Doctors asked to call off strike for negotiations to continue
A medic carrying a placard participates in a peaceful demonstration along the Nakuru-Eldoret highway on March 26, 2024.
In the ongoing saga of the doctors' strike and the plight of suffering Kenyan patients, a glimmer of hope for resolution seems elusive as the government and the Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) once again find themselves at an impasse.
Despite repeated attempts at negotiation, the chasm between the two parties is widening, leaving patients in uncertainty.
As the doctors maintain that they have the right to demonstrate and strike, the government has said that they are in contempt of court and that negotiations on their demands will only take place if they call off the strike.
As the protest entered its 14th day, a Whole-Of-Nation approach Committee meeting convened to address the escalating crisis bringing together key stakeholders including the doctors, the Ministry of Health (MOH), the Council of Governors (COG), the Public Service Commission, the Salaries and Remuneration Commission (SRC), Ministries of Labour and Social Protection, National Treasury, and the Head of Civil Service flopped.
In a show of disunion, the government officials, led by Deputy Chief of Staff and Deputy Head of Public Service, Josphat Nanok, walked out of the meeting with the doctors, citing the doctors’ adamancy to continue the strike with disregard to the order by the Employment and Labour Relations Court.
“We have convened in line with the direction given by the court on March 21. This was the second meeting following the first meeting which was held last week by the Head of Public Service, Felix Koskei. The court had also given direction that the strike is either stayed or suspended. The strike has not been stayed and has not been suspended, disabling the ability of the role of government approach to proceed, and to deal with the meeting issues which the union has raised,” said Nanok.
Mr Koskei had also indicated that the doctors were in contempt of the law and they should call off the strike for the meetings to continue.
“So, in that regard, we have concluded the meeting, we have asked the union any time between now and April 1, to comply with the ruling and lift the strike, stay or suspend it, then we will proceed to call the next meeting so that we can be able to discuss the 19 issues which they have made.,” announced Nanok.
“Failure to do that, then each of the parties will report back to Court. We are committed, as national government and county governments, to resolve this issue and also to comply with all the guidelines regarding this matter. We also do the same, we have to fail to comply directly so that we can be able to, in the various issues.”
However, the KMPDU officials, led by the union’s Secretary General Dr Davji Atellah, accompanied by members of the union’s National Executive Council, accused the government of walking out of the meeting, and for not being fully constituted as directed by the Court.
“In this particular meeting today, in the pursuit to resolve the issues that led to the industrial action, the government has walked out of the meeting. This evening as we were to start the meeting, they decided to all stream out of the engagement saying that they don't bother and they don't care how long the strike takes, they don't care how many Kenyans die, they don't care whether there are no doctors in the hospital or not. They are ready to wait until the next day in court on April 3, when they will engage us. So as a union, we want to say that we will continue being out until the government sits down and be ready to resolve the issues we have,” said Dr Atellah.
“We have a court order of 2017 that has not been complied with to date. We also have the judgment that Justice Mbaru delivered on October 28, 2021, that has not been complied with. As they have walked out, there has been no negotiation. We will therefore wait up to 3rd when we will be in court.”
“But in the meantime, we are on with the strike, we are on with our solidarity, we are on to tell the government that it is them to decide when they want Kenyans to be treated.
Some of the issues that the doctors want addressed by the government are the posting of interns and their salaries, Collective Bargaining Agreement and counties to harmonise doctors' pay.
"On the issue of internship, we have agreed that the term 'intern' is a bit confusing and we have that in all professions. Our friends want them to be called interns and they are paid Sh206,000 as opposed to other interns who are paid between Sh25,000 and Sh35,000 and at the same time (we) absorb all of them at the same time," said Mr Koskei.
"We are saying we want to harmonise payments across the board and because they passionately explained the role of an intern doctor and having realised that an intern doctor is a qualified doctor who has graduated and a doctor who does everything that is required of a doctor when he is posted, only that he is under supervision for a year, we agreed that the term intern may not be appropriate for a doctor because they are qualified and working."
KMPDU secretary-general, Dr Davji Atellah, strongly disagreed with the recommendation.
He insists that the existing Medical Practitioners and Dentists Act already provides a clear definition of the term "intern".
“CAP253 of the Act of Parliament states that an intern is a doctor who has graduated, taken an oath, and is working under supervision. In our collective bargaining agreement, it is well defined in job group L. Changing the title does not change the work that they do at the hospitals,” he remarked.
In an earlier meeting by the COG, the COG Chairperson Anne Waiguru granted the county government’s liberty to take disciplinary action against doctors who do not return to work soon. She asked the doctors to exercise goodwill and return to work in respect to their oath to protect life.
"We ask the doctors to show goodwill and return to work as negotiations go on. We also call upon the doctors who are striking to go back to work under the court orders issued on 13th March 2024 and 15th March 2024. Failure to which, the respective county governments who are their employers will be at liberty to take any appropriate action or disciplinary action," said Ms Waiguru.
