Hospitals crisis drags on as Duale, Clinical Officers clash over pay deal

KUCO led by chairperson Peterson Wachira and Secretary General  George Gibore march from Green Park to Afya House, Nairobi, to demand delayed salaries and the signing of the CBA on January 7, 2026. [Jenipher Wachie, Standard]

The crisis in public health hospitals may not end soon as Clinical Officers and Health Cabinet Secretary Aden Duale differ over an unsigned pay deal.

Duale said he will not sign the Collective Bargaining Agreement (CBA) even as Kenya Union of Clinical Officers (KUCO) insisted the ministry was being dishonest on the deal.

“The CBA before me applies to only 150 clinicians working directly at the Ministry of Health. Yet we have over 7,000 clinicians in counties and more than 400 in national referral hospitals. As minister, I cannot sign an agreement that benefits a few and discriminates against the majority,” Aden Duale said. 

On Wednesday, as the strike action by Clinical Officers entered day 16, they took to the streets to demanded that the CBA is signed.

The strike, which began on December 23, 2025, was triggered by what the KUCO describes as the government’s refusal to sign a CBA already approved by the Salaries and Remuneration Commission (SRC).

The union accuses Duale of dishonesty and neglect, claims the ministry disputes.

The union’s claims are backed by correspondence from the Salaries and Remuneration Commission (SRC) confirming that the proposed CBA had already received regulatory approval months before the strike.

In a letter dated September 15, 2025, addressed to Health Principal Secretary Mary Muthoni, the SRC confirmed that during its 678th meeting held on September 11, 2025, the commission deliberated on the proposed CBA between the Ministry of Health and Clinical Officers.

The deliberations, the SRC said, took into account key remuneration determination factors including affordability, fiscal sustainability, comparability, and prevailing government policies and guidelines.

Clinical Officers march from Green Park to Afya House, Nairobi, to demand delayed salaries and the signing of the Collective Bargaining Agreement on January 7, 2026. [Jenipher Wachie, Standard]

The commission noted that the National Treasury had allocated funds for the review of the Health Risk Allowance for clinical officers in the Ministry of Health, with effect from July 2025, paving the way for implementation.

“Consequently, the Commission advises the Ministry of Health to negotiate the proposed Collective Bargaining Agreement with the Kenya Union of Clinical Officers within the following parameters,” the letter states.

Speaking at the ministry of health offices, Duale dismissed claims of neglect and insisted he was ready to sign a CBA but only one that covers all Clinical Officers in the public sector, not a select group.

Duale said the main sticking point is risk allowance, which he noted had been reviewed upward from Sh3,000 to Sh7,000.

He argued that referral hospitals and counties, which employ the bulk of clinical officers, must be part of the agreement.

“If I sign for 150 and leave out the rest, I will be violating Article 10 of the Constitution on fairness and equity. I have asked the union leadership to consult the Council of Governors and referral hospital boards so we can sign one comprehensive CBA,” Duale said.

He accused union leaders of misleading their members and engaging in populist politics.

“These leaders are not representing the 8,000 clinicians in the public sector,” Duale said. “They should be agitating for all clinicians, including those in counties, referral hospitals, interns joining in July, and UHC staff transitioning to permanent terms.”

The standoff between Duale and nurses puts Kenya’s public health system under strain as a nationwide strike by clinical officers extend a long-running labour dispute into the new year.

It also puts the Ministry of Health under renewed pressure to resolve an impasse over an unsigned CBA that the Duale insists on not signing.

Under the approved framework, the Health Risk Allowance was set at Sh7,000 per month, effective July 2025, subject to availability of funds.

The SRC further directed that basic salary, house allowance, and commuter allowance be paid in line with its earlier circular dated June 21, 2024.

The Commission also advised that the Emergency Call Allowance be retained at existing rates as outlined in an SRC circular issued in March 2017, while the Health Service Allowance be maintained at Sh20,000 per month.

