Introduction: A Debate Over Scope of the CBA
Health sector tensions spilled into public view after Health Cabinet Secretary Aden Duale dismissed calls for a Collective Bargaining Agreement (CBA) that would apply only to a narrow group of clinicians employed directly by the Ministry of Health. Duale said any future CBA must reflect the realities of the wider health system, including county health facilities and referral networks. His stance signals a push for a more inclusive contract framework that protects healthcare workers across different jurisdictions and service levels.
The Core of the Dispute: Who Should Be Covered?
The current contention centers on whether a CBA should be limited to roughly 150 clinicians tied to the Ministry, or whether it should extend to the broader cadre working in county facilities and referral hospitals. Proponents of a universal approach argue that the health system operates as a network, where patients move between ministries, counties, and referral centers. Excluding county-based clinicians could create rifts, administrative complexities, and unequal labor conditions across the country.
Implications for Counties and Referral Pathways
By insisting that counties and referral networks be included, Duale highlighted the integral role of county governments in delivering frontline health services. County Staff, including nurses, clinical officers, and allied professionals, are often the backbone of public health delivery. A CBA that omits them risks undermining morale and widening gaps in pay, benefits, and work conditions between Ministry workers and those in the counties.
What a Comprehensive CBA Might Look Like
Experts suggest a framework that addresses wage scales, allowances, overtime, working hours, and hazard pay across the entire public health system. A broad CBA would ideally harmonize pay bands and benefits to prevent parallel agreements that create disparities. It could also include clear guidelines on deployment, retirement benefits, and training opportunities to ensure consistent professional development across all counties and referral facilities.
Political and Administrative Considerations
The push for an inclusive CBA is not merely a labor issue; it intersects with political and administrative priorities. Health policy in Kenya involves both the national government and county administrations, which may require negotiation, funding allocation, and legislative support. Duale’s stance frames the debate within a need for equity, system-wide reform, and the efficient use of scarce health resources during periods of strain in public health infrastructure.
Impact on Strikes and Negotiations
As strikes continue or simmer, the outcome of this debate could influence bargaining dynamics. A universal CBA may dampen tensions by offering a clear, nationwide standard of employment terms, while a fragmented approach could prolong impasses. Stakeholders—clinicians, union leaders, county health officials, and central government representatives—will likely engage in extensive consultations to determine a path forward that balances equity with financial feasibility.
What This Means for Patients
For patients, the impact of a broad, system-wide CBA could translate into more consistent service levels, predictable staffing patterns, and improved access to essential care. A fair and comprehensive agreement might reduce disruption from strikes and ensure that counties and referral facilities can attract and retain skilled clinicians across the public health network.
Conclusion: A Call for Inclusive Health Labour Reform
Secretary Duale’s comments underscore a broader push toward inclusive health labour reform in Kenya. By insisting that any CBA must cover counties and referral networks, the administration signals a commitment to uniform standards across the national health system. The coming negotiations will reveal how ready policymakers are to commit to systemic changes that support clinicians and patients alike, regardless of where care is delivered.
