Medics insist 11 demands must be met before calling off strike

KMPDU Secretary General Davji Attellah (3rd right) and deputy secretary general Dennis Maskellah (right) singing solidarity songs with doctors, medical interns and medical students at the Mega Doctors assembly after a press briefing on the ongoing doctors' strike on 2nd April 2024 [David Gichuru, Standard] Demand for Sh1.1 billion basic salary arrears owed by counties and employment of all jobless doctors are part of 11 grievances by Kenya Medical Practitioners and Dentist Union (KMPDU). Rival submissions by the doctors on the current stalemate indicate that doctors are aggrieved by the Ministry of Health and county governments' shifting goalposts on the implementation of the 2017/2022 Collective Bargaining Agreement (CBA) and unpaid debt by devolved units. Health Cabinet Secretary Susan Nakhumicha said in public that the agreement between doctors and their employers was done before her tenure. However, documents filed by the union in court show that Nakhumicha last year appended her signature on a follow-up document that is also at the heart of the dispute. Her signature is dated on January 9, 2023, alongside that of Nairobi Governor Arthur Johnson Sakaja, who is the Council of Governors (CoG) chairman on Human Resource, Labour and Social Welfare Committee. KMPDU Secretary-General Davji Atellah also signed the document. On the basic pay as provided under the CBA, the document indicates that it was agreed that the issue would be discussed at the multi-agency level and escalated to CoG for the way forward. The timeline of implementation was indicated to be within 60 days. The second issue was provision of comprehensive medical insurance for all doctors. The agreement was that the county provide the same with immediate effect. On the other hand, KMPDU was to provide a list of all counties that do not have a medical cover for doctors for action. Delayed posting of medical interns was also at the heart of the document signed by Nakhumicha, Sakaja and Atellah. The resolution was that 889 of the November 2022 cohort of medical officer, dentist and pharmacist interns be posted by the second week of January 2, 2023. The December 2022 cohort of 200 interns were to be posted within 2022-2023 financial year. Other issues that were agreed on was absorption of jobless doctors, provision of protective gears, post-graduate training and promotion of doctors to the right groups. In addition, county governments were to come up with modalities to ensure that salaries were paid on time. Doctors, the ministry and governors also discussed about mortgage and car loan which was to be considered while negotiations for the next CBA was to immediately commence. However, doctors decry failure by the national and county governments to honour their end of bargain. For example, on basic pay, the agreement was that it was to increase by Sh10,000 per month. However, Dr Atellah said that this has not been effected to date. "It is imperative to note that on account of the petitioner and first interested party's lethargic and callous approach, the CBA negotiations have lasted in excess of three years for a four-year CBA cycle, effectively making the entire process an academic exercise," said Atellah. The KMPDU boss said that after the Employment and Labour Relations Court (ELRC) ordered that they should meet for minimum safety services, the national government and governors came with a made-up mind that union members should go back to work. He asserted that the union had ensured that there is no death or danger to Kenyans as it has asked its members to attend all persons in Intensive Care Units (ICUs), surgical and maternity emergency. At the same time, he said, KMPDU members committed to offer services in private hospitals. "It is also important to reiterate that the union, Cabinet Secretary Ministry of Health on January 9, 2024, and the COG chairperson Human Resources, Labour and Social Welfare Committee on January 6, 2024, executed an implementation matrix for the issues outlined in the two notices of industrial action dated November 28, 2022, and March 6, 2024," he stated. He claimed that the ministry and governors have frustrated the conciliation process before Kisurulia Kuloba, the conciliator. According to Atellah, Kuloba had on several occasions decried the inaction and frustrations by the two. Mary Muthoni, the Principal Secretary for the State Department for Public Health and Professional Standards, claimed that since health is a devolved function, KMPDU should seek and negotiate separate CBAs with each of the counties and national government. While KMPDU raised 11 issues, the ministry raised six issues. In the meantime, CoG raised 10 issues, among them posting interns within 30 days after completion of their internship. The PS claimed that at the time the ministry was negotiating with KMPDU in 2017, it had enough money to cover the salaries for all interns. Muthoni stated that there is a 'drastic' surge of medical practitioner interns. In 2014, she said there was some 4,985 medical, dental, nursing, clinical medicine and pharmacist interns. In 2023, there were 6,765 interns. The PS's suggestion is that the Ministry of Education and health training institutions needs to be involved to control the number of interns requiring placements in health facilities. She said the ministry may not be able to absorb all of them. The PS also claimed that the conciliator noted that the interns earn more than the approved Public Service Commission (PSC) structure. She alleged that the Ministry of Health sought for advice from the Salaries and Remuneration Commission (SRC) and further asked for more funds from the National Treasury and would be able to take up interns from April 1, 2024. SRC chairperson Lyn Mengich, in her letter to Nakhumicha, said that the commission sat on March 12, 2024, and decided that healthcare interns should get a stipend. For a medical officer intern, the commission approved Sh47,000 minimum and Sh70,000 maximum stipend. A pharmacist intern and a dental officer intern ought to get the same amount. A nursing officer intern and clinical officer intern who has a degree was allocated a minimum stipend of Sh35,000 and Sh50,000 maximum. Clinical officer intern who holds diploma was allocated Sh27,000 on the lower end and Sh35,000 maximum. The ministry requested Sh597 million to post 3,759 interns. According to the letter by Muthoni, the ministry had decided to pay medical officer interns Sh59 million and it targeted 849 of them. Pharmacists of interest were 289 with a total Sh20 million monthly requirement. In the meantime, the ministry asked for Sh5 million for 72 dentist officers. It also sought for Sh56 million for 1,134 nursing officers. Clinical officers targeted by the ministry were 145 and targeted amount was Sh7 million and for 1,270 clinical officers who have diplomas, the ministry asked for Sh44 million. In total, the ministry said it was asking for Sh579 million for the financial year 2023/2024 and the remaining Sh1.7 billion would be considered for the financial year 2024/2025 The conciliator said the ministry does not owe doctors anything under the CBA. Kuloba, however, observed that the counties owe doctors Sh1.1 billion in basic salary arrears. Meanwhile, the Kenya National Union of Nurses (KNUN) has a separate battle over its CBA with Kenyatta National Hospital. The union says it wrote to KNH seeking to have the CBA forwarding to the ministry but the hospital has refused to grant the request. They argue that both SRC and KNH have failed to submit the CBA to court for more than 42 days which contravenes Section 60 (1) of the Labour Relations Act 2007. KNUN wants the court to compel the two to file the CBA in court since they are already in violation of their rights and those of their members. KNUN's Industrial Relations Officer David Benedict Omulama, in an affidavit, says the responsibility to file the CBA to court lies with KNH for registration with the ministry. "The applicant is apprehensive that such delay or failure to submit the said documents for registration is causing irreparable prejudice to the members of the applicant in terms of delayed earning and benefits and it is affecting Industrial relations," he said.

Medics insist 11 demands must be met before calling off strike

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