Kenya adopted a rights-based approach and devolved the responsibility of public health service delivery of primary and secondary health services to 47 counties.

Establishment of counties’ structures, capacity building and transition planned to take 5 years.2

The constitution (Article 41) gave all types of workers (except disciplined armed forces) the right to: (1) fair remuneration, (2) reasonable working conditions, (3) form, join or participate in the activities and programmes of a trade union and (4) go on strike.

Every trade union was given the right to engage in collective bargaining2

Doctors’ Union called for a strike citing poor working conditions and poor wages.

Musyimi Task Force formed (six government officers and six Union members) to address health sector issues raised by the Union.15

Strike lasted a few days

Musyimi Task Force agreed on Return to Work Formula including formulation of a CBA and a proposal to establish Health Service Commission to manage service delivery.15

CBA aimed at aligning remuneration of doctors with the labour market by demanding a 300% pay rise to all medical practitioners and compensation if working>40 hours per week, review of job groups, promotions, deployment and recruitment of more doctors.

The county governments were not signatory to the CBA and they felt negotiation should have been with each county government,5

The national government did not submit the CBA to the industrial court for registration.

Devolution of healthcare launched officially.

June 2013, all county level functions speedily transferred to the counties in response to demand by the newly elected county governors.

Some counties lacked structures and capacity to take the new roles in management of human resource for health and medical supplies resulting in delayed salary processing and stock out of essential medicines.1

A nation-wide health professionals strike in late 2013.

The strike called off after several weeks when the striking health professionals were sacked.1

Nurses’ Union formed

The Union negotiated a 25%–40% pay raise, improvement of all its members working conditions and the absorption of all its members into permanent and pensionable schemes.

The strike affected all public hospitals under national and county governments (including the tertiary and university teaching hospitals).

Several attempts by the employer and doctors to negotiate made but marked with power games, mistrust, miscommunication, jailing of union officials and political interference.5

The 100-day nationwide strike ended after agreement.

A duty resumption agreement signed on 14 December 2016 between the national and the county government and nurses’ union to end the strike.8

Award of specified allowances agreed on.8

Salary issues were to be addressed in a comprehensive CBA.

Strike attributed to failure of the national and county governments to sign a CBA on pay and working conditions.8

County Governors persuaded the County Nursing Officers to call nurses back to work, a strategy that worked in some counties (affected two Clinical Information Network hospitals), though it was disapproved by the Union officials.

150-day nation-wide nurses’ strike ended after agreement8

(CBA was signed later in March 2018)