Fault Lines between National and County Officials Push Kenyan Health Workers to the Brink

Kenyan health workers are pushing the government to honor agreements made in December, but negotiations have exposed fault lines between county and national officials. John Mbati reports from Nairobi.


In Kenya, medical strikes in December have resulted in key concessions for health workers. But a standoff between county and national government officials has delayed the implementation of return-to-work agreements. These tensions will likely continue to shape the politics and policies affecting health workers, especially given the fiscal challenges inflamed by the impacts of the COVID-19 pandemic.

Medical strikes result in concessions and more protection for health workers

By December 2020, hundreds of health workers in Kenya had contracted COVID-19, with over 30 dying from the virus. Among them was 28-year-old Dr. Stephen Mogusu, who passed away on Monday, December 7, 2020. His death sparked uproar, particularly after revelations that he had not received his salary for the four months leading up to his death.

That same day, the Kenya National Union of Nurses (KNUN) and the Kenya Union of Clinical Officers (KUCO) went on strike as they had been preparing to do for weeks. Then, on December 21, the Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) also went on strike. The result was that doctors, nurses, and clinicians did not report for work as the Christmas festivities approached, paralyzing a sector that had already been weakened by the COVID-19 pandemic.

With schools set to fully reopen on January 4, 2021, the Ministry of Health, the Labour Ministry, and the Council of Governors (COG), which represents Kenya’s 47 counties, bowed to pressure and held talks with KMPDU and KUCO. The nurses’ union, KNUN, however, was left out of this round of negotiations.

In the return-to-work formula that emerged from these talks, the parties agreed that the Treasury would fast-track funding allocations to enable counties to pay the striking doctors and clinicians all arrears owed, provide life insurance, and ensure personal protective equipment (PPE). Doctors serving at public hospitals were guaranteed salary increases across the board, with some medical officers receiving raises of about 60 percent of their prior salaries, up to as much as Ksh 80,000 (or about US$750) per month. The government also agreed to hire additional healthcare workers.

Following the agreements, KMPDU called off their strike on Thursday, December 24, 2020, with clinical officers under KUCO ending their strike on Friday, January 1, 2021.

Tension between national and county governments has stalled the implementation of these agreements

Signing the return-to-work formulas, however, has proved to be one thing and implementing them another. Doctors and clinicians are now caught in a standoff between the national government and  county governments, as the latter argue they have not received the money set aside to pay health workers.

Amid the uncertainty, many health workers have refused to return to work. Threats and intimidation have followed. In Mombasa County, Governor Hassan Ali Joho’s administration fired 86 striking workers for boycotting duty. One of those sent home on Wednesday, January 6, was KMPDU Secretary General Chibanzi Mwachonda. In Kisumu County, Governor Anyang’ Nyong’o locked 400 nurses out of their work stations and their names have been struck from the payroll.

“The issue is with the Council of Governors,” Dr. Alex Thuranira, an official at KMPDU, said in an interview for this piece. “The COG is projecting their fight with the national government onto healthcare workers. We are caught in the war.”

He continued, “In the signed agreement, we concurred on some issues that needed immediate solutions and others that are works in progress. We shall have a meeting on Friday, January 8, to deliberate on our way forward and we have not yet decided whether we shall proceed on another strike.”

On January 5, only five days after calling off their strike, KUCO Chairman Peterson Wachira issued a 48-hour ultimatum to governors to honor their return-to-work agreement, threating that clinicians would resume the nationwide strike.

In an interview for this piece, Wachira said the COG has not demonstrated goodwill in negotiations with his members. “The risk allowance they are talking about comes from the National and not County Treasury. They should not talk about money issues. If the problem was the resources, then the Ministry of Health would not have signed the agreements. COG was represented in the meeting.”

He added, “We are worried that going forward, they may always sign deals but never implement them.”

KNUN, which had been left out of the first round of negotiations, has not yet called off their strike, as the union has been unable to reach an agreement with the government. In an interview for this piece, Secretary-General Seth Panyako said that the union had settled their issue with the Health Ministry, but the debacle between the national government and the governors was frustrating talks and delaying arriving at a return-to-work formula for nurses.

He explained that KNUN has focused specifically on the risks nurses face treating coronavirus patients. “We are pushing for risk allowance and issues related to COVID-19,” he said. “We have not asked for salary increases like the rest, yet they are already disappointing us. The union made some agreements with Kagwe and the team, and we are ready to sign the deal. We would rather have an offer that has not been implemented rather than not have one at all. Then we can fight for it.”

Tensions are likely to continue, especially given the government’s fiscal challenges

The row between the governors and the national government threatens to complicate the public health response to COVID-19 and to further exacerbate Kenya’s fiscal challenges for the financial year 2020/21.

As of early January, Kenya has recorded around 100,000 positive COVID-19 cases, with 1,700 fatalities. But there are also positive signs. A second wave of new cases appears to be receding, and the current test-positive rate is at a relatively low 4.6 percent. On Wednesday, January 6, Health CS Mutahi Kagwe announced that Kenya has ordered 24 million doses of COVID-19 vaccines from Gavi, the Vaccine Alliance. Frontline workers, comprising police, teachers, and health workers, will be given the first priority when the doses arrive in February.

But this remains a critical  moment in containing the pandemic. In a public statement, former Prime Minister Raila Odinga, a political ally of President Uhuru Kenyatta, argued health workers should be required to be on standby especially as schools reopened, while also highlighting the tensions between county and national officials.

“I wish to make an urgent appeal to the two levels of government—the counties and the National Government—to immediately talk to each other and urgently bring to an end this ill-advised and ill-timed stand-off and a possible strike,” he said, while also calling on nurses to end their strike.

At the same time, though, the national government has reversed some of the key economic relief measures passed last year, and President Kenyatta recently signed a bill which raised the rate of the pay-as-you-earn (PAYE) tax to 30 percent, up from 25 percent, effective from January 1. While maintaining the 100 percent tax holiday for those who earn less than Ksh 24,000 per month (or about US$220), the bill has also brought nearly half of the working population into the maximum tax rate. Moreover, the government has introduced new taxes, including the Digital Service Tax on transactions conducted online.

These new policies are meant to help the Kenyan government shore up a tenuous fiscal position, severely worsened by the COVID-19 pandemic’s economic impacts. New expenditures to support health workers, on the other hand, will increase pressure on the budget. Exacerbated by conflicts between the COG and the national government, these issues are likely to shape the politics and policies affecting health workers far past the current moment.


For more on this topic, see our previous report, “Kenya’s Frontline Health Workers Are Dying From COVID-19.”


About the Author

John Mbati is a multi-media journalist at Kenyans.co.ke. He is also a content creator with a passion for telling human interest stories. Follow him on Twitter: @mbati_john.


via COVID-19 Africa Watch
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