Crucially, SRC stated that once negotiations were concluded within the approved parameters, the Ministry of Health was required to submit a signed copy of the CBA to enable the Commission to issue written concurrence and facilitate registration of the agreement at the Employment and Labour Relations Court.

KUCO says the ministry’s failure to act on that advisory despite funding having been allocated and regulatory approval granted, is what precipitated the industrial action.

On Wednesday, KUCO members marched through Nairobi’s Central Business District, moving from Green Park Terminus to Afya House before proceeding to the Council of Governors’ (CoG) offices. Carrying placards and chanting slogans, the clinical officers said demands raised over the years had been pushed into 2026 without resolution.

At the centre of the dispute is a CBA that KUCO says has taken more than eight years to negotiate, alongside demands for payment of 19 months’ salary arrears and implementation of SRC-approved salary structures across counties.

Speaking outside Afya House, KUCO National chairman Peterson Wachira said the strike was avoidable and blamed it squarely on the Ministry of Health.

“It has taken us more than three years to reach this point. Now that the decision has been made and SRC has approved the CBA, we are only here seeking a signature,” Wachira said. “Instead, Kenyans are losing hope, and they are losing lives. Children who need our services are not being treated.”

Wachira accused the ministry of prioritising select issues while ignoring the broader crisis in the health sector, arguing that failure to address longstanding grievances had deepened discrimination among health workers.

He also raised concerns about the implementation of SRC salary phases, claiming funds released to counties for earlier phases had been misused.

“For more than five years, SRC has been harmonising salaries through phased implementation. But the money given to counties for phases three and four has been swindled, and now there is no money to move forward,” he said. “We are now being told counties have been directed not to implement approved salaries. This is corruption, and it affects all county workers.”

The union further highlighted the plight of clinical officers working under donor-funded programmes, including those supported by the Global Fund, who they say have gone for months without pay.

According to KUCO, others continue to work without medical cover, under heavy workloads, and with no job security.

“You want people on rotas every day, yet they have families to feed, school fees to pay, and no medical cover,” Wachira said. “That cannot be accepted in a country that wants to become Singapore.”

He linked these conditions to declining quality of care, citing severe staff shortages in public facilities.

“Official ministry documents show we need about 24,000 clinical officers in the public system. We only have around 6,500,” he said. “One officer ends up doing the work of four, seeing more than 150 patients a day. That leads to fatigue, mental exhaustion, and sometimes misdiagnosis not because officers are incompetent, but because they are overwhelmed.”

Wachira said the crisis had also taken a toll on workers’ mental health, with some officers reportedly turning to substance abuse due to stress and burnout.

KUCO argues that the current standoff reflects a pattern of disregard for court orders and negotiated agreements. In August 2023, the Employment and Labour Relations Court ordered the union, the Ministry of Health, and the Council of Governors to engage and resolve the dispute within 90 days. The union says that order was ignored.

In 2024, a 120-day strike ended after another court-supervised return-to-work agreement, which included commitments to recruit more clinical officers and improve working conditions. KUCO says those commitments remain largely unimplemented.

The union also criticised what it termed broken public promises, pointing to statements made by CS Duale in the media that the issue would be resolved within a week.

“We are now heading to one month since that promise,” Wachira said. “We issued a strike notice on December 2, gave 21 days, and SRC approved the CBA on December 20. Instead of calling us to the table, the government rushed to court.”

While KUCO insists services have been disrupted, the ministry downplayed the impact, with Duale claiming operations in most hospitals remain unaffected.

Beyond the strike, Duale outlined broader reforms in the health sector, including plans to absorb Universal Health Coverage (UHC) workers into permanent and pensionable terms and to transition donor-funded programmes fully under government oversight.

He also announced a move to restrict licensing of foreign doctors, except specialists and practitioners from the East African Community, citing unemployment among Kenyan-trained doctors.

“We cannot allow foreign doctors to treat Kenyans when our own doctors are at home without jobs,” Duale said. “This year, basic medical officers and dentists from outside the region will not be licensed.”