Broken promises stoke health crisis as doctors threaten strike

Kenya Medical Practitioners Pharmacists and Dentists Union officials led by Secretary General Davji Bhimji Atellah(C) singing solidarity song after addressing press on Dec 3, 2024 at Blue Violet Plaza in Nairobi. [Edward Kiplimo, Standard]

Healthcare services are set to grind to a halt once again as doctors announced a second strike this year, leaving patients in desperate need of care to bear the brunt of unfulfilled promises by the Kenya Kwanza administration.

Doctors, under the Kenya Medical Practitioners, Pharmacists, and Dentists Union (KMPDU), have declared the strike, just five months after a 56-day walkout in April. The ongoing impasse highlights a worsening healthcare crisis, with the government’s failure to honour agreements fueling unrest among medical professionals.

Key issues at the heart of the impasse include the harmonization of salaries, promotions, provision of medical cover, payment of fees for postgraduates, and demands outlined in the 2017 Collective Bargaining Agreement (CBA). A breach of intern doctors’ pay, slashed by 70 per cent, has also angered doctors.

In a strike notice, seen by The Standard, doctors have decried the disregard shown by both National and County Governments for their agreements, particularly the 2017 CBA. They remain firm that they will only resume duty if both levels of government meet their demands.

“Today, December 3, 2024, we hereby issue a 21-day strike notice, set to commence on December 22, 2024, unless our demands—outlined in the return-to-work formula—are met. This includes payment of arrears owed to interns, Ministry of Health doctors, doctors in all 47 counties, and registrars who are overworked in level 6 hospitals,” the notice reads.

Several months after doctors signed a return-to-work formula in May, KMPDU Secretary-General Davji Atellah said none of the agreements have been fulfilled.

While strikes paralyse the healthcare system, Atellah maintains that this is the best way to communicate with the government. “Strike is a solution because it means they lied to us. When timelines pass, and nothing has been done, it means you are acting in ill will. You cannot tell us that Sh1.7 billion to pay half the money for doctors in this country will be too much when we have money for other activities. This is just a lack of priority,” he said.

He adds, “We are not negotiating. Timelines were put. The government has to get this (promises) done”.

Dr Atellah regrets the lack of goodwill by the government, in meeting the demands of doctors.

READ: Doctors' strike presents critical moment for reflection and action

KMPDU Deputy Secretary-General Dennis Miskellah said that the union has been negotiating with the government since December 2022, but remains reluctant to fulfil its promises.

“The government has not paid fees for registrars since 2019. They promised to get us medical cover as per SRC guidelines, they promised to give promotions, they promised postgraduate students working at Kenyatta National Hospital (KNH) and Moi Teaching and Referral Hospital (MTRH) that wherever they work past hours they will be reimbursed money, but this has not happened,” Miskellah says.

The union also accuses the national government of failing to honour the 2017 CBA, despite its validation by the Employment and Labour Court on October 26, 2024.

The union further claims that the government disputes the CBA rather than actualizing it. For instance, according to the CBA, each intern doctor should earn Sh206,000 monthly, but they are currently paid based on Salaries and Remuneration Commission (SRC) rates, as per a March 2024 circular. Interns are paid Sh41,000 monthly, which is a gross amount of Sh70,000 after a 70 per cent reduction. Despite this, most intern doctors have yet to receive their four-month pay since being posted in August.

“It is painful. Why has the government been paying intern doctors for the last 15 years without a problem?” Atellah asked.

There are at least 1,410 intern doctors. Dr. Satia Arnold, an intern doctor at Thika Level Five Hospital in Kiambu, lamented that the pay is too little to meet the needs of intern doctors.

“Interns perform more roles in hospitals. It is a sad moment that we have lost two brilliant minds by suicide, whose cause is frustrations through the internship program,” emphasises Arnold.

Hospitals where intern doctors are posted according to the representative are also understaffed, leading interns to reform more roles.

Posting and payment of interns were among the issues that led doctors to go on strike early this year.

At the helm of the strike, the President showed his dedication of solving the strike after he directed the Head of Public Service, Felix Koskei, to find a solution for the strike force. Linus Kariuki from the Office of labour was appointed to chair the negotiation committee.

ALSO READ: Handling doctors' strike exposes systemic failures in governance

During the negotiation process, the then CoG chairperson Anne Waiguru called on the government to implement the stalled 2017 CBA under contention to unlock the impasse.

In the return to work formula, promotions of doctors were also to be effected in all 47 counties across the country by September 1, 2024, but so far, none of the more than 2,000 doctors set for promotions has been promoted, notes the union.

The Kenya Medical Association (KMA) has expressed concern over the persistent frustrations facing doctors due to unresolved issues that have plagued the healthcare sector for years.

According to KMA Secretary General Dr Diana Marion, the challenges include delays in honouring the 2017 CBA. Dr Marion also notes the paradox of high unemployment rates among doctors, despite the critical need to meet recommended health worker-to-patient ratios.

Efforts by The Standard to obtain official responses from health ministry officials and the Council of Governors were unsuccessful, as calls and messages went unanswered.