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We have clocked three weeks since the doctors took to the streets, issuing 19 demands to the national and county governments, among others. We are yet to see any tell-tale signs of the proverbial light at the end of the tunnel. And, as the union goes for the jugular, both levels of government have created euphoria around big meetings to chart a way forward only to ‘ask’ medics to call off the strike before any further dialogue. How will it play out? I do not know. But these are my guesses. I will be ticking them off as they happen. When the doctors troop back to work at the end on the strike, I will scan through this blog and probably laugh at things I totally created out of imagination or boast how accurate I turned out. But what matters is that the strike is called off soonest. 


Here are the 10 Things we have learnt in over a decade of Kenya Medical Practitioners, Pharmacists and Dentists’ Union (KMPDU) existence, about any doctors’ strike. 

  1. The judiciary never declares any strike legal 

This used to be the clarion call of a couple of secretaries general of the union during previous doctors industrial actions. What is different now? It is that the doctors have put forward a framework for “essential service” coverage during a strike. It reads like a page from a UN resolution calling for protection of humanitarian corridors and respect for bilateral ceasefires for aid supply during battles. Never mind that the implementation of the said proposed framework is one of the contentious issues in the current strike. 

“It is never our intention to judge the success of a doctors strike by the number of patients who suffer or die,” KMPDU deputy secretary opined during a TV interview.  

The question remains legal, of how to hold tight to article 41 of the constitution that guarantees every employee the freedom to belong to a trade union and to picket. The courts stand as the interpreters of the same law and constitution. I cannot authoritatively speak to this but I hope that one day, wisdom will seep from the corridors of justice and advise how unionised essential service providers can procedurally procure a strike that will bear the judiciary’s seal of approval. 

2. Striking doctors are threatened, ‘fired’ and their jobs advertised.

We have already seen this in KUTRRH and the county government of Nairobi. More will come. As we used to say back in the days, “kaza mshipi nanii”. It’s time to tighten the belts. More will come. When the doctors went on strike in 2012, the then minister and current Kisumu governor Prof Anyang’ Nyong’o declared all positions in the public sector vacant and all doctors sacked. The advertisement ran on the Standard Newspaper. We all know how that ended. Sometimes it is really painful to just spend all the money issue paid advertisement for positions for which no substantive recruitment will take place. Anyway, eventually we are fighting inflation and pumping money back into the economy. 

3. A government officer issues an inflammatory remark that escalates matters.

This may have happened in the current strike when the CS said she had 50 interns calling and offering to undertake internship for free. The reality though is that more inflammatory remarks may come out. In 2012, Prof Nyong’o likened the striking doctors to sulking children demanding for peremende (candy) from him. The doctors went wild on twitter and Facebook (yeah, now they are named X and Meta or whatever, I am a fossil). The hashtag Peremende Movement trended for long and became the tagline for the strike. But most of us will recall the 2016/17 100-day doctors strike when union officials were jailed, heightening the industrial dispute to the political courtyard of the nation. By the time a truce was brokered, private hospitals had been sucked into the dispute. I was just finishing my training in Aga Khan then and there was significant disquiet and a walkout. A nurse who had been a staff for two decades told me, ” I have never seen this (strike in Aga Khan) in all my years here.” 

4. Other healthcare cadres declare their own industrial action and join the doctors.

Clinical officers, nurses and medical lab technologists have made their pronouncements. Some have started their own industrial action. The doctors argue that they inspire the rest of the health sector cadres. The public see it as a deepening of the healthcare crisis. Some other quarters will call them Johnny come latelys. But joining the strike is not the issue. How they end their strike is what I would like to highlight. In the first ever doctor’s strike (Linda Afya) in December 2011, the nurses returned to work shortly after declaring their strike. There was a talk about their return to work formula as solely containing a uniform allowance. I am not privy to its contents and therefore cannot talk to it. This leads to my next point. 

5. Authorities Negotiate With  Other Cadres and Secure Return To Work Formulae. 

My considered view is that the government will target to address the issues by these other healthcare cadres as they might not be as heavy as the doctors litany of demands. Secondly, the government might wish to bring to and end the other cadres industrial unrests to score PR brownie points by telling the public that doctors are the unreasonable hardliners. This may be playing out in the near future. It is when all the other unions have called off the strike actions that the real second half of the doctors strike starts. The government representatives often walk away from the negotiating table. ‘After all, you are leading an illegal strike’ they point out to the union leaders. Internal pressure also mounts as doctors have gone unpaid for months. 

