Why doctors in Kenya are sticking to their guns

The nationwide strike by doctors in public health hospitals has crippled the health sector. Reuters/Thomas Mukoya

The doctor’s strike in Kenya has been going on for nearly three months, and both sides are digging in. The government is refusing to give in to the doctors’ demand and has gone as far as declaring the strike illegal. This has led to the court’s involvement and the arrest and jailing of doctors.

For their part, the doctors remain determined. As far as they are concerned the government has been abusing the court process to coerce them back to work instead of addressing the issues that led to the strike. They have made it clear that they will only go back to work if a deal that aligns to the collective bargaining agreement, which was reached in 2013, is reached. The agreement covers, among other things, fair working hours, improving work environments and equipment, training, research and remuneration.

The arrest and brief incarceration of union leaders saw doctors in the private sector join their peers in the public sector by withdrawing their services in private hospitals and clinics for 48 hours.

The issues raised in the ongoing strike have been on the table for more than five years. Yet the government has avoided tackling them.

In the process it has exhausted its goodwill among members of the doctors’ union by failing to deliver on its promises and agreements. It’s therefore not surprising that doctors have dug in and vowed not to resume work until the government meets its end of the bargain.

Public health crisis

Many Kenyans have suffered greatly from the ongoing strike. And there is growing concern that the government has not being doing enough to end it.

Jailing the doctors has exacerbated the situation. In the week preceding the sentencing of the seven doctors there was hope that the strike could be sorted out amicably by a mediation committee commissioned by the labour court to negotiate with the union leaders.

This hope was shattered the moment the sentence was delivered. Soon after the convicted leaders were handcuffed and whisked away to be locked up in separate prisons, doctors across the country vowed not to resume work or negotiate with the government until their leaders were freed.

The doctors held a peaceful night vigil in solidarity with the jailed leaders but this was broken up by armed police officers. Shortly afterwards, a number of doctors’ associations issued a notice to withdraw services in the private health sector for 48 hours.

The sentencing also increased levels of concern among ordinary Kenyans, many of whom expressed dismay at the doctors being jailed.

The doctors were freed on their third day in jail after a Court of Appeal ruling which also instructed the parties to resume mediated talks to end the strike. This was a wise decision as keeping them in jail would have hardened the stance of doctors and prolonged the strike.

The doctors have dug in. For most the fight is personal, having experienced the depressing state of the health care system in Kenya.

Roots of the strike

The promulgation of a new constitution in Kenya in the year 2010 spelt out the right of every worker to join a union. A year later doctors registered the Kenya Medical Practitioners, Pharmacists and Dentists Union. I was honoured to be on the founding national executive committee of the union. Our most urgent cause was to agitate for better terms and conditions of service as well as improved health care.

We engaged the ministry of health with proposals for better terms of work for doctors and quality health care in public facilities but the government brushed us off.

This led to the union’s first strike in December, 2011. The strike lasted a week after which the lowest doctor’s salary was doubled and an undertaking was made to address other issues within a few months.

The first issue was the improvement of health service delivery in public hospitals. This was addressed by a multi-partite taskforce and within a month a report was produced which made recommendations on how the health sector could be turned around. The main focus areas were facilities, equipment and human resources.

Most of the recommendations of this report have not yet been implemented.

The second task was to address industrial relations by negotiating a collective bargaining agreement between the doctors’ union and the government.

This process took much longer than expected and the final document was signed in June 2013. The agreement was supposed to be implemented from July 2013 – June 2015.

The union has engaged the ministry of health and the salaries and remuneration commission, which was set up to advise on the salaries of public servants, in bid to have the agreement implemented. Despite these efforts, it was never implemented.

The government’s position is that the agreement has no legal standing because it was never presented to a court for registration.

In the intervening period, the union and the government were involved in ongoing talks, arbitration failed and both parties resorted to the courts. The union finally ran out of patience at the lack of progress and in November 2016 gave 21 days notice that its members would go embark on strike action if the agreement was not implemented.

The doctors are determined not to back down. They view their demands as important, not just for their own well being but also for the future of health care in Kenya. It’s about time the issues the doctors have put on the table are sorted out once and for all.