Kenya’s doctors have given the national and county governments 90 days to conclude salary negotiations and address a raft of outstanding employment grievances — or face a nationwide strike that would cripple the East African nation’s public hospital system. The ultimatum, issued on May 10 at the Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) Annual Delegates Conference in Nairobi, sets Kenya on a collision course with its medical workforce at a time when the health system is still recovering from years of underfunding and the legacy of the COVID-19 pandemic.
The Financial Dimension
At the centre of the dispute is the Collective Bargaining Agreement (CBA) for 2025-2029, under which KMPDU is demanding a 55 percent salary increase for medical practitioners. The union argues that a decade of inflation has catastrophically eroded doctors’ real earnings, making it impossible to attract and retain talent in the public health sector.
A KMPDU-commissioned analysis shows that doctor salaries have lost approximately 40 percent of their real purchasing power over the past decade when adjusted for inflation. Rural allowances, which were meant to compensate doctors for serving in underserved areas, have not been revised in seven years.
The union is also demanding immediate payment of all 2024/2025 salary arrears owed under court-ordered settlements. Dr. Atellah accused the government of systematically failing to comply with existing court orders on doctor compensation. The union is further pushing for comprehensive medical insurance coverage for every doctor employed by both the national government and all 47 county governments.
Employment Structure: The Internship Problem
Perhaps the most structurally significant demand concerns the employment of medical interns. KMPDU is calling for the mandatory annual hiring of 3,000 doctors and the direct absorption of medical interns into permanent and pensionable positions. This demand strikes at a longstanding government practice of using internship programmes as a buffer against full employment.
This arrangement has produced a growing backlog of trained doctors who complete their internships but find no pathway into the formal public health system. Many emigrate — to the United Kingdom, the United States, Australia, or the Gulf states — where their skills are in demand and compensation is significantly higher. Kenya currently has one of the lowest doctor-to-population ratios in the region, a situation that mass emigration is actively worsening.
The union also announced it would lobby parliament to repeal Section 5A of the Universities Act, which KMPDU argues threatens the quality of medical training by imposing regulatory constraints that limit the capacity of medical schools to admit sufficient numbers of students.
A System Under Structural Stress
Kenya’s public health system has been under sustained pressure for years. The transition to the Social Health Authority (SHA) — a reformed national health insurance scheme — has been uneven, with rural facilities particularly affected by supply chain disruptions and reimbursement delays.
Last year, a doctors’ strike in Trans Nzoia County that lasted 14 days resulted in dozens of elective procedures being postponed and several patient deaths being linked to the absence of emergency surgical cover.
The national government and county governments — who employ the majority of Kenya’s doctors under the country’s decentralised constitutional framework — have yet to formally respond to the KMPDU ultimatum. The Ministry of Health has acknowledged the legitimacy of some claims but has cited fiscal constraints as a limit on what can be offered.
With 90 days on the clock, and a 21-day deadline for payslip compliance already ticking, Kenya’s public hospitals are entering a period of acute uncertainty. What happens next will test both the government’s willingness to invest in its medical workforce and the union’s capacity to sustain a strike in a political environment where healthcare access is already fragile for millions of Kenyan families.