6. KMPDU Leaders are Branded Hardliners Without Feelings for Kenyans. 

Of course, overlapping with the above two points and the below two points, the government can use many tricks like we have seen before. It is usually the rallying call across. It has won severally. Just switch on to any YouTube recording of a conversation on the doctors strike and scroll through the comments. Just the other day a doctor shared on social media about how their cab driver, unaware of the profession of his client, quickly commented that doctors should remain in the hospitals because it is Kenyans who will suffer, that they should ‘continue doing the Lords work’. He was shocked when the doctor asked him if he could take a medical advice for fare at the end of the trip. ‘It is a calling’! The most divisive statement I have encountered in my short life in this profession. Twisted by all and sundry, depending on the circumstances. 

7. Bloggers Run Social Media Propaganda Campaigns Against Medics. 

For this strike, we have already had the tags ‘Greedy Medics’ and ‘KMPDU Exposed’ that have trended for some days last week. I remember 
during the 100-day doctors strike there was something akin to ‘Doctors Exposed’ and ‘System ya Facts’. One can tell the campaigns are sponsored since most of the ring leaders happen to the bloggers affiliated with the government of the day. 

8. Government Gets Violent with Individual Leaders of KMPDU To Inflict Personal or Group Pain and Disadvantage. 

The secretary general of the union was injured during the earliest days of the strike. It was a terrible miscalculation by the police if at all it was intended. That moment means Dr Davji has already crossed his proverbial Rubicon in this strike. Negotiators from the government side will go to him with a guilty conscience (assuming they have a formed conscience and do not harbour any hatred against doctors). The other members of the union top leadership may be isolated and harassed. Other personal dirty work-related matters can be unearthed touching on leaders, sometimes incorrect and trumped up. 

I pray and hope one day we don’t turn on our TVs and hear the president at a public function telling the doctors…”mambo ni matatu“! We have been there before and it did not augur well.

9. The president directs senior members of the government to sit down with KMPDU leadership, mediated by a respected trade unionist or senior medic in Kenya. 

The Whole of Nation Approach (WONA) is a multi-agency task force chaired by the head of public service directed by the court to sit down and handle the strike. We have heard their sit down and their resolution to form a technical group to address all the issues in the doctors strike. It is commendable it has come this soon. It was reported that the talks broke down between the WONA team and the doctors. We wait to hear what the 13-member technical group will bring to birth. If this does not work, it will need the intervention of respected senior colleagues in the health sector or trade union movement who have access to the political leaders to restart the mediation process, either as intermediaries or convenors of a different negotiation team. The recent Op-Ed the Kenya Medical Association former presidents comes in at a pivotal moment, opening another dialogue avenue should the WONA caucus hitch a snag. 

10. A Return to Work Formula is Reached and The Strike Called Off. 

    The final turn is a signed return to work formula between the protagonists. As per the union constitution, the leadership must quickly sermon the highest decision-making organ (a group comprised of leadership across the various branches countrywide) to okay any return to work formula and endorse an official end to the strike after which the SG officially calls off the strike. Operationally, the first clause of the return to work formula ensures no one is victimized- anyone fired is reinstated, any salary withheld is paid out, any workplace disciplinary (funny eh!) case against a union leader or member ongoing relating to the strike withdrawn etc. And of course, the doctors get time to resume work (like one or two days to allow for travel and all). 

    The above steps need not be sequential nor exhaustive. The issue is, the turnaround time of the above is what will determine how soon the strike will end. 


    People change, and circumstances change people. Yet, this is one strike where doctors can look with hope to a few people who have the ears of who is who in the national government. If the who is who in government is truly unaware about the matters being canvased by the doctors, it is because they have not asked a few questions along their office corridors. I do not talk for anyone but just express my expectation that the following gentlemen (woi, what happened to gender parity?) must be working hard behind the scenes to give in a good word. Also, listing their offices is actually doing them a disservice. They harbour experience and connections that span ministries, state departments and other critical stakeholders in the health sector. I always belief, there is no useless experience. It is time to connect the dots backwards. 

