The strike is over — but Kenya’s healthcare crisis has only changed its uniform
Kenya National Union of Nurses and Midwives and the Council of Governors signed a return-to-work formula
Nurses are back at work, but the 43-day shutdown revealed institutional failures that a return-to-work agreement alone cannot fix
By Levis Wangamati
For 43 days, Kenya’s public healthcare system operated under extraordinary pressure as nurses stayed away from duty in a nationwide industrial action that exposed weaknesses far deeper than a disagreement over salaries and allowances. Yesterday, the Kenya National Union of Nurses and Midwives and the Council of Governors signed a return-to-work formula, bringing the prolonged strike to an end and directing nurses to resume duty immediately or within 24 hours.
The agreement gives both parties 45 days to conclude negotiations on the implementation of the 2017 Collective Bargaining Agreement. County governments have also committed to developing a model career guideline for nursing personnel within the same period. The agreement further provides for the employment of Universal Health Coverage staff by all 47 county governments on permanent and pensionable terms from July 1, 2026, subject to the applicable remuneration framework.
The return of nurses is unquestionably welcome. For the millions of Kenyans who rely almost entirely on public hospitals, dispensaries and health centres, the announcement means that an essential part of their healthcare system can begin functioning again. Yet celebrating the end of the strike without honestly examining why it lasted more than six weeks would be a serious mistake. The central dispute did not emerge overnight, and neither did the grievances behind it. At the heart of the confrontation was the implementation of a collective bargaining agreement dating back to 2017 — meaning some of the issues now being negotiated have remained unresolved for nearly a decade. The strike may have ended, but the institutional failures that produced it have merely moved from hospital corridors back to negotiating tables.
This is the uncomfortable reality Kenya must confront.
A government that signs an agreement with healthcare workers creates a reasonable expectation that the agreement will eventually be honoured. When implementation takes years, the consequences extend far beyond the workers themselves. Public healthcare is not an ordinary sector in which institutional delays stay confined to offices. The nurse who is dissatisfied with an unresolved agreement is also the nurse standing beside a hospital bed at three in the morning — monitoring patients, administering treatment, responding to emergencies and providing continuous care that other cadres cannot simply absorb. When that workforce withdraws its labour, the disruption quickly becomes a public health emergency rather than merely an industrial relations dispute.
The past six weeks demonstrated precisely how interconnected Kenya’s healthcare workforce is. When nurses stayed away, doctors were left carrying additional responsibilities in facilities already struggling with shortages and impossible workloads. On September 7, the Kenya Medical Practitioners, Pharmacists and Dentists Union gave the government seven days to resolve the nurses’ dispute, warning that doctors could issue their own strike notice if the situation remained unresolved. The union argued that doctors could not indefinitely absorb duties normally carried by nurses, and that the prolonged disruption was placing unbearable pressure on an already strained system. That warning was significant because it showed the dispute was no longer confined to one professional group.
It should have been read as a sign of systemic vulnerability. Kenya’s healthcare system does not operate through isolated professions working independently of one another. Doctors, nurses, clinical officers, pharmacists, laboratory personnel, radiographers, nutritionists and support staff form an interconnected chain in which the failure of any single component places pressure on all the others. A hospital may possess modern equipment and qualified doctors, but without sufficient nurses to provide continuous patient care, the institution cannot function normally. The lesson from this strike is therefore bigger than the immediate dispute: Kenya cannot build a resilient healthcare system by negotiating with its workforce only when the system is already on the verge of collapse.
The human cost of that collapse was perhaps the most disturbing aspect of the crisis. The Kenya National Commission on Human Rights warned on September 4 that the strike had evolved from a labour dispute into a public health and human rights concern, citing disruptions to the rights to life, health, emergency medical treatment and dignity. The commission also reported 79 maternal, neonatal and perinatal deaths between August 31 and September 2. Such figures must always be interpreted with care — the relationship between industrial action and individual deaths can require detailed clinical investigation — but the broader message is unmistakable. When essential healthcare services are disrupted for weeks, it is the most vulnerable patients who carry the heaviest burden.
For the ordinary Kenyan, the constitutional right to health is not tested in policy documents or budget speeches. It is tested when a parent walks into a county hospital with a sick child and expects someone to attend to them. It is tested when a pregnant woman requires urgent maternity care, when an accident victim needs immediate attention, or when an elderly patient depends on a public facility because private treatment is financially out of reach. These citizens experience healthcare through waiting times, available staff, medicines, functioning equipment and the competence of the people attending to them — nothing more, nothing less.
That is why the government must resist treating the return-to-work agreement as the conclusion of the matter. It is better understood as a deadline for accountability. The next 45 days should not become another period of negotiations in which each side issues statements while underlying commitments remain unresolved. The country needs a clear implementation framework, identifiable responsibilities, concrete timelines and transparent communication about what has been agreed. If there are genuine financial constraints, the government should explain them openly. If certain commitments require phased implementation, that process should be made public. What Kenya cannot afford is another agreement that quietly becomes another unresolved historical document.
The dispute also raises serious questions about the financial architecture of devolved healthcare. Since health services were devolved to county governments, counties have carried significant responsibility for frontline delivery. Yet healthcare workers remain affected by national remuneration frameworks, national policy decisions, county budgets and intergovernmental negotiations — a complicated chain of responsibility in which a worker employed at county level may find that crucial aspects of their pay and conditions are influenced by institutions entirely beyond the county’s control. This complexity may explain certain disagreements, but it can never become an excuse for allowing essential services to deteriorate.
