We reject 'rigid controls', doctors tell Duale on insurance plan

KMPDU Secretary General Davji Atellah. [File,Standard]

The Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) has rejected a proposal by Health Cabinet Secretary Aden Duale to block insurance claim pre-authorisations by doctors during official working hours.

Duale plans to direct the Social Health Authority (SHA) and Digital Health Authority (DHA) to reprogram insurance systems to reject claims pre-authorised by public doctors between 8 am and 5 pm, allowing such authorisations only during off-duty hours.

According to the CS, the move aims to reduce conflicts of interest, prevent diversion of public service time into private practice, and control rising insurance costs under the new Social Health Insurance Fund (SHIF).

However, in a statement on Wednesday, December 17, KMPDU said the approach ignores chronic staff shortages in public hospitals, where doctors work extended shifts and emergency calls that blur the line between on-duty and off-duty time.

Kenya's doctor-patient ratio falls far below World Health Organisation (WHO) standards, forcing public sector doctors to work beyond official hours and take on private practice to supplement low salaries.

"Rigid clock-based controls do not match how public hospitals operate and risk arbitrary enforcement," said KMPDU Secretary-General Davji Atellah.

The union said dual practice has become a coping mechanism amid heavy workloads, delayed remuneration, and a lack of incentives for exclusive public service.

KMPDU warned that the ministry developed the proposal without consulting organised labour, potentially breaching collective bargaining agreements and constitutional labour protections.

The union has called for alternative measures, including roster-based or facility-verified approval systems, structured dual-practice framework, and accelerated recruitment to ease pressure in public facilities.

KMPDU also demanded suspension of any unilateral implementation and warned of legal or industrial action if the policy proceeds without consultation.