    1. Dr Ouma Oluga 

    How can politics be clean if the clean people do not engage in politics? I remember Dr Ouma Oluga for this statement. It was back in 2009 in medical school and we were discussing something about politics. You know those AOBs after the official AOBs in a meeting? The ones that are actually not minuted. He was the president and I was the secretary general of the Medical Students Association of Moi University (MSAMU). Dr Oluga has gone on to be among the most impactful leaders that has traversed the space of the KMPDU in its more than a decade of existence. Back in 2017, I was happy to co-author with him a peer reviewed paper looking at the history and the future projections of the Kenyan doctors union. Now, why am I mentioning him here on small matters? Because I think his profile is perfect for the unseen players who could shape this strike. 

    He is a former SG and now a senior ministry staff. Surely, there will be people taking a flight of stairs or a walk across the hallway to ask ” just a quick one” about this union thing. His voice can only be for the better of the Kenyan Doctor, the Kenyan Patient and the Kenyan Healthcare. I wish him all those opportunities. He understands the doctors CBA like the back of his hand. Most of the reference documents the WONA and the technical working group will be perusing will most definitely bear his signatures. 

    2. Dr Sultan Matendechero

    When I watched the prime-time TV interview featuring KMPDU SG and Kenya National Union of Clinical Officers (KUCO) National chairman, I was surprised to see that MOH was represented by Dr Matendechero. A former KMPDU SG himself, I couldn’t help but notice the sobriety and considered weight of his statements. Completely calm and a polar opposite of what we have seen from many a ministry official. 

    There is a song I frequently hum in theatre, with nostalgia remembering the 2011 strike. During that strike, someone had brilliantly cropped and merged the mugshots of then Minister for Health Prof Nyong’o and Director of Medical Services Dr Kimani.  One half displaying a black face with a grown beard, the other a brown, rotund one with clean shaven cheeks. It was one of the most popular of the placards with the caption ‘KIMANYONG’O’; a Kimani- Nyong’o chimera in a word. 

    On this occasion of the many demos to the ministry, we gained access to Afya House. In my small splinter group, Dr Matendechero was in the lead. We took the stairs to the minister’s office. He was not there. Then out of nowhere (although I really think it was out of Dr Matendechero’s vocal cords 😅) the tune rent the air. 

    Soloist: Ninashangaa sana moyoni mwangu

    Response: Ni nani aliyemtibu Nyong’o 

    Soloist: Ninashangaa sana moyoni mwangu

    Response: Ni nani aliyemtibu Nyong’o 

    All: Si sisi madaktari (x2)

    Alitoroka akaenda ng’ambo. 

    It was a surreal experience and the height of picketing for me during the particular strike . The doctors of course were using this chant to reiterate that the minister had sought treatment in a foreign land, underscoring the underfunding and ill-equipping of the Kenyan hospitals. 

    Again, as a former vice chairman and secretary general of KMPDU, Dr Matendechero has knowledge of which red tapes in the MOH bureaucracy could curtail a speedy resolution of the current dispute. He has seen it first-hand how government sanctioned task force report such as the Musyimi report can gather dust in Afya House shelves while implementation does not see the light of day. If there is anyone in the ministry of health who is keen on understanding the medics issues in context, surely, they should knock at the door of the deputy director general. 

    3. Dr Thuranira Kaugiria

    I am so cool I cool I am mentioning two undergraduate classmates in three paragraphs, ah! But I don’t brag, I am a general surgeon here removing cancers and diseased gall bladders when not repairing hernias and unblocking blocked intestines. In this serious than life profession, when the knife touches the skin, opinions are sacrificed on the altar of evidence based science, imagination and postulations cast aside to clear the way for established standard procedures. A small deviation from the cordinates and you get into uncharted waters, often taking the patient’s life there where a return ticket may not be guaranteed. It is for this reason that I try to write. Writing gives me the freedom to roam the world unhindered. Like a pendulum, whichever swing my pen takes, I know for sure it will come back, for that’s what pendulums do. I do not have to be correct. No life depends on this piece. If it is utter balderdash, no patient goes to ICU and accumulates millions in hospital bills, another person will write a rebuttal. 

