Human Rights Watch accuses Kenyan government of failing to support health workers fighting Covid-19

Human Rights Watch on Thursday accused the Kenyan government of failing to fulfill its pledge to support health workers fighting Covid-19, exposing them to avoidable risks of trauma, infection, and even death, asserting that “the government’s haphazard, uncoordinated response has affected the welfare of thousands of health workers, and hindered Kenya’s ability to provide timely and quality health care during the pandemic.”

The organization argued that “despite significant resources being dedicated to the Covid-19 response in Kenya, the government failed to provide health workers with adequate protective equipment, testing, or other safety measures to ensure that they could safely and effectively respond to the Covid-19 pandemic.”

It noted that President Uhuru Kenyatta ordered an investigation in August 2020 into the misuse of funds meant for the Covid-19 response, and it found that Kenya had lost KSH7.8 billion (US$70.4 million) meant for Covid-19 response through corrupt tendering, but over one year later, no meaningful changes have resulted from the investigation.

“Kenya’s negligence regarding the safety and needs of health workers in the middle of a pandemic is completely unacceptable,” said Otsieno Namwaya, East Africa director at Human Rights Watch. “Kenyan authorities should take urgent steps to ensure health workers on the front lines of the fight against Covid-19 are able to work in an environment that would not put them at unnecessarily heightened risk.” 

Kenya has 58,000 registered nurses, 12,000 registered doctors, and 14,000 clinical officers. Around 18,000 nurses are under government employment and thus went on strike during the Covid-19 crisis period, while 7,200 doctors are working in government facilities nationwide.

Between March and July 2021, Human Rights Watch interviewed 28 government health workers and officials, including 14 nurses, 7 doctors, 3 clinical officers, 3 laboratory technicians, and a Health Ministry administrator. Six of the 14 nurses were union officials and four were officials of two different professional associations of nurses: National Nurses Association of Kenya (NNAK) and Kenya Progressive Nurses Association. Two of the seven doctors were union officials, and one was an official of the Kenya Medical Association (KMA), the country’s professional association of doctors. All union officials are active health workers. We also reviewed government documents, reports, records, and newspaper articles.

Health workers said that at first, they did not have any personal protective equipment (PPE) – masks, gloves, or overalls/gowns. When they finally received equipment, there was either not enough or it was of poor quality. They said they did not receive training before being assigned to wards treating Covid-19 patients, greatly undermining their ability to respond in the early days of the pandemic. Fearing for their lives, some health workers said that they would sometimes panic and run away when they encountered people in the hospital with Covid-19-related symptoms.

The lack of support led health workers nationwide to go on strike, with the nurses in at least five of the 47 counties starting the strike in June 2020 followed by doctors and clinical officers in August 2020. The strike spread across Kenya quickly as health workers accused government of failing to address their grievances. Government addressed only some of the concerns, including provision of PPE to all health workers deployed to Covid-19 wards. Doctors responded by calling off the strike in December 2020, followed by nurses and clinical officers at the end of February 2021.

Human Rights Watch research indicates that Kenyan authorities did not deliver on its promise to provide risk allowances; ensure that health workers hospitalized with Covid-19 had access to quality and affordable care; and that funeral expenses for the health workers who die from the disease would be covered.

The doctors and nurses interviewed expressed disappointment that the authorities did not recruit enough staff, despite an available pool of trained but unemployed health workers to manage the expanded testing facilities. Nor, they said, did the authorities buy enough kits and reagents to ensure regular testing of everyone, including patients, staff at hospitals, and other members of the public. 

One doctor said that the limited availability of PPE made it difficult to observe basic safety protocols, such as regular replacement of PPE or having enough for all times on duty.

All health workers interviewed said they felt overworked, stressed, and unsupported by the authorities, particularly because the authorities only recruited fewer than 1,000 nurses nationwide on one-year contracts, and underpaid them, and no new doctors to respond to the Covid-19 crisis. “We were being paid 10,000 Kenyan shillings [$100] per month, which we did not get for six months,” said one such newly contracted nurse. “The authorities gave us no risk allowances, no insurance, no health cover, no PPEs, and then we were placed at the emergency area where we were the most exposed.”

An entry-level nurse at government hospitals earns about KSH51,600 ($516) per month and other allowances that could amount to almost the same amount. Three union officials said that several health workers attempted suicide due to the stressful work environment, but they did not provide details and Human Rights Watch could not independently confirm this.

On July 19, Human Rights Watch wrote to Health Minister Mutahi Kagwe with a list of questions based on the findings and the issues raised by the health workers interviewed. The ministry’s legal officer said, via phone, that the ministry could not comment because the issue of health supplies is still under investigation, referring to the investigation the president ordered.    

The Kenyan government should take urgent steps to ensure that those implicated in corrupt enrichment from Covid-19 funds are held accountable, Human Rights Watch said. The authorities should also identify and address the systemic weaknesses that have facilitated corruption in the health sector and undermined the delivery of health services during the pandemic and beyond.

Kenyan authorities have a responsibility to address these concerns both in the short, medium, and long terms, by urgently supplying materials health workers require to adequately respond to the ongoing Covid-19 crisis. They should strengthen the health infrastructure and ensure accountability for malpractice, including corruption, that has negatively affected both supplies and access to adequate health care. The authorities should consider allocating additional resources to the health sector to improve the overall quality of services.

Under international and African law, Kenya has an obligation to minimize the risk of occupational diseases, including by ensuring that workers have health information, adequate PPE, and appropriate training in infection control. The Kenyan government should, as a matter of urgency, allocate the necessary funds and resources to ensure that healthcare facilities have adequate equipment, supplies, and staff to ensure the highest possible quality care.

“The government of Kenya owes doctors, nurses, and other health professionals, but also its global partners, corrective actions regarding its poor treatment of health workers,” Namwaya said. “The pandemic is still here, and the grave concerns of doctors and nurses should not be ignored.”