Kenya needs a more predictable mechanism for resolving healthcare labour disputes before they become national emergencies. Negotiations should begin long before agreements expire or grievances accumulate into industrial action. Government and unions should have structured channels through which unresolved implementation questions are identified and addressed continuously — not saved up for a strike notice. Parliament, county governments, the national government and relevant commissions must also understand that healthcare labour relations are not peripheral administrative matters. They are a matter of national health security.
The argument that government must operate within its budget is entirely legitimate. No responsible administration can honour every demand without considering available resources, competing priorities and long-term fiscal sustainability. But fiscal constraints cannot serve as a permanent justification for failing to implement agreements that government institutions have already entered into. If an agreement is genuinely unaffordable, that reality must be confronted during negotiation — not after years of accumulated frustration have sent workers to the picket line.
There is also a clear lesson for county governments. The 47 counties cannot simultaneously demand greater responsibility for healthcare and then distance themselves from the consequences when the system experiences a labour crisis. The return-to-work formula places considerable responsibility on counties, including the commitment to develop a model career guideline for nursing personnel and address employment arrangements for UHC staff. Those responsibilities must be approached collectively and consistently. A Kenyan seeking treatment in one county should not face dramatically different standards of staffing, remuneration or service simply because healthcare administration stops at a county boundary.
The crisis also exposes the danger of treating Universal Health Coverage primarily as a financing question. Insurance reforms, enrolment systems and new health financing mechanisms all matter enormously, but universal healthcare cannot exist on paper alone. A person may be financially covered and still fail to receive timely treatment if a facility lacks sufficient healthcare workers. A sophisticated insurance system cannot substitute for a nurse beside a patient. A digital claims platform cannot administer medicine. A policy document cannot monitor a patient through the night. Universal healthcare ultimately depends on human beings — and those human beings require functional institutions, fair working conditions and predictable employment.
The nurses’ strike should therefore change the way Kenya discusses healthcare investment. Building facilities matters. Purchasing equipment matters. Expanding insurance coverage matters. But the workforce must remain at the centre of the equation. A hospital is only as effective as the people operating it. If Kenya is serious about improving maternal health, emergency care, primary healthcare and chronic disease management, it must invest not only in buildings and technology but in recruitment, retention, training, career progression and professional welfare.
The government now has an opportunity to demonstrate that this crisis can produce a lasting institutional improvement. The 45-day negotiation period should deliver something far more durable than a temporary truce. It should establish a credible framework for implementing the outstanding provisions of the 2017 CBA, clarify responsibilities between national and county governments and reduce the likelihood of another prolonged confrontation. The country should not have to endure another 40 days of disruption before discovering that an agreement signed years earlier still contains unresolved obligations.
There is another reason to act with urgency. The doctors’ ultimatum demonstrated how easily one unresolved dispute can spread through an interconnected system. Had the nurses’ strike continued, the country could have faced a broader confrontation involving another critical group of healthcare workers. Industrial action in healthcare is fundamentally different from disruption in other sectors. When hospitals cannot function properly, the consequences fall on people who are already vulnerable, already frightened and often with nowhere else to turn.
Kenya should also remember the patients who became largely invisible during this dispute. Press conferences naturally focused on unions, governors and government officials — those are the people at the negotiating table. But behind every statement were patients whose treatment was delayed, families scrambling to find alternatives and healthcare workers who remained at their stations under conditions of extraordinary stress. Their experiences must form part of any honest national reckoning with what happened. A healthcare crisis cannot be judged solely by whether two parties eventually sign a document. It must also be judged by what happened to the citizens the system was created to serve.
The return of nurses should be warmly welcomed — but relief must not become complacency. Hospitals can resume their normal routines, patients can begin receiving services again, and healthcare workers can return to their stations. But the country has not yet earned the right to move on without fully understanding what happened. The strike revealed how quickly unresolved labour disputes become public health emergencies. It revealed the fragility created by staffing shortages. It revealed the cost of delayed implementation. And it reminded Kenya that healthcare workers are not simply employees on a government payroll — they are a central pillar of the country’s social infrastructure.
The real test begins now. Government officials, governors and union leaders have negotiated a temporary pathway back to work, but the credibility of that agreement will depend entirely on what happens during the next 45 days. If the commitments are genuinely implemented, Kenya will have converted a damaging confrontation into an opportunity to strengthen its healthcare system. If the promises once again become trapped in bureaucratic delay, the country will merely have postponed the next crisis.
Kenya does not need another healthcare strike to remind it that its hospitals are fragile. It does not need another ultimatum from doctors to understand that nurses cannot simply be replaced. It does not need another generation of healthcare workers waiting years for agreements negotiated in good faith.
What it needs is a healthcare system in which government commitments are honoured, workers are heard before they are forced to walk out, and patients do not become collateral damage in disputes between institutions.
The nurses are returning to work, and Kenya should welcome them back with genuine gratitude. But the country should also listen — carefully — to what their 43-day absence revealed. The problem was never simply that nurses had stopped working. The deeper problem is that a healthcare system so essential to national life had allowed unresolved grievances to fester for years until the consequences finally reached the hospital gates.
The strike is over. The negotiations are beginning again. The responsibility now belongs to every institution involved to ensure that the next chapter is written differently.
Because Kenya’s healthcare system should not have to collapse before its leaders remember that the people who keep it alive deserve to be heard.
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