Physicians’ Industrial Action: An Interrupted Time Series Analysis Assessing Impact in 11 Kenyan Neonatal Units

Background

Skilled healthcare workers are essential for neonatal survival; however, the Kenyan public health system has historically faced strikes compounded by a human resource crisis. Evidence on how strikes affect neonatal care and mortality remains limited. This study evaluated changes in neonatal admissions, clinical care processes, and inpatient mortality associated with 56 days of disruption during the 2024 Kenyan physicians’ strike.

Methods

We conducted a retrospective interrupted time-series analysis of 12,184 admissions to 11 Kenyan neonatal units implementing with the NEST360 Alliance, recorded in the Neonatal Inpatient Dataset from December 2023 to August 2024. Weekly admissions and inpatient mortality were modeled over a 72-week window (27,638 admissions) using hospital-clustered generalized estimating equations with seasonal terms. Care processes, case fatality, and birthweight-specific mortality were compared across study periods.

Results

Weekly admissions fell from 413 to 189 during the strike (incidence rate ratio (IRR) 0.49, 95% confidence interval (CI) 0.31–0.75), approximately 1,700 fewer admissions than expected, and returned to baseline afterward (IRR 1.00, CI 0.81–1.23). Newborns admitted during the strike were of lower birthweight, more often premature, and more often outborn. Admissions fell across all birth-location categories, most steeply among inborn neonates. No measurable change was detected in documented inpatient coverage of care measures, in crude mortality (12.5% to 14.9%; risk ratio (RR) 1.07, CI 0.85–1.33), or in trend-adjusted mortality (IRR 0.88, CI 0.53–1.45). Case fatality among neonates with recorded infection doubled, from 4.7% to 9.6% (RR 2.06, CI 1.18–3.58; adjusted p = 0.047).

Conclusions

The 2024 physicians’ strike was associated with severe disruption to neonatal service utilization, with admissions returning to baseline when the strike ended. Among newborns who continued to reach care, inpatient mortality did not change measurably, but case fatality among those with recorded infection doubled. This analysis was confined to inpatient data; hence, the outcomes of newborns who did not reach the hospitals were not captured. Both inpatient and population-level data are needed to assess the full impact of the strike. Mitigating harm during future labor disruptions requires interventions such as resilient care models, formalized task-shifting protocols, and minimum service coverage agreements.

WHAT WAS KNOWN?

• The public health care system in Kenya experiences recurrent healthcare worker strikes during which maternal and general health services utilization is disrupted

• Neonates are among the most vulnerable populations in the Kenyan public health system. However, few publications have quantified the impact of healthcare provider strikes on neonatal outcomes and processes

WHAT WAS DONE THAT IS NEW?

• Data from 11 Kenyan neonatal units, comprising 12,184 admission records from December 2023 to August 2024, were analyzed to evaluate changes in neonatal admissions, case mix, care processes, and inpatient mortality associated with a 56-day national physicians’ strike

• Because the strike had an exact-dated onset and conclusion, both the disruption and recovery were estimated using an interrupted time series design, with hospital-clustered generalized estimating equations applied across all 11 units

WHAT WAS FOUND?

• Weekly admissions fell by approximately half during the strike, an estimated shortfall of around 1,700 admissions against seasonal expectations, and returned to seasonal baseline once the strike concluded

• Newborns admitted during the strike period were of lower birthweight, more often premature, and more often outborn. Admissions fell across every birth-location category but most steeply among neonates born in the admitting hospital

• There was no measurable change detected in documented coverage of seven screening and intervention measures, or in inpatient mortality overall or by birthweight band. Case fatality among neonates with infection as the primary discharge diagnosis doubled.

WHAT NEXT?

• Inpatient data do not capture the outcomes of newborns who failed to access hospitals. Community-level data are necessary to quantify the full impact of service disruption.

• As industrial actions continue to be increasingly prevalent with frequent disruption of services, mitigation strategies should be put in place to protect vulnerable patients.