Health crisis deepens as more unions join doctors' strike

Nairobi county doctors protest outside City Hall. 13/02/23

Photo credit: File| Nation Media Group

As the doctors' strike enters its third week, many Kenyans cannot access healthcare, and a full-blown crisis is looming.

The Kenya Union of Clinical Officers (Kuco) and the Kenya Medical Association (KMA) have joined the strike with different demands from a government that has been unable to resolve the impasse with the doctors, instead resorting to intimidation and threats.

Kuco is demanding comprehensive medical cover for their members, ratification of career progression guidelines, payment of interns as per their job groups and promotion and re-designation. On the other hand, KMA wants the immediate suspension of an Electronic Tax Invoice Management System (eTIMS), which will allow the Kenya Revenue Authority to force doctors to disclose patients’ data.

Kuco also wants the government to complete Collective Bargaining Agreement (CBA) negotiations for all health workers employed under Universal Health Coverage (UHC) and those employed under contracts absorbed into the workforce.

These are clinical officers hired by the Ministry of Health in 2020 to boost Covid-19 rapid response efforts. The Union is demanding clinical officers dismissed by Kirinyaga County be reinstated.

The Union has announced they will hit the streets on April 3 at Green Park Terminus, beginning at 8am. The Clinical Officers are second in line to down their tools after the doctors who have been out of work for more than two weeks.

Kuco Secretary General George Gibore issued a strike notice about a week ago, giving the government a seven-day ultimatum to resolve these issues.

In the notice, the union laments that clinical officers have been struggling with perennial delays of salaries, lack of promotions and resignations, a dire shortage of clinical officers in hospital facilities and discriminatory contracts.

“The perennial issues affecting service delivery by Clinical Officers, include dire shortage of over seventy thousand Clinical Officers, discriminatory and exploitative short-term contracts, and failure to implement approved staff establishments for interns, among others, persist unabated,” said Gibore.

“That despite the commitment made in "The Kericho Declaration On Human Resources for Health in Kenya" signed on October 18, 2023, to address these issues within specific timelines, no tangible progress has been made,” he added.

Gibore also lamented that the negotiations towards the creation and signing of a CBA between the union and the government have remained elusive. 

Besides, the government, he said, has failed to honour and implement return-to-work formulas that they signed with the union to avert previous industrial actions.

“The most recent agreement, signed by the Ministry of Health in July 2023, stipulated a 90-day negotiation and conclusion period for the CBA, a commitment that has been blatantly disregarded by the government. A court order was issued by the Employment and Labour Relations Court in 2019 ordering parties to resume negotiations to record consent. Regrettably, the Council of Governors, representing the 47 County Governments, has shown contempt by failing to resume the negotiations,” said Gibore.

The KMA is concerned that through the eTIMS, medical practitioners will be forced to commit crimes by disclosing “patient data including names, sex, hospitalisation and treatment details to the Kenyans government,” thus exposing the public prejudice in employment opportunities and public service provision.

“In Kenya, the Data Protection Act, 2019 provides for Administrative fines of up to Sh5 million, or in the case of a business, up to 1 per cent of its annual turnover of the preceding financial year, whichever is lower for breach of data privacy. ETIMS implementation will expose Doctors to the dangers of these penalties because it is now forcing Doctors to disclose confidential patient information,” said Dr Simon Kigondu, KMA’s president.

“Every person has a right to privacy which includes the right not to have the privacy of their communications infringed. The KRA eTIMs is designed to get information on the patients attended to by Doctors, their diagnosis and treatment by becoming the communication hub between Doctors, Hospitals and payers including Insurance Companies. This is an infringement of the private communications of Doctors, patients and their payers, including insurance companies,” added Dr Kigondu.

The association announced that the nationwide strike would begin on March 26 after KRA failed to suspend the eTIMS implementation in the healthcare sector. They also announced that they would apply to the court to stop its implementation “because it is a clear violation of the Constitutional Rights to Healthcare, Data Protection and Privacy.”

On Thursday, more than 300 doctors in Mombasa County participated in a peaceful demonstration to push the national government to implement a raft of demands, with the doctors saying they will continue with their strike until their grievances are addressed.

“The state has not been fulfilling our 2017-2021 collective bargaining agreement. This is the time for all doctors in Kenya to stand in solidarity. Interns have not been posted infringing our CBA which stated that they should be posted 30 days after graduation," said Dr Gharib Salim Ali, KMPDU’s Secretary General in Mombasa County.

Dr Ali accused counties in the coastal region of refusing to promote doctors. He cited consultants still stuck in job Group N, receiving salaries as other doctors.

“Some consultants have gone for fellowships but are still stuck in job groups M and P, which is a big shame. We need progression as per the scheme of service. It’s a shame that Lamu County has been lacking a gynaecologist for more than a month. We are going to lose more expectant mothers and newborns in Lamu. We are fighting for Kenyans because of the health crisis besieging this country," added Dr Ali.

Within Nairobi County, there seems to be a slow but steady return to work in some health facilities. A spot check by Nation.Africa showed some doctors have returned to work through local agreements with the hospital administrations.

At Mama Lucy Kibaki Hospital, services, including maternity and emergency care, are ongoing, albeit with delays. John Mokua, a Nairobi-based resident who had accompanied his sick father, recounted a long wait, arriving in the morning and leaving the facility past 4pm.

“We are exhausted but relieved. We hit a dead end at Kenyatta National Hospital a week ago because there was no doctor to see him. My father is diabetic and has rheumatoid arthritis.  Thankfully, here at Mama Lucy Kibaki Hospital, they finally saw him and prescribed him the medications he needs,” he said.

Another resident reported a more positive experience, with his wife receiving maternity care after successfully giving birth at the facility.

Mama Lucy Kibaki Hospital CEO Dr Alfred Wekesa asserted that 70 per cent of the facility doctors had returned to work.

“I held discussions with about 20 trusted doctors, colleagues I've known for a long time, and encouraged them to resume their duties,” Dr Wekesa explained.

KMPDU have remained resolute in carrying on the strike, even as the government halts remittance to the body in a bid to cripple its operations. The doctors will relaunch their strike on Tuesday.

“A union is about all of us or none of us. As their leaders, we will continue championing for the doctors’ rights and will bravely pursue those ideals. Even if all of them will walk back to work, we will still be there championing that they should remain on strike because we will not sign a back an adjourned back to work agreement that condemns the fate of the medical officers,” said Dr Dennis Miskellah, Deputy Secretary-General, KMPDU.

By Mercy Chelangat, Lilys Njeru and Winnie Atieno