Kenyatta National Hospital in Nairobi.
Dr Daniel Ndege Chacha treated patients without pay, but when he fell ill two weeks ago, Kenyatta National Hospital (KNH) denied him medical attention because he couldn’t afford it.
Dr Chacha, 37, left the referral hospital where he worked tirelessly to save lives but which had let him down in his hour of need. The young medic turned to a local facility desperate to save his own life.
But here he got no salvation. By the time he was referred to KNH, it was too late.
A medical registrar specialising in obstetrics and gynaecology at the University of Nairobi (UoN), Kenyatta National Hospital (KNH) Campus, Dr Chacha worked at KNH as he pursued his Master’s degree.
According to Dr Dennis Miskellah, Deputy Secretary General of the Kenya Medical Practitioners, Pharmacists, and Dentists Union (KMPDU), Dr Chacha initially sought treatment at KNH but was unable to pay for medical attention.
The hospital refused to treat him without medical cover, and Dr Chacha did not have cash to take care of his treatment. He was forced to seek care at a local hospital, where his condition deteriorated.
"Despite dedicating his time and expertise to saving lives at KNH, Dr Chacha was left to fend for himself when he needed care the most," lamented Dr Miskellah.
Dr Miskella explained since Dr Chacha had no salary, he was doing locums to sustain himself and his family, and making his remittances to the Social Health Authority (SHA).
"He visited a local healthcare facility and was mismanaged. By the time he was being referred to KNH, he had developed an acute liver injury, which affected his kidneys. He was admitted to the Intensive Care Unit (ICU) for a week. Unfortunately, he died yesterday (March 17). The total bill came to around Sh300,000, but SHA said they can only pay about Sh30,000,” said Dr Miskellah.
“The family cannot afford to sort out the bill, and KNH, which should have submitted its remittances on time, and which refused to treat him, has refused to waive the bill and has detained his body until the bill is cleared. Unfortunately, he leaves behind an expectant wife,” Dr Miskella complained.
Dr Davji Bhimji, Secretary General of the Kenya Medical Practitioners Pharmacists and Dentist's Union (right) and his deputy Dr Miskellah Dennis during a press briefing in Nairobi on November 9, 2023.
A senior manager at Kenyatta National Hospital (KNH), who spoke on condition of anonymity, stated that Dr Chacha was not an employee of the hospital and that responsibility for his medical cover lay with the University of Nairobi (UoN), where he was pursuing his Master’s degree.
"He was a resident doctor and a Master's student. As such, it was UoN’s responsibility to provide him with medical cover, not KNH. He was not on our payroll," the official explained.
Medical trainees
The statement has further fuelled debate on who should be responsible for the welfare of medical trainees, highlighting gaps in the system that leave young doctors working in hospitals without health coverage.
Dr Miskellah told the Nation that a major flaw in the memorandum of understanding between UON and KNH has left postgraduate medical trainees in a vulnerable position. Despite working long hours at the hospital, these doctors are not considered employees and are not provided with health insurance.
"KNH does not recognise medical trainees as employees. They work tirelessly, offering services for free, yet when they fall sick, they have no medical cover. It is heartbreaking and unacceptable," Dr Miskellah added.
"Doctors, healthcare workers, and civil servants deserve medical cover. It makes no sense that we work and serve this government, but when we fall sick, nobody cares for us. Who cares for the career? Registrars should be paid and must have a medical cover or be allowed to be seen for free in the hospitals they serve at,” said Dr Miskellah, adding that doctors will go on a go-slow until the bill is waived.
As they grieved Dr Chacha, doctors hit the streets today, lamenting the delayed remittance of SHIF contributions, leading to their being denied treatment in hospitals. The doctors are also objecting to a further reduction of salary for medical interns.
“We are also demonstrating our frustration with the SHA. We have doctors detained because they cannot pay medical bills. As we speak today, over 30 counties have not remitted their deductions to the Social Health Authority (SHA). The government deducts our money and then does not remit it to itself. SHA removing workers from accessing services every 9th of the month has to stop. There is no way doctors will be going to the hospital and not getting care while they are working faithfully,” said Dr Atellah.
The entrance to the Accident and Emergency unit at Kenyatta National Hospital in Nairobi.
"We will not allow the government to think that they can wake up one day and say that they can reduce the wages that we negotiated. As a union, we were here last year in a series of demonstrations expressing to the government that the CBA that was signed in 2017 and 2021 is sacrosanct. We fought very hard, but at the end of the day, the threats of the government, the intimidation, and any doubts that they would not comply with the CBA were kicked out, and the interns who are currently in facilities were paid as per the CBA. Now there is a thought to reduce intern wages from Sh70,000 to Sh40,000. We shall not allow it,” added Dr Atellah.
“If these matters are not resolved, we shall issue a strike notice on May 9, and there will be total withdrawal of services across the entire country,” he added.
In a petition presented to SHA, MOH, Treasury, and the Parliament, Dr Atellah explained that doctors have had to “suffer great losses and catastrophic expenditure by making out-of-pocket payments whenever they want to seek healthcare services under the Social Health Insurance.” He added that doctors have, “in some instances suffered loss of limb, adverse medical outcomes, and even loss of life following denial of access to healthcare services from the non-payment of premiums to the Social Health Authority by employers.”
Dr Atellah also lamented that the country’s cost of living has increased ever since the CBA was signed in 2017 and that the double deduction of pension dues-NSSF and County Employers’ Pension, Housing Levy, and the SHIF contribution—"only leaves workers at a worse off economic state of earnings and standards of living, more so when healthcare insurance is dysfunctional.”
“There is a very extreme and severe shortage of medical practitioners, dentists, and pharmacists in all national and county public health facilities. Every year, some medical interns complete undergraduate training and are required to undertake a mandatory internship in professional practice. The MOH, National Treasury, and Public Service Commission have over several years abdicated their duties, breached the internship policy, and CBA with the union as regards the prioritising and planning of the posting of the young doctors, which affects the annual demonstrations and picketing to have postings undertaken,” explained Dr Atellah.
“Every year, there are medical doctors, pharmacists, and dentists undergoing postgraduate training under the MOH Programme to promote specialised training. In the last four years, medical doctors, pharmacists, and dentists have struggled and suffered to complete their training owing to their non-commitment to pay training fees to the universities. This matter has taken a large toll on the mental health of the doctors, and the eventual consequence is a dire shortage of specialist practitioners in the country,” he added.
Kenyatta National Hospital entrance pictured on February 8, 2025.
Dr Atellah now demands that the parliament recommend the immediate implementation of the CBA and regular posting of medical interns on school completion to reduce career depression and stagnation and allow for the professional growth of the youthful doctors. He is also calling on the parliament to recommend regular planning and postgraduate training of specialized doctors to enable the country to attain an adequate threshold of specialised doctors’ numbers.
“We pray the parliament recommends the provision of express comprehensive health insurance coverage and health services access to all members of the union, civil servants, public servants, and county workers by provision of a four-month moratorium on late premium payments by employers.
Parliament should also direct and order that the salary deductions so far made and planned on workers’ payslips be met with commensurate and proportional salary increases, and direct the government to develop a plan for the immediate and progressive employment of doctors,” he said.
KNH CEO Evans Kamuri did not respond to the Nation's enquiries on the matter.
mchelangat@ke.nationmedia.com
