The impact of the nurses', doctors' and clinical officer strikes on mortality in four health facilities in Kenya
The impact of the nurses', doctors' and clinical officer strikes on mortality in four health facilities in Kenya
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DOI：
10.1186/s12913-020-05337-9
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发表时间：
2020-05-26
影响因子：
2.8
通讯作者：
Adam, Mary Beth
中科院分区：
文献类型：
--
作者：
Kaguthi, Grace Kiringa;Nduba, Videlis;Adam, Mary Beth
背景卫生工作者罢工是对全球特别是撒哈拉以南非洲普遍获得医疗服务的重大威胁。肯尼亚卫生部门的此类劳工行动有所增加。在全球范围内，研究与紧急服务保留国家的此类罢工相关的死亡率的数据有限。我们试图评估100天医生罢工对死亡率的影响，随后肯尼亚发生151天护士罢工和20天临床医生罢工。方法收集肯雅塔国家转诊医院、AIC Kijabe医院、Mbagathi医院和Siaya医院4家公立医院2016年12月至2018年3月的月度死亡率数据。使用t检验和多元线性回归校正设施、使用医院和科室的患者数量来评估死亡率的差异。结果与非罢工和罢工时期相比，患者人数显著减少；贝塔系数为-0.0001。医生罢工显著降低了死亡率系数-19.0(95%可信区间-29.2，-8.87)p<；0.0001。护士和临床医生罢工对死亡率没有显著影响。罢工后贝塔系数(Ss)系数7.42(95%CI-16.7，1.85)p=0.12，无死亡增加。结论：与非罢工设施相比，罢工月份的设施死亡率有所下降，而非罢工设施的死亡率则上升。这一下降可能与患者数量的减少以及可能的护理质量变化有关。公共卫生设施拥挤不堪，被当地居民过度使用，他们中的大多数人甚至负担不起低成本的私人保健。肯尼亚的卫生工作者罢工，那里的公共卫生系统是80%的人口在经济上唯一可以获得的选择，对普遍获得医疗服务构成了重大威胁。在卫生基础设施和人员配备方面进行明智的投资可能会减少拥堵，提高护理质量，并降低随之而来的死亡率。
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 < 0.0001. The physicians' strike saw a significant decline in mortality (ss) coefficient - 19.0 (95%CI -29.2, - 8.87) p < 0.0001. Nurses and Clinical Officer strikes' did not significantly impact mortality. There was no mortality increase in the post-strike period beta (ss) coefficient 7.42 (95%CI -16.7, 1.85) p = 0.12. Conclusion Declines in facility-based mortality during strike months was noted when compared to a non-striking facility, where mortality increased. The decline is possibly associated with the reduced patient volumes, and a possible change in quality of care. Public health facilities are congested and over-utilized by the local population majority of whom cannot afford even low cost private care. Health worker strikes in Kenya where the public health system is the only financially accessible option for 80% of the population pose a significant threat to universal access to care. Judicious investment in the health infrastructure and staffing may decrease congestion and improve quality of care with attendant mortality decline.