By Kepher Otieno - Reporter
Kenya, 10 August 2026 - Kenya’s public health system is edging deeper into a nationwide labour crisis as health workers in several counties remain on strike, demanding better pay, promotions and secure employment, while county governments insist that they cannot make commitments without guaranteed funding.
From Migori, Homa Bay, Kisii, Nyamira and Kisumu to Embu health workers have downed tools, turning a dispute over salaries and employment terms into a broader test of how Kenya’s devolved health system is financed and managed.
In Embu, the confrontation entered its third week on Monday, with nurses, clinical officers, casual workers and other health cadres marching to the County Public Service Board and later to Governor Cecily Mbarire’s office.
Their message was blunt no meaningful settlement, no return to work.
The workers are demanding salary adjustments, promotions, proper job placement and conversion of long-serving contractual and casual employees to permanent and pensionable terms.
Some workers earning about KSh35,000 want to move to the KSh50,000 salary scale, while casual workers earning KSh15,000 are demanding confirmation into permanent employment. Workers on so-called “Casual H” terms earning about KSh20,000 want their pay reviewed to KSh40,000 and confirmation letters issued.
The dispute is now testing the limits of county finances.
At the centre of the national standoff is Mombasa Governor Abdulswamad Nassir, chair of the Council of Governors Health Committee, who has argued that the solution lies in negotiation rather than prolonged industrial action.
“We can resolve this through dialogue, not strike,” Nassir said, insisting that issues surrounding UHC contracts, allowances and further studies could be addressed through negotiations.
But the unions are refusing to treat dialogue as a substitute for implementation.
That hardening position has turned the dispute into more than a fight over salaries. It is increasingly about trust.
Health workers say they have signed agreements before, only to see promotions delayed, contracts extended and commitments left unimplemented.
The Council of Governors, however, says counties cannot simply absorb thousands of Universal Health Coverage workers into permanent and pensionable employment without assured resources.
Nassir made that position explicit in a recent response to a proposal seeking to move UHC workers onto county payrolls.
“We wish to state that the proposed central transfer of payroll is not practical until outstanding matters relating to availability of resources for payment of salaries by county governments are addressed conclusively,” Nassir said.
He also argued that converting UHC workers to permanent and pensionable terms is a function of county governments through their County Public Service Boards and cannot be imposed unilaterally by the national government.
That argument goes to the heart of Kenya’s devolved health dilemma.
Counties inherited responsibility for health services, but the financing of those services remains heavily dependent on national transfers. As wage demands rise and counties struggle with competing priorities, governors are being forced to balance worker welfare against increasingly constrained budgets.
For health workers, however, the financial argument is becoming less persuasive.
In Embu, Kenya National Union of Nurses national chairperson Joseph Ngwaci accused the county of allowing the nursing workforce to deteriorate since devolution.
“Since the beginning of devolution, it is only in Embu County that the number of nurses has halved, out of the 47 counties. This is not acceptable,” Ngwaci said.
He also accused the county of allowing healthcare workers to stagnate in the same job groups.
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“There are so many healthcare workers stagnating in the same job group for a long time. We need these workers promoted and issued with letters of promotion,” he said.
The unions’ demands extend beyond basic pay.
They want eligible workers promoted, employees who have acquired additional qualifications properly placed, and long-serving contract and casual workers converted to permanent and pensionable terms.
The national dispute was formally escalated after health unions issued strike notices over unresolved grievances involving UHC and Global Fund workers, service gratuity and implementation of collective bargaining agreements. Clinical officers, for example, issued a 14-day nationwide strike notice beginning July 20, citing unresolved labour disputes and failure to implement commitments in a January 2026 return-to-work formula.
The economic consequences are becoming harder to ignore.
Every additional day of industrial action shifts more patients towards private hospitals, pharmacies and clinics. For poor households, that can mean postponed treatment, higher out-of-pocket costs and longer journeys in search of functioning public facilities.
For county governments, prolonged strikes threaten revenue collection, public confidence and the credibility of devolution itself.
The irony is that the crisis is not entirely about money.
Mombasa provides a contrasting example. Earlier this year, Nassir averted a doctors’ strike after agreeing to structured promotions and a review of contractual employment. The agreement included promotions for eligible doctors and a review of contracts across cadres.
That episode suggests that some disputes can be contained when unions and county governments negotiate concrete timelines and commitments.
But across counties now facing industrial action, workers appear increasingly unwilling to accept broad assurances.
The Embu protesters say they will remain on the streets until they receive written commitments on pay, promotions, placement and job security.
That is the warning sign for governors.
The longer the dispute continues, the less it looks like an ordinary industrial disagreement and the more it becomes a crisis of confidence in Kenya’s devolved health model.
The counties need money. The workers want dignity and predictable careers. Patients need functioning hospitals.
The challenge for Nassir and the Council of Governors is to bridge those competing demands before the strike moves from a labour dispute into a full-blown public health emergency.
For now, health workers across several counties are sending one unmistakable message: dialogue without delivery will not get them back to work.