31 days and counting: Health workers dig in as patients bear the brunt

Kenyans seeking care at public hospitals are running out of options as a looming health crisis draws closer. A month after clinical officers downed tools, they have been joined by doctors and other health workers in Nairobi. 

This week, the Kenya Union of Nurses, the Kenya National Union of Medical Laboratory Officers (KNUMLO), and UHC staffers announced they, too, are preparing to strike over longstanding systemic failures — threatening a near-total paralysis of the public health system.

Clinical officers and interns under the Kenya Union of Clinical Officers (KUCO) have been on strike since December 22, 2025. All health workers in Nairobi County — doctors, laboratory officers, pharmaceutical technologists, public health officers, and nutritionists — joined them on January 16. 

KUCO's National Chairperson, Peterson Wachira, blamed the Ministry of Health (MoH) and county governments for chronic failure to honour legal agreements, court mandates, and government directives, citing "contempt of court" and "delaying tactics" as the primary catalysts.

The grievances centre on four areas. First, negotiations for a Collective Bargaining Agreement (CBA) have stalled. Although MoH is ready to sign, talks with county governments have been deadlocked for over a year due to a single unresolved issue.

Second, there is a significant disparity in salary reviews. While the ministry has reached the fifth phase of salary increases directed by the Salaries and Remuneration Commission (SRC), most counties have reportedly refused to progress beyond the second phase.

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Third, the union points to a breach of the 2024 Return-to-Work Formula, noting that court-ordered agreements for promotions and staff recruitment remain largely unfulfilled.

Finally, staff under the UHC and Global Fund programmes have reportedly worked for 20 months without pay due to bureaucratic disputes, despite existing budgetary allocations and presidential directives.

Wachira maintained that industrial action has historically been their only successful tool for securing professional rights, such as union registration and intern pay, adding that clinical officers are being forced to compromise public health to protect their professional dignity against employers who refuse to negotiate in good faith.

"Today is the 31st day of the strike, and in Nairobi, all health workers are on strike. We are here to show that we have leaders who do not seem to care and are not doing their duty to ensure these issues are resolved," said Wachira.

"Patients are devastated. I have had to find alternative means for my patients and those who call me for help. Others have flocked to national referral hospitals, including Kenyatta National Hospital (KNH) and Moi Teaching and Referral Hospital, yet these cases could be handled in lower facilities where clinical officers were stationed. Patients are suffering, but I can only see the governor talking about helping students go to school while patients — the people who voted for him — are dying," he added.

KUCO met with the Council of Governors on Thursday to deliberate on their grievances, but failed to reach an agreement. The meeting is expected to continue today.

In Nairobi County, Dr Maero Deogracious, Chairperson of the Kenya Medical Practitioners and Dentists Union (KMPDU) Nairobi branch, explained that doctors are striking over four issues: unstable medical cover, delayed promotions, repeated salary delays, and non-payment of gratuity for doctors who worked under the defunct Nairobi Metropolitan Service (NMS).

“We used to be under Jubilee medical cover, but Nairobi City County moved us to the Social Health Insurance Fund. The challenge with SHA is accessibility. Many hospitals are not accepting it. If you live on the peripheries of Nairobi and take your sick child to a facility, they will not be able to access care. The SHA dental cover is also limited — the amount allocated for dental treatment is insufficient, forcing us to top up with cash," said Dr Maero.

Since 2020, no doctors have been promoted. Some have waited more than 10 years. We have common cadre and non-common cadre promotions dependent on job groups. For a common cadre, from entry point you work for one year, then move to the next job group, work for three years, then move again. From there, it's a matter of specialisation — you do your master's, specialise, then progress to the next cadre and job group," the medic noted.

This has not been happening, despite doctors striking in 2020, signing a return-to-work agreement in court, and following up for five years. In a strike that lasted 39 days in April 2025, the same issues were raised in a court-mediated process. The doctors and county signed a return-to-work formula, agreeing that most issues would be resolved by July.

“None of what we agreed on has been implemented — not medical cover, not promotions. Gratuity for those who worked for NMS was to be paid by September last year. By law, they are entitled to it upon contract completion. The county has done nothing," Dr Maero said.   

Persistent salary delays have been a recurring catalyst for industrial action, plaguing Nairobi County doctors for the past two years. Salaries should ideally be disbursed before the start of a new month, but members frequently face delays of two weeks, and in some instances, up to two months.

The county previously paid staff before the 23rd of each month, a practice that has since ceased.

Preparing to strike

"They had an overdraft arrangement with the bank so salaries could be paid while awaiting county funds. But they defaulted on interest payments, so most banks refused to work with them," he explained.

“They moved us to another bank, hoping to resolve this. But the new bank reviewed their books and was uncomfortable — December and January salaries were supposed to be paid on time, but weren't, so the deal fell through. December salaries, typically paid before Christmas, only came through on January 19, leaving parents scrambling to sort themselves and their school-going children," Dr Maero added.

Countrywide, nurses under the Kenya Union of Nurses and laboratory technologists under KNUMLO are also preparing to strike.

Seth Panyako, Secretary General of the Kenya Union of Nurses, explained that the Ministry of Health and Public Service Commission have refused to transition contracted nurses into permanent and pensionable terms. These include UHC staffers who were frontline workers during the Covid-19 pandemic, some of whom have not been paid for more than seven months.

"This practice undermines the principle of equal pay for equal work, perpetuates discrimination, and hampers the career progression of affected nurses. Moreover, these nurses have been irregularly placed in a job group not recognised under established career progression guidelines for nursing personnel," said Panyako.

"Despite the national government promising to factor Sh9 billion into the budget for revenue allocation, we have credible information that the funds have not been included in the FY2026-2027 budget."

 The union also laments that county governments have failed to implement the 2024 and 2025 revised SRC salary structures that should have taken effect from July 1, 2024 and July 1, 2025. These structures had been communicated via SRC circulars. The union notes that this delay has resulted in "unlawful underpayment, breach of statutory remuneration obligations, continued erosion of nurses' economic power, and outright discrimination."

"The union urges all public sector employers to respect the legal framework governing remuneration and human resource management, sign a CBA that covers all nurses employed in public health facilities, immediately release salaries for all unpaid UHC nurses, and make public the reports on the UHC verification exercise," said Panyako.

"We appeal to stakeholders, including the Ministry of Health and Council of Governors, to intervene constructively and bring these matters to an amicable and sustainable resolution for the benefit of the Kenyan public and health sector," he added.

In 2025, health workers' strikes caused significant disruptions to the public health sector, resulting in patient deaths, the collapse of county-level services, and immense pressure on national referral facilities.

The absence of clinical officers meant primary care was virtually non-existent, forcing patients to wait up to eight hours to see a skeleton staff of interns or locum doctors. Patients at local dispensaries, who should have been treated free under UHC, were forced to pay cash or travel long distances to higher-level hospitals. When clinical officers downed tools, entire communities lost access to preventative care, including tuberculosis and HIV management, as these cadres are responsible for most community-based health promotion.

Currently, services in Nairobi are minimal. Some hospitals have employed locum doctors to see outpatients, provide first aid, and refer patients to KNH. But KNH is full and not admitting. Pumwani Maternity Hospital has also brought in medical officers on locum, keeping the maternity wing operational. However, with no consultants available to handle complications, admissions are being limited.

UHC staffers have also announced a resumption of nationwide demonstrations starting January 27, to demand transition of their contracts to permanent and pensionable terms, and payment of five-year gratuity totalling over Sh6.2 billion.

With no resolution in sight and more unions preparing to down tools, the question for millions of Kenyans is no longer where to seek care, but whether care will be available at all.

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