UHC staff crisis: Health workers threaten nationwide strike over permanent jobs

The absorption of Universal Health Coverage (UHC) contract staff remains a contentious issue, with health workers’ unions issuing a 21-day ultimatum to county governments. The unions are demanding the immediate transition of all UHC workers to permanent and pensionable employment, warning that failure to comply by the end of September will trigger widespread unrest across the health sector.

In a joint statement released on September 8, the unions stressed that the smooth integration of UHC contract staff into permanent county roles is long overdue and should be treated as a national emergency. They criticised the current contract terms issued by counties as exploitative and punitive.

"Healthcare workers can no longer tolerate systemic injustice, impunity, and blatant constitutional violations by the Council of Governors and individual county administrations," the statement read. It warned that without urgent action, the health sector would face escalating unrest and intensified industrial action.

The statement was endorsed by key unions, including the Kenya National Union of Medical Laboratory Officers (KNUMLO), Kenya Union of Clinical Officers (KUCO), Kenya Environment Health and Public Health Practitioners Union (KEHPHU), Kenya National Union of Nutritionists and Dietitians (KUNAD), Kenya National Union of Pharmaceutical Technologists (KNUPT), and Kenya Health Professional Society (KHPS).

The unions demanded that punitive contracts be regularised in line with statutory and constitutional standards and called for the immediate resumption of union dues deductions.

They also pressed for the finalisation of Recognition Agreements and Collective Bargaining Agreements (CBAs), particularly in Kiambu, Kirinyaga, and Tharaka Nithi counties. Attempts to decentralise CBA negotiations were rejected, with the unions insisting that such agreements must be negotiated centrally to preserve national labour standards.

Pay salaries promptly

"Relevant agencies must ensure counties pay salaries promptly and remit all lawful deductions without delay," the unions added.

The union leaders also appealed to the National Assembly and Senate to investigate the mistreatment of healthcare workers by certain county governments and urged Parliament to enact lasting legislative reforms.

This ultimatum follows a recent Council of Governors (CoG) declaration on UHC staff absorption and the implementation of Career Progression Guidelines, which the unions argue has produced few tangible results.

President William Ruto weighed in on the dispute, calling for dialogue among the national government, county officials, and health workers to reach a resolution.

"The government acknowledges the critical role health workers play in delivering quality care and is committed to ensuring their welfare is prioritised," the President said. "We urge all stakeholders to engage constructively and avoid actions that could undermine our healthcare system."

He further pledged to provide resources and policy support to facilitate the smooth absorption of UHC staff, urging both county governments and unions to cooperate in the interest of the Kenyan public.

On the other hand, governors have accused the Ministry of Health of sidelining county governments in the absorption of UHC staff and the rollout of the electronic procurement system, warning that these moves could disrupt service delivery nationwide.

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Speaking after an Extraordinary Council Meeting on human resource management and e-procurement, CoG Chair Ahmed Abdullahi said counties would not be forced to take over UHC staff without proper resources. He emphasised that all pending gratuity payments and critical funds must be cleared first.

"The Ministry continues to paint a public picture that County Governments are derailing the process of absorbing the UHC staff. County Governments cannot be back-peddling with the Ministry over a devolved function," Ahmed said.

He stressed that any changes to UHC staff contracts must involve counties and would only be accepted if the equitable share of revenue is increased to cover additional costs.

According to Ahmed, staff transfers must be preceded by Sh7.7 billion in allocations from the Ministry of Health, based on SRC-approved salary scales. Verification of UHC staff must also be jointly validated, with an official report issued before any transition begins.

The CoG chair reminded the Ministry that gratuity payments amounting to Sh9.4 billion for contract staff must be settled before transfers. He added that counties are ready to employ verified UHC staff once resources are provided and obligations cleared.

Urged patience

On labour relations, Ahmed acknowledged grievances raised by health workers’ unions but urged patience to avoid strikes.

"We call upon the Unions to exercise patience as the Counties resolve these issues and forestall any industrial action that could disrupt county health services," he said. He also appealed to the national government to provide funds to implement return-to-work agreements.

The governors criticised the Public Service Commission (PSC) for issuing career guidelines for health workers without consulting counties, noting that the guidelines have significant financial implications.

"We shall be calling upon the PSC to discuss the Career Guidelines. We urge the Commission to desist from approving cadre-based career progression guidelines without factoring the cost of implementation into the equitable share of revenue to the County Governments," Ahmed warned.

He added that while the national government implemented pay rises for FY 2024/25, county staff were excluded due to funding constraints. Counties require Sh4.77 billion to implement these reviews and have demanded an increase in the equitable share to meet this legal obligation.