Kenya’s public health system has repeatedly been tested by waves of industrial action involving doctors, nurses, and clinical officers. While individual strikes may begin in response to immediate grievances, the pattern reveals deeper structural challenges that continue to undermine healthcare delivery across the country. These disputes are not isolated events. They reflect long-standing weaknesses in funding, workforce management, and the implementation of labour agreements within a devolved health system.
At the heart of the crisis is the role of healthcare workers as the backbone of public service delivery. Kenya relies heavily on doctors, nurses, and clinical officers to serve millions of citizens, particularly in county hospitals and primary healthcare facilities. When these workers withdraw their labour, even partially, the impact is felt immediately by patients, hospitals, and the wider economy.
The Scale of Kenya’s Health Workforce
According to the most recent consolidated government data, Kenya has slightly over 4,000 doctors working in public county facilities, alongside more than 30,000 nurses. Clinical officers, though often less visible in national debates, form one of the largest frontline cadres in the health system. They are frequently the first point of contact for patients in dispensaries, health centres, and sub-county hospitals, especially in rural and underserved areas.
This workforce serves a population of more than 50 million people. Even under normal circumstances, staffing levels remain below World Health Organisation recommendations. As a result, any disruption, whether localized or nationwide quickly pushes facilities beyond their limits.
Why Doctors Go on Strike
Doctors’ strikes in Kenya are often triggered by delayed or unpaid salaries, stalled promotions, and failure to implement agreed Collective Bargaining Agreements (CBAs). In many counties, doctors report working for months without full pay, despite budgetary allocations being approved at national and county levels.
Promotion delays are another recurring grievance. Doctors can remain in the same job group for years, despite meeting qualification and experience requirements. Allowances linked to risk, call duties, and special skills are frequently unpaid or paid inconsistently across counties.
These issues persist despite multiple return-to-work agreements signed over the years between doctors’ unions, county governments, and the national government. Each unresolved agreement adds to mistrust and increases the likelihood of future strikes.
The Central Role of Clinical Officers
Clinical officers play a unique and critical role in Kenya’s healthcare system. In many facilities, especially at the primary level, they provide diagnosis, treatment, minor surgical procedures, and emergency care. Their presence often determines whether a facility remains operational.
Industrial action by clinical officers has increasingly drawn national attention due to its scale and impact. Their strikes commonly focus on unimplemented CBAs, lack of permanent and pensionable terms, and delayed absorption of staff initially hired under donor-funded or Universal Health Coverage (UHC) programmes.
Many clinical officers have worked for extended periods on temporary contracts, sometimes for over a year, without job security or clear career progression. Salary arrears, in some cases stretching over many months, further fuel frustration. When clinical officers withdraw services, entire facilities may shut down, as they often outnumber doctors at the grassroots level.
Nurses and the Continuity of Care
Nurses form the largest segment of Kenya’s healthcare workforce. They ensure continuity of care across wards, maternity units, outpatient departments, and community health programmes. While nurses are not always on nationwide strike at the same time as doctors or clinical officers, they frequently face similar challenges.
Delayed promotions, heavy workloads, staff shortages, and inconsistent implementation of CBAs are common complaints. In some counties, nurses have staged protests or issued strike notices when salary delays persist or when court orders and negotiated agreements are ignored.
Even when nurses remain at work during other strikes, the absence of doctors or clinical officers places enormous pressure on them. This leads to burnout, reduced quality of care, and growing dissatisfaction within the profession.
Devolution and Its Unintended Consequences
Health services in Kenya are largely managed by county governments under the devolved system. While devolution aimed to bring services closer to the people, it has also introduced disparities in how health workers are treated across counties.
Some counties meet payroll obligations on time and honour CBAs. Others struggle with delayed disbursements, weak financial planning, or competing political priorities. The result is an uneven health system where workers in one county may enjoy stable conditions while their counterparts elsewhere face prolonged uncertainty.
The national government retains a policy and oversight role, but responsibility for employment terms often rests with counties. This fragmented structure complicates negotiations and delays the resolution of disputes.
Impact on Patients and Communities
The most immediate victims of health sector strikes are patients. During prolonged industrial action, outpatient services are suspended, elective surgeries postponed, and referral hospitals overwhelmed. Vulnerable populations — including expectant mothers, children, and people with chronic illnesses — are particularly affected.
Patients are often forced to seek care in private facilities, where costs are significantly higher. For low-income households, this means delaying treatment or going without care altogether. Over time, these disruptions erode public confidence in the health system.
Strikes also place pressure on referral hospitals such as national and regional facilities, which experience sudden patient surges when county hospitals reduce services.
A Cycle That Keeps Repeating
What makes health worker strikes in Kenya particularly challenging is their recurring nature. Agreements are negotiated, strikes are called off, and services resume, but underlying issues often remain unresolved. Months or years later, the same grievances resurface, triggering fresh industrial action.
This cycle points to systemic weaknesses rather than isolated management failures. Poor implementation of agreements, lack of accountability, and inadequate workforce planning continue to undermine stability in the sector.
Looking Ahead
A sustainable solution requires more than short-term negotiations. It calls for consistent funding, transparent payroll systems, harmonised human resource policies across counties, and timely implementation of CBAs. Strengthening dialogue between unions, county governments, and the national government is essential.
Kenya’s healthcare workers are not merely employees. They are the foundation of the country’s public health system. Ensuring their welfare, job security, and professional growth is not just a labour issue it is a public interest imperative.
Until structural reforms address these long-standing challenges, strikes by doctors, nurses, and clinical officers are likely to remain a recurring feature of Kenya’s health landscape, with patients continuing to bear the greatest cost.
