No sigh of relief yet: UHC workers still waiting for formal appointment letters
Universal Health Coverage (UHC) workers protest outside the National Treasury Building in Nairobi on May 27, 2025.
What you need to know:
- A letter dated July 13 from Principal Secretary for Medical Services, Dr Ouma Oluga, indicated that the transition of all UHC staff to PnP establishment was underway and requested a central and full payroll transfer to allow all 47 county governments to begin paying salaries to their newly absorbed staff starting this month.
For thousands of Universal Health Coverage (UHC) workers who have spent more than four years fighting to be absorbed into permanent and pensionable (PnP) terms, this week's flurry of county announcements might look, on paper, like the breakthrough they have been waiting for. On the ground, however, the mood among the workers themselves is far from celebratory.
A letter dated July 13, 2026 from Principal Secretary for Medical Services, Dr Ouma Oluga, indicated that the transition of all UHC staff to PnP establishment was underway and requested a central and full payroll transfer to allow all 47 county governments to begin paying salaries to their newly absorbed staff starting this month. The move follows a presidential directive issued in September 2025 and subsequent guidance from the Public Service Commission that the transition be concluded by June 30, a deadline that has now passed.
Some counties appear to be acting on the directive. Embu County has set aside Sh314 million in its 2026/2027 budget to confirm all UHC healthcare workers on permanent and pensionable terms and to promote staff who have stagnated in the same job groups for years. Chief Officer for Health Patrick Mukavi said the move would end the cycle of strikes, lift staff morale, and improve service delivery across the county.
Makueni County also issued a formal notice on July 10, 2026, informing its UHC staff that their absorption process had begun, with county officials saying they were working with national agencies to ensure a smooth payroll transfer and that the remaining administrative steps were being finalised.
"The Department of Health Services, on behalf of the government of Makueni County, wishes to inform all UHC staff that the Ministry of Health (MoH) has announced the commencement of the absorption of UHC staff into the public service on permanent and pensionable terms, as communicated in the press release issued by the Cabinet Secretary for Health on July 6, 2026," said Dr Harvey Mbithi, chief officer for Health Human Resource Management and Administration, in a letter to the CEO of Makueni County Referral
Hospital, concerned sub-county medical officers of health, and concerned medical superintendents.
"The transition is being undertaken collaboratively by the Ministry of Health, the Council of Governors, the Public Service Commission, the National Treasury, and other relevant stakeholders… During this transition period, all UHC staff are encouraged to remain committed to their duties. The Ministry has assured all UHC staff that every effort is being made to finalise the remaining administrative processes as expeditiously as possible," added Dr Mbithi.
In a letter to the Kisii Teaching and Referral Hospital CEO and sub-county medical officers of health, Susan Kalinda, the chief officer for Medical Services, Public Health and Sanitation from Kisii County Government, explained that they are in the process of transitioning UHC staff from the national government payroll to county government payrolls. She acknowledged that the current contracts have lapsed but asked that they notify UHC staff to "continue rendering their services pending the finalisation of the transition process."
However, for UHC workers countrywide, these announcements are being met with caution bordering on suspicion. Shiru Kihara, a representative of the UHC workers, said she had fielded a wave of questions from workers after reports emerged that some counties had begun processing absorption letters, but she could not confirm that any letters had actually been issued. She said what she was seeing looked more like public relations than a completed transition, and that no county had produced documentation to show otherwise.
"The disconnect comes down to money," said Kihara. "While the Ministry of Health maintains that the transition process is complete on its end, counties say they have not received the payroll or the funds needed to formalise the absorption. The money that was provided in the budget was a conditional grant. Counties want the money to come from the equitable share fund so that it becomes recurrent. Governors are unwilling to issue PNP letters without an assurance that the funding will be guaranteed annually, even as some counties simultaneously claim to have already budgeted for the positions."
A leaked communique from PS Oluga's office, referencing a directive from the President's office, showed the ministry pressing the Public Service Commission to release payroll funds to the counties. However, county governments maintain that what they have received so far does not include the actual money.
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"The unions have now advised us to watch closely for our July payslips. If the payslips reflect PnP terms, we will know that we have been retained at the national level rather than transferred to county payroll, since counties have not yet issued the letters that would make a county-level PnP appointment official. If salaries are delayed or routed through county payroll systems that have flagged centralisation issues, that would be a signal that our status remains unresolved," said Kihara.
In an internal memo to UHC workers in Marsabit County, the county's chief officer of Medical Services, Dr Adan Al-Amin, said the county is fully committed to the absorption of eligible UHC personnel into the county public service, subject to the successful completion of the ongoing staff appraisal and verification processes.
However, it was also announced that workers "who have absconded duty, deserted their work stations, or are found to have abandoned their assigned duties without lawful authority will not be considered eligible for absorption into the county public service. Such conduct will be treated as a serious breach of public service regulations and may lead to disqualification from the transition process."
Because of this uncertainty, the Health Caucus has held its position that it will not call off its ongoing strike until PNP appointment letters are formally issued to UHC workers, not merely promised, budgeted for, or referenced in inter-agency correspondence.
"All these letters do not change anything regarding the impending strike by the Health Caucus unions. Only PnP letters will," said Peterson Wachira, the caucus chairperson.
The caucus announced during the week that they would go on strike starting Monday, July 20, at midnight, to protest against the delay in absorption of UHC workers and the subsequent payment of their gratuity.
The standoff is the latest chapter in a struggle that has defined the working lives of UHC staff for more than four years. Across this period, UHC workers on temporary contracts have repeatedly described irregular pay compared with their permanently employed colleagues, exclusion from medical insurance and pension schemes, and a persistent sense of inequality with PNP staff who perform identical duties but receive better pay and clearer paths to promotion.
The recurring theme, workers say, is not a lack of promises but a lack of follow-through broken commitments from national and county authorities that have left many feeling like second-class citizens within Kenya's health sector.
