Perennial strikes expose chronic failures in the healthcare sector

Recurring strikes by healthcare workers across the country are increasingly being cited as evidence of a failing health system, with experts warning that chronic underfunding, weak governance and lack of political prioritisation continue to paralyse service delivery.

The failure to reform human resource management in the sector has left patients bearing the brunt of prolonged industrial action, with little indication of swift resolution from authorities. Clinical officers countrywide are on strike. Nurses, meanwhile, have issued a seven-day strike notice demanding implementation of the 2017 return-to-work formula and the conclusion of negotiations on their 2017 Collective Bargaining Agreement (CBA).

Clinical officers have been negotiating their CBA for more than eight years, a delay unions describe as negligence by employers. The failure to conclude the agreement has triggered a nationwide strike that has now lasted more than five weeks.

In Nairobi, public hospitals are facing a health crisis as clinical officers continue their strike, now in its 29th day. The industrial action has left facilities largely run by interns and students, raising serious concerns over patient safety and access to care.

As a result, many Kenyans are being forced to seek treatment in private hospitals, where services are often unaffordable and, in some cases, exploitative.

Speaking at Mama Lucy Hospital, Kenya Union of Clinical Officers (KUCO) Chairperson Peterson Wachira said patients were arriving early in the morning only to leave untreated.
“Many patients come here at 8:00am and leave in the evening without being seen, especially those who cannot afford private healthcare,” he said.

Wachira accused the Council of Governors of ignoring a court order and failing to honour a return-to-work agreement. “The county had ample time to budget and plan. They are also in contempt of court,” he said.

KUCO Nairobi Branch Chair Stephen Muthama said current staffing arrangements compromise patient care.
“The interns here are not employed by the county government. It is not possible for specialists to practise as general practitioners,” he said.
“We are not going back to work until the agreement recognising our training is honoured and implemented.”

Clinical officers have warned that public hospitals could face a complete shutdown within seven days if their demands are not met, further straining the health system. Implementing their CBA would cost an estimated Sh320 million.

The officers are demanding the signing of the CBA, employment and absorption of Universal Health Coverage (UHC) staff, and payment of Global Fund-supported workers who have gone unpaid for 19 months.

“There are disparities where some counties promote workers while others do not. Everything depends on the county,” said KUCO Secretary-General George Gibore.

The paralysis comes even as the Kenya Kwanza administration prides itself on expanding access to quality healthcare through UHC.

Health economist and public policy expert Beatrice Kairu argues that strikes are not the problem, but a symptom of deeper structural failures.
“Healthcare workers strike because the system has failed. It begins with chronic underfunding, reduced allocations to counties, and a general failure to prioritise health,” she said.

Kairu noted that successive administrations — from President Mwai Kibaki to Uhuru Kenyatta — signed CBAs without corresponding budgetary allocations, directly fuelling repeated industrial action. “Signing CBAs without budgeting for them inevitably leads to strikes,” she said, warning that many agreements are concluded without any financial plan.

According to Kairu, national budgets rarely factor in CBA obligations, leaving counties unable or unwilling to implement agreed terms. While counties blame delayed disbursement of funds by the national government, she argues that some county governments fail to prioritise healthcare even when resources are available. “Some counties park money in banks to earn interest instead of paying health workers. Healthcare is treated as a recurrent cost rather than a priority investment,” she said.

Poor working conditions further compound the crisis, with many facilities lacking essential equipment and operating with skeletal staff.

Clinical officers say failure to prioritise human resources lies at the heart of the sector’s woes. Ideally, a clinician should attend to about 40 patients a day, spending roughly 15 minutes per patient. In reality, many now see between 50 and 100 patients daily, compromising quality of care.

“Our hospitals are critically understaffed, leaving patients unattended,” said Gibore, noting that despite HR policies requiring promotions every three years, many officers stagnate in the same job group for up to a decade.

Kenya has about 8,000 clinical officers, with 7,000 on permanent and pensionable terms.
“Counties rarely complain about lack of money. The real issue is lack of priority in managing health human resources,” Gibore said, taking issue with Nairobi Governor Johnson Sakaja and President William Ruto for failing to intervene.

Kenya’s health sector has witnessed repeated strikes by doctors, nurses, clinical officers and laboratory technologists. In March 2024, doctors staged a 56-day nationwide strike, while clinical officers and lab technologists were out for more than 90 days.

Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) deputy secretary-general Dr Dennis Miskellah attributes the unrest to poor leadership and governance.

“Even with sound ideas on health financing, commodities and technology, there can be no service delivery without human resources,” he said, faulting leadership at the Presidency and Ministry of Health for failing to enforce policies at county level.

“Why do governors build hospitals without staff? Why are county hospitals non-operational over weekends? Why construct mother-and-child hospitals without doctors?” he posed.

Miskellah suggested establishing a Health Commission or reverting healthcare to the national government through a referendum.
“It is disturbing to see mushrooming hospitals that can barely provide quality services. Drugs and machines cannot serve patients without people,” he said. “I would rather see patients treated under tents than have fully built hospitals that are non-functional due to lack of staff.”

He warned that poor Kenyans suffer most during strikes. “Once someone dies, they are gone forever, yet leadership does not feel the pain. How can Nairobi be on strike for over a month and nobody is bothered?” he asked.

County-level disputes persist. Doctors in Embu recently suspended a strike over promotions and staff shortages, while those in Meru have complained about unfair contracts. Strike notices have been issued in Trans Nzoia, Isiolo and Homa Bay, while Marsabit doctors only returned to work last week.

Under the Kenya Kwanza administration, doctors staged the longest nationwide strike in March 2024, demanding full implementation of the 2017 CBA. Several issues remain unresolved, triggering recurrent stoppages.

Last year, it was alleged that several infants died in Kiambu following a doctors’ strike that lasted more than 100 days.
“There is hardly a day without a strike somewhere. If it is not a county, it is national. This paralyses care,” said Miskellah.

To address the crisis, President William Ruto appointed a task force led by Prof Khama Rogo to tackle human resource challenges.

Meanwhile, the Kenya National Union of Nurses and Midwives has renewed calls for healthcare management to be returned to the national government. Secretary-General Seth Panyako warned that many county health systems are on the brink of collapse.

“County governments cannot manage health human resources. The honourable thing is to return this function to the national government. Why hold on to what you cannot manage?” he said.