CBA battle: Why health workers keep striking

Kenya National Union of Nurses and Midwives from various hospitals across the country converged in Nairobi for a strike. [Wilberforce Okwiri,Standard]

Kenya’s healthcare system is once again facing industrial unrest, with health workers taking to the streets over Collective Bargaining Agreements (CBAs).

Since 2017, repeated strikes have paralysed services, leaving patients struggling to access care.

At the center of the latest dispute is a CBA — an agreement that sets out health workers’ salaries, allowances, working conditions, medical cover, pension and other benefits.

What should be a routine process of negotiating and implementing employment terms has instead become a recurring battle between health workers, counties and the national government.

The latest standoff is led by nurses, who through the Kenya National Union of Nurses and Midwives (KNUNM) have pushed for a CBA since 2016.

Ten years later, the agreement remains unresolved, with nurses vowing to stay off duty until it is honoured.

The failure to implement the agreement has now resulted in a nationwide strike, with KNUNM Secretary General Seth Panyako vowing that nurses will not return to work until their CBA is honoured.

But the Council of Governors (CoG) and the Salaries and Remuneration Commission (SRC) have pushed back against the nurses' demands.

CoG chairperson Ahmed Abdullahi has declared the nurses' strike illegal and directed individual governors to take action against striking workers, including dismissing them and employing new staff.

The Wajir Governor, speaking during an Intergovernmental Budget and Economic Council (IBEC) meeting, also argued that the CBA was signed under duress and is financially unsustainable.

The position has angered nurses and other healthcare providers who say the government cannot disown an agreement that was signed by its own officials.

Panyako questions why nurses are being singled out when other health cadres are also on strike, over CBA related disputes.

“Why is it nurses are the only ones? They are saying they have gone to court to stop nurses' strike. Why haven't they gone to stop clinical officers, laboratories and public health officers?” poses Panyako.

In an exclusive interview with The Sunday Standard, the official maintains that nurses are the engine of healthcare and are simply demanding to be paid according to the work they do.

Initially, Panyako says, the CoG and SRC were reluctant to actualise the nurses CBA on the grounds that nurses are too many.

Kenya has a total of 22,000 nurses working across the country.

But Panyako rejects the argument that their numbers make their demands unaffordable.

“Someone telling us we are too many, when you look at a nurse and families, are they too many even when they want to pay school fees for their children? Do we have supermarkets for nurses, and petrol stations for nurses? We must be remunerated as per the work we deliver and what we deserve amid economic struggle,” poses the unionist.

The much contested 2017 nurses CBA was signed and offered under the highest office of the land, led by then President Uhuru Kenyatta, alongside senior government officials including former Health Cabinet Secretary Cleopas Mailu, the CoG chairperson and the chairperson of the Health Committee.

The agreement, Panyako says should therefore be honoured by the current leadership.

“You cannot come and tell us these government officials signed a document that was never to be implemented. If it doesn't happen, let them give us their offers. We have given them what we want,” he adds.

Among the provisions of the CBA are enhanced uniform allowances, which were to rise from Sh10,000 to Sh25,000, paid once a year.

It also provides for nurses' allowances to increase from Sh20,000 to Sh30,000, among other benefits.

“Why would employer agree to pay but someone sitting somewhere else saying there is no money, yet approves payment of other people in respective departments of this government?” poses Panyako.

The CBA also stipulates the services that should continue during a strike.

Currently, however, services have been severely disrupted across the country, with emergencies being prioritised.

Panyako accuses Abdullahi of avoiding direct engagement with nurses and addressing them through the media.

“Nurses are engines to healthcare. Nobody can go on strike and hospitals are closed. Today, we've hospitals closed completely,” he observes.

“Only nurses in Wajir and Mandera are partially working because the CoG chairperson is victimising them. We shall move there and close all those hospitals, so that he can listen to nurses,” he adds.

Asked whether counties can afford the nurses' CBA, Panyako says, “If they afforded CBA for doctors, clinical officers, why can't they afford for nurses? We must be given our rightful share.”

On Monday, nurses through their union met the CoG health chairperson, Mombasa Governor Abdulswamad Nassir, and are awaiting the conclusion of discussions before the matter is taken to SRC.

Panyako says this could pave the way for the strike to be called off.

“The best minimum is SRC letter of no objection. It is not agreement if CoG. We want a deal at CoG and a letter of no objection from SRC,” he maintains.

But the CBA dispute extends beyond nurses.

Clinical officers, laboratory technicians and public health officers have also joined the industrial action, each citing unresolved issues around their employment agreements.

Kenya Union of Clinical Officers (KUCO), say they have been pushing to have their CBA implemented but have not been invited to negotiations with the relevant authorities.

This is despite CoG Chief Executive Officer Mary Mwiti maintaining that KUCO should not have gone on strike because the union has a CBA and a return-to-work formula.

Mwiti said the document is ready but is awaiting concurrence by SRC on remuneration and allowances to ensure standardisation and harmonisation across the civil service.

KUCO chairperson Peterson Wachira, however, disputes this position.

He says about 18 counties are yet to sign their respective CBAs.