The Council addressed 10 out of 19 issues raised by the Kenya Medical Practitioners Pharmacists and Dentists Union (KMPDU), and for which they have based the doctor's strike on. These issues, says the COG have remained unaddressed since June 2017 and 6 July 2021 when a Collective Bargaining Agreement was signed between KMPDU, the COG and the Ministry of Health.
"On delayed posting of interns, we would like to mention that this is a national government issue. However, we wish to inform the doctors and the public that all internship training centers within the county facilities are available to receive and welcome the interns once they are posted," said Ms Waiguru.
"On the extension of contracts for Universal Coverage staff, in the summit held in Naivasha on February 12, 2023, the Ministry of Health was directed to extend the contracts of UHC staff for three years under the same terms and conditions. We ask the Ministry to implement this resolution of the summit as we look into their transition."
These are health workers who were hired by the Health Ministry during Covid-19 period to support the Pandemic rapid response efforts.
The COG also addressed doctors' complaints of perennial delayed payments of fees for doctors on postgraduate training. The governors urged MOH for timely disburse of the funds to allow doctors complete their studies within the stipulated time.
The council highlighted their efforts to improve working conditions for the doctors, including releasing 890 medics for postgraduate training. They also defended their position on payments of arrears of basic salaries as agreed upon during the signing of 2017 CBA.
" The CBA was signed by the national government and counties were not funded yet was expected to implement the same. Nevertheless, counties have progressively made efforts to ensure that the medical practitioners are adequately remunerated," she said.
According to KMPDU, there has been a perennial delay in payments of salaries and remittance of statutory deductions and is among the 19 issues filed during the conciliatory meeting chaired by The Head of Public Service, Feli Koskei.
The doctors’ union had also complained that county governments were conducting disciplinary processes against medical officers who had been released to attend trainings, including compulsory head counts and termination. However, the COG said that counties, following human resource policies, only undertaken disciplinary action against doctors who had absconded duty.
“Desertion of duty is a disciplinary issue and not a unionisable issue to warrant a nationwide strike. We urge where those cases arise that the medical practitioners appropriately deal with the issue through the county public service boards, the human resource committees, and also if that fails they have a way to get that issue addressed,” said Ms Waiguru.
She also told KMPDU, who had complained about delays in salary payment to advise its members to address the matter with their respective county employers.
“This is because many times the salaries don't only affect the medical practitioners but affect the entire counties and this is in relation also to ex-chequer releases by the National Treasury. When ex-chequer releases are done on time, salaries are paid on time. Furthermore, many counties have put measures in place to ensure that we are avoiding delay in the payment of salaries by having separate negotiations with banks,” said Ms Waiguru.
“On the failure (of counties) to provide medical insurance to union members, counties appreciate the need to provide medical cover for all their staff. This is done according to each county's ability to do so and according to what each county can afford. This has been progressively achieved over time with the majority of the counties being able to provide medical cover, not again just medical practitioners but also across for all the staff,” she added.
The doctors, said Ms Waiguru, also need to negotiate new CBAs with individual county governments who are their employers. the negotiation, she said, cannot be done on a national level because “health function in every county government is a separate and individual employment.”
While admitting that the health sectors is not adequately funded, Ms Waiguru defended county governments, saying that each county funds health to the best depending on their ability according to the available resources.
“Every county at least allocates a 30 per cent of their allocation to health. We are going and are hopeful that this amount of money that is released to the counties will increase and as the resources increase to counties, so will the allocation of the resources to health sector. In conclusion, we conclude and we ask the national government, the county governments and the doctors to exercise authority as parties to resolve this matters,” she said.
“We appeal to the doctors to remember their highest goal which is to protect and to preserve life. We ask all doctors across all countries to accept the goodwill that has been extended by both the national and county governments to negotiate and ensure that there is a win-win sustainable solution,” added Ms Waiguru.
However, the doctors expressed dis-satisfaction with Ms Waiguru’s remarks, with Dr Atellah saying that “there’s nothing that has been addressed” and that they have “not been given a report of anything of the 19 issues they raised or offered anything to counter.”
KMPDU’s Deputy National Chairperson, Dr Kahura Mundia lamented that doctors are still on strike because they have not been accorded the dignity and the decency that they deserve at their workplace, and that county governments have failed to manage the healthcare sector as regards human resources.
“Today, all doctors want that dignity returned. You have not seen police officers serving contracts. You have not seen magistrates or judges serving contracts. All these people enjoy decent work. Today, we've been embarrassed here when the government has walked out on Kenyans, not just on doctors, all because they don't want to resolve the problem that falls on their throats. Besides, only four governors showed up, yet the orders of the court say all 47 should have,” said Dr Mundia.
