BACKGROUND While health worker strikes are experienced globally, the effects can be worst in countries with infrastructural and resource challenges, weak institutional arrangements, underdeveloped organizational ethics codes, and unaffordable alternative options for the poor. In Kenya, there have been a series of public health worker strikes in the post devolution period. We explored the perceptions and experiences of frontline health managers and community members of the 2017 prolonged health workers' strikes. METHODS We employed an embedded research approach in one county in the Kenyan Coast. We collected in-depth qualitative data through informal observations, reflective meetings, individual and group interviews and document reviews (n = 5), and analysed the data using a thematic approach. Individual interviews were held with frontline health managers (n = 26), and group interviews with community representatives (4 health facility committee member groups, and 4 broader community representative groups). Interviews were held during and immediately after the nurses' strike. FINDINGS In the face of major health facility and service closures and disruptions, frontline health managers enacted a range of strategies to keep key services open, but many strategies were piecemeal, inconsistent and difficult to sustain. Interviewees reported huge negative health and financial strike impacts on local communities, and especially the poor. There is limited evidence of improved health system preparedness to cope with any future strikes. CONCLUSION Strikes cannot be seen in isolation of the prevailing policy and health systems context. The 2017 prolonged strikes highlight the underlying and longer-term frustration amongst public sector health workers in Kenya. The health system exhibited properties of complex adaptive systems that are interdependent and interactive. Reactive responses within the public system and the use of private healthcare led to limited continued activity through the strike, but were not sufficient to confer resilience to the shock of the prolonged strikes. To minimise the negative effects of strikes when they occur, careful monitoring and advanced planning is needed. Planning should aim to ensure that emergency and other essential services are maintained, threats between staff are minimized, health worker demands are reasonable, and that governments respect and honor agreements.

中文翻译：

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肯尼亚长期卫生工作者罢工——基利菲县一线卫生管理人员和当地社区的观点和经验。

背景 虽然全球范围内都经历过卫生工作者罢工，但在基础设施和资源面临挑战、制度安排薄弱、组织道德准则不发达以及穷人无法承担其他选择的国家，影响可能最为严重。在肯尼亚，权力下放后时期发生了一系列公共卫生工作者罢工。我们探讨了一线卫生管理人员和社区成员对 2017 年卫生工作者长期罢工的看法和经历。方法 我们在肯尼亚海岸的一个县采用了嵌入式研究方法。我们通过非正式观察、反思会议、个人和小组访谈以及文件审查（n = 5）收集了深入的定性数据，并使用主题方法分析了数据。对一线卫生管理人员（n = 26）进行了个人访谈，并对社区代表进行了小组访谈（4 个卫生机构委员会成员小组和 4 个更广泛的社区代表小组）。护士罢工期间和罢工后立即进行了采访。调查结果 面对主要卫生设施和服务关闭和中断，一线卫生管理人员制定了一系列策略来保持关键服务的开放，但许多策略都是零碎、不一致且难以维持。受访者表示，罢工对当地社区，尤其是穷人，造成了巨大的健康和金融负面影响。有限的证据表明卫生系统已做好应对未来罢工的准备。结论 不能脱离现行政策和卫生系统背景来看待罢工。2017 年的长期罢工凸显了肯尼亚公共部门卫生工作者的根本性和长期的挫败感。卫生系统表现出复杂的适应性系统的特性，这些系统是相互依赖和相互作用的。公共系统内的反应性反应和私人医疗保健的使用导致罢工期间的持续活动受到限制，但不足以增强对长期罢工冲​​击的抵御能力。为了最大限度地减少罢工发生时的负面影响，需要仔细监控和提前规划。规划的目的应是确保维持紧急服务和其他基本服务、最大限度地减少工作人员之间的威胁、卫生工作者的要求合理以及政府尊重和履行协议。