The clinical officers CBA, was set for implementation by March, with the agreed benefits reflected in their payslips.

“Which CBA is the CoG talking about? The agreement was to have CBA signed by February 2. CoG took only 16 counties to SRC for signing,” Wachira tells The Standard, adding that they shall call off the strike, only if their needs are met.

Though doctors are currently the only health cadre at work, but they acknowledge that services remain paralysed because healthcare providers do not work in isolation.

The Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) has called on SRC, CoG and other stakeholders to find a quick solution to the dispute.

KMPDU Secretary General Davji Atellah says the nurses' strike is already affecting services, including admissions and surgeries.

“When nurses are on strike, the particular services ongoing, admissions are affected, including surgeries. KMPDU is asking government to ensure the strike does not persist more. People are suffering,” says Atellah.

Doctors own experience with CBAs offers a glimpse into why the current dispute has become so difficult.

The 2017 doctors' CBA was not simply handed to them.

Doctors negotiated a CBA in 2013, but after it was signed, the government disowned the agreement, including the wages that had been agreed.

That pushed doctors into another strike in 2016.

The strike began on December 5, 2016, and ended on March 13, 2017, lasting about 100 days.

“Doctors took 100 days strike that Kenyans suffered, 100 days that people were not able to access healthcare, 100 days where doctors were even jailed to get the CBA,” says Atellah.

“It was a painful process of over 100 days of strike. Doctors suffered, patients suffered and government ignored before the matter went to court, leading to CBA negotiation of 2017 CBA” he adds.

Even after the 2017 agreement was signed, doctors again went on strike for 60 days in 2024 to push for its implementation.

Today, the union says about 80 per cent of the 2017 CBA has been implemented. But another deadline is approaching.

Doctors are now negotiating the 2025/2029 CBA and are warning that the country could be headed for another health crisis if an agreement is not reached.

Atellah says doctors have already explained to President William Ruto and other government officials that they want the new CBA negotiated and agreed without industrial action.

If this is not attain, the union threaten to head on strike.

“By mid-November, we don't have a CBA of 2025/29, then we will actually issue a strike notice that commences on December 5, 2026,” says Atellah.

“The reality is if we as a union are not able to have the document, or CBA, through negotiation and talks, then we have to make it a priority. The only way to make it a priority is by going on strike,” he adds.

Atellah says doctors do not want to strike in an election year, but that the timing is dictated by the CBA cycle set by SRC.

Atellah emphasises that a CBA, is a constitutional right.

Article 41 of the Constitution guarantees every worker the right to fair remuneration and reasonable working conditions, while workers have the right to form, join and participate in the activities of a trade union and to go on strike.

The CBA provides the framework through which workers and employers negotiate those terms.

“CBA gives mechanisms that ensure there is protection of health workers in terms of wages, social protection and even medical cover and protection of a patient treated by a healthcare worker,” he explains.

“It is a cornerstone of engagements in employee-employer relationship, and is also in ILO convention ratified in 1964 that gives every employee the right to bargain,” he adds.

Yet in Kenya, health workers have repeatedly had to leave their workplaces and take to the streets to secure agreements they say should be settled through negotiation.

Whereas in other jurisdictions, CBA is a smooth process, in Kenya every four years brings another cycle of negotiations, according to SRC.

But actualisation Atellah regrets leads to disagreements over financing and implementation often spilling into industrial action.

“Once a CBA expires, the government resists, pushing for a lot of negotiations. This is why we have persistent strikes,” he regrets.

The doctors' experience illustrates the cycle.

The 2017 CBA increased doctors' salaries and medical call allowances, among other benefits. Seven years of salary arrears have since been paid, while counties have committed to adjusting basic salaries. Homa Bay, Nyamira and Kisii have already actualised the adjustments, according to the union.

The CBA provided for Sh206,000 for doctor interns, while the union says recruitment of more doctors, provision of medical cover, drugs and other working conditions remain inconsistent across counties.

At the moment, 33 counties have not remitted deductions for doctors medical cover, according to KMPDU, cutting some doctors off from accessing care.

Nakuru, Kajiado and Laikipia are among counties the union says have performed poorly in providing comprehensive medical cover.

The 2017 CBA also provided for the employment of at least 2,000 doctors every year, a commitment yet to be realised.

Kenya has about 8,000 doctors, with roughly 6,000 working in counties and 2,000 under the Ministry of Health and other national government departments.

The new CBA is therefore expected to address salaries, recruitment, medical cover and pension, among other issues.

But Atellah says it should go further by guaranteeing the conditions needed for doctors to provide quality care.

“Salaries for doctors have not been increased for the past ten years. Wage of doctors has gone down because of inflation. CBA will ensure patients go to hospital, be reviewed, get tests, and have them leave with drugs,” explains Atellah.

The doctors new CBA is currently at the negotiation stage.

The document has been sent to county and national governments for a counter-proposal.

According to Atellah, the Ministry of Health and CoG have also received the document and promised to provide a response in September.

“If by November, we shall take action to have it happen. We have given them a window to finalise,” says Atellah.