    Anyway, back to Dr Kaugiria. He was a firebrand unionist in Nairobi. We baptised him ‘matron’ akin to the nurse duty managers who man hospitals at night. Matrons (slowly turning into ‘nurse covering’ to recognize the boy child) are literally the ops managers at night. They will know the hospital inside out. From the security booth to the kitchen to which patient has complicated in the ward to which consultant is dragging his feet to attend to an emergency. They act CEOs, Finance directors and all other offices combined. If you have a patient and you have no idea where they landed in a big hospital, do not bother with CEO’s telephone, just call the hospital matron and they will know the patient by name and location. 

    When the union doctors were jailed during the 100- day doctors strike, Dr Thuranira was among those who kept the doctors united. Though the CBA the doctors registered may not bear his name or signature, he is the embodiment of Robin Sharma’s best-selling  book- the leader who had no title

    And now tables have turned and Dr Thuranira (or îkûlû, as we refer to each other) is a presidential advisor. When the president decides to reach outside the cabinet for some clarification on any underlying matters of the doctors union, he will be briefed in the spirit and the letter. 

    4. Dr Anthony Akoto

    Remember the viral picture of a gentleman carrying a bag suspected to belong to the cabinet secretary? 

    Let us get to know him. First things first though, I do not know if that picture was true. My little shallow research indicates that the doctor is the chief of staff in MOH. That is a title I have come to respect tremendously. But Dr Akoto is not only a chief of staff, he is a former KMPDU leader representing one of the branches. National and branch leaders who served with him praise his devotion to the doctors’ course during his term.

    This current role then makes him the quintessential listener to every hushed comments by the CS. If there is any pronouncement to be made by the CS, then her chief of staff will be aware of, if not be fully responsible for. It then means dotting of the ‘I’s and crossing of the ‘T’s might be Dr Akoto’s JD even as the CS appends the signature and owns up the document. 

    Rumour has it that by the time of going to the printer, the housing levy was supposed to have a ceiling amount. Meaning that the 1.5% would be to a maximum of a certain figure. But somewhere along the way, the gazette notice came out without indicating the ceiling amount, meaning the more you make the more you will pay to the fund. 

    As a former unionist, a chief of staff should be able to comb through critical documents originating from the CS desk. I hope there will be no typos to critical documents, and no critical clauses deleted at the last minute. A former unionist can only mean the best for the union, in his present circumstances. 

    For whatever its worth, everyone with an ounce of influence should go their full length to contributing towards the end of the doctors strike.


    Before the doctors strike took off, industry statistics showed that 53% of the bed capacity in the country is spread in the private sector. We also had issues with how NHIF would transition to SHA and the critical role the CHPs are playing for primary healthcare. 

    It is a tough time for the Kenyan healthcare.. The problems that bedevil the health ecosystem need extensive thinking and deliberate implementation of established solutions. There was this phrase that ‘Kenya makes policies and Rwanda implements them’.

    After a decade of devolution, I am tempted to think that the doctors union has put a strong case for the public health sector. Otherwise, it may as well have collapsed had devolution happened without the doctors union. Granted that any union’s sole mandate is to fight for their members labour matters, it is time to think hard how we can keep the public health sector afloat and strong. The World Health organization (WHO) list the following 6 building blocks of any health system:

    • Leadership and governance.
    • Service delivery.
    • Health system financing.
    • Health workforce.
    • Medical products, vaccines and technologies.
    • Health information systems

    The current doctors strike and the attendant cross-cadre health work force industrial unrest already touches on 3 of those 6 pillars. These must be confronted head on by the ministry of health, the council of governors and indeed the Kenya Kwanza cabinet to save the public healthcare and elevate it to a working middle income country health system as envisioned in Kenya’s vision 2030. Tik Tok…… 

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    About the Author

    Dr. Stanley Aruyaru

    Dr. Aruyaru is a Consultant General and Laparoscopic Surgeon and a Healthcare Manager. He has solid experience in managing busy surgical units and leading clinical teams to deliver in the lines of quality health provision and evidence based surgical practice.

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