities under the Hippocratic Oath, and that their work is a calling. However, the health workers have argued that while they have responsibilities, they also have rights. One of those rights is a safe work environment, and as it is now, the public health facilities where they work do not qualify.
The WHO Global Atlas of Health Workforce identifies Kenya as having a “critical shortage” of healthcare workers. While the minimum threshold of doctors, nurses and midwives per population should be at least 23 per 10,000, Kenya’s current ratio stands 13.
One of the challenges that the health sector faces is the lack of capacity in the health sector to absorb the large pool of trained, unemployed health workers available, made worse by an unclear division of health facilities between the county and national governments. One of the terms in the CBA proposes
Social Media as a force for public good
The recent developments in the medics' strike have added to the already heated discussion over how social media can be used positively.
The use of social media to channel issues is nothing new. Kenyans are among the most vocal people on Twitter, occasionally making '#SomeoneTell...' hashtags trend. The #LipaKamaTender hashtag shows how new information spaces can be coopted as a negotiation tactic, where information can be shared in order to drive conversations around facts rather than hearsay.
Social media is inherently neutral. Unlike mainstream media, which is constrained by among other factors partisan interests, anyone can say anything on social media, and this free flow of information is what has kept the agenda firmly in the public eye, even as mainstream media trips over itself in the run-up to Kenya's general election.
By laying out the terms of the CBA, the KMPDU has made the public aware of what the impetus of the strike is, and as doctors share their personal experiences, stories that would otherwise go untold are being shared and retweeted widely, further driving the conversation and drawing in interested citizens who then add in their two cents.
Through various engagements on social media, medical workers have magnified their individual and collective voices to speak about their own experience. They have revealed details about their individual and institutional realities, challenged various ideas and assumptions held by the public about the medical profession and tackled questions such as ethics and the importance of industrial action in driving change.
As the strike continues, we are seeing Kenyans calling on the Government to honour the CBA so that the matter can be resolved.
You can't refuse to pay doctors fairly, overwork them, frustrate them then start crying brain drain. It's bound to happen. #LipaKamaTender— Cynthia Waliaula (@cynthia_wali) January 12, 2017
Hang on in there doctors. This one you must win. We must have well paid, well facilitated, able doctors all over Kenya. #LipaKamaTender— TheNortherner (@alaminkimathi) January 12, 2017
The conversation has become a matter of life or death, as the facilities remain closed, and Kenyans remain unable to access all but essential medical services. It appears that public goodwill is with the doctors, however, as counter-narratives accusing the doctors of greed and reneging on their duties have largely fallen flat. That said, the dispute needs to be resolved quickly before any more lives are needlessly lost.