The planned march on the Salaries and Remuneration Commission and Council of Governors comes after more than a month of strike action over agreements, contracts and stalled career progression

 

 

At 9am on Thursday, 200 nurses and midwives from each of Kenya’s 47 counties are expected to gather at Green Park in Nairobi.

 

They will then set off along Ngong Road towards the offices of the Salaries and Remuneration Commission (SRC), the constitutional body that advises the national and county governments on the pay and benefits of public officers, before making their way along Waiyaki Way to Delta House, where the Council of Governors has its offices.

 

 

The planned procession is expected to bring about 9,400 health workers into the capital.

 

The route takes the nurses first to the SRC and then to the Council of Governors, the two institutions named in their grievances.

 

The union wants answers from the institutions it says have allowed agreements with health workers to remain unresolved, or have stood in the way of their implementation.

 

The march comes more than a month after nurses and midwives went on strike on 29 July, following the collapse of talks over a series of longstanding demands.

 

Among them are the conclusion of a 2025-29 collective bargaining agreement, implementation of a 2017 return-to-work agreement, permanent and pensionable employment for Universal Health Coverage workers, adoption of career progression guidelines and the reinstatement of 46 nurses dismissed by Kisii county in 2021.

 

The dispute has continued through several rounds of talks.

 

Now it is moving from hospital wards and county offices to the streets of Nairobi.

 

Agreements that never became settled

 

For nurses, the 2017 return-to-work agreement is one of the clearest examples of how the dispute has endured.

 

The agreement was reached after an earlier period of industrial action, but its implementation is now itself disputed.

 

On Monday, Council of Governors chair Ahmed Abdullahi said the agreement had been signed under pressure and was never implemented.

 

The union rejects that position and continues to demand its implementation.

 

The disagreement points to a difficulty that has followed the devolution of health services: responsibility for employing health workers sits largely with counties, while decisions on public-sector remuneration involve national institutions.

 

It goes to the heart of what happens when health workers negotiate terms with institutions that do not have the same responsibilities, powers or financial room to implement them.

 

County governments employ health workers and are responsible for delivering most public health services.

 

The SRC, meanwhile, has a constitutional mandate to advise the national and county governments on the remuneration and benefits of public officers.

 

National government decisions can also determine whether money is available for programs and workers whose services are eventually managed by counties.

 

For health workers, the distinction can be difficult to see when an agreement has been made but the promised change does not appear in their contracts, promotions or pay.

 

The dispute over Universal Health Coverage staff has brought that problem into sharper view.

 

About 7,786 workers recruited under the program have been on contracts. President William Ruto directed that they be moved to permanent and pensionable terms, and Sh8.6bn, including statutory employer contributions, has been allocated for the transition.

 

But the move has still required negotiations over who would take the workers onto county payrolls and how the money would reach them. On Monday, Health CS Aden Duale said about 12 counties had yet to integrate their payroll systems, warning that the September salaries could be affected.

 

That means the question facing the workers is no longer simply whether the government has agreed to change their employment terms. It is how a decision made at national level is carried through 47 county administrations.

 

 When Kenya’s constitution transferred most health functions to county governments, responsibility for providing services moved closer to the people using them.

 

But the system did not create a single institution responsible for every decision affecting the people delivering those services.

 

A county government may employ a nurse. The national government may provide funding for a health programme, while the SRC advises both levels of government on the remuneration and benefits of public officers. A collective bargaining agreement can then commit an employer to terms that have financial consequences beyond the negotiating table.

 

The result is that a health worker can be employed by a county, covered by a collective agreement and still wait for the institutions involved to agree on how its terms should be implemented.

 

The union is going to the SRC because it wants its position on remuneration addressed.

 

It is going to the Council of Governors because county governments are the employers responsible for much of the health workforce.

 

The governors, for their part, have argued that they have offered health workers terms but that remuneration questions involving the SRC still need to be resolved.

 

Abdullahi has said the counties could approach the SRC jointly if an agreement is reached with the nurses.

 

For the union, however, another proposal is difficult to separate from the agreements it says have already gone unimplemented.

 

Meanwhile, patients are still waiting

 

The nurses’ strike is not taking place on its own.

 

Clinical officers are also on strike, adding pressure to public hospitals and health centers in counties where services have been disrupted.

 

The Kenya Union of Clinical Officers says the action will continue until its grievances are addressed, although some counties have made progress in signing agreements with the union.

 

The effect is uneven.

 

In some counties, facilities have continued operating with reduced staff. In others, patients have been sent elsewhere or have had to turn to private facilities for treatment.

 

For a patient who arrives at a health center and finds no nurse, the institutional argument over who has the authority to approve a salary or sign an agreement can feel very far away.

 

What matters is whether there is someone on the other side of the consultation room.

 

The dispute is therefore being played out not only between nurses and their employers but across the institutions responsible for health services, public-sector pay and county finances.

 

A different kind of protest

 

Thursday’s march is unusual in another respect.

 

The nurses are not simply gathering to protest outside one government office.

They are going to both.

 

According to the notification sent to the police, the procession will begin at Green Park and move along Ngong Road to the SRC before continuing towards Delta House, where the union intends to present its grievances to the Council of Governors.

 

The route takes the nurses from the institution constitutionally mandated to advise on the remuneration of public officers to the body representing the county governments that employ them.

 

One institution has a constitutional role in public-sector remuneration. The other brings together the county governments that employ health workers and run devolved health services.

 

Between them are thousands of nurses whose employment, pay and career progression depend on decisions made across that system.

 

 

By Thursday morning, 9,400 of them are expected to be in Nairobi. After years of agreements and negotiations, they will be asking the same question: who will make them happen?