DEADLOCK

Governors: Why we can't pay nurses an extra coin

Governors say they are some of the best paid civil servants in the counties

In Summary

• KNUN secretary-general Seth Panyako, who is campaigning to be re-elected next month, wants a 500 per cent increase in nursing allowance to Sh15,000.

• The Kenya Health Service Delivery Indicator Survey 2018 Report shows rampant absenteeism of 60.7 per cent by doctors followed by nurses (54.5 per cent) and clinical officers (49.5 per cent).

Governors Wycliffe Oparanya, the Council of Governors chair and James Ongwae of Kisii during a meeting with editors in Nairobi on January 13, 2021.
Governors Wycliffe Oparanya, the Council of Governors chair and James Ongwae of Kisii during a meeting with editors in Nairobi on January 13, 2021.
Image: Douglas Okiddy

"You won't get a cent more." That's what governors have told striking health workers.

The governors say they have accepted all demands by the striking workers except for higher allowances, which they reject outright.

The governors, who spoke to the media in Nairobi yesterday, said financial demands can only be considered in a new Collective Bargaining Agreement.

Nurses and clinical officers in 34 counties went on strike on December 7. They demand higher allowances, adequate personal protective equipment, comprehensive medical insurance cover and an end to salary delays.

But the governors say they are some of the best paid civil servants in the counties and, perhaps, do not deserve any more pay. Any pay rise is untenable and will distort counties payroll.

The lowest-paid nurse, at certificate-entry level, earns total Sh71,870 monthly salary and an extra Sh10,000 every year as uniform allowance. A certificate in nursing takes about two years and is open to people with C- (minus) and above.

On the other hand, an entry-level clinical officer with a diploma earns a gross salary of Sh83,380 per month.

Council of Governors' chair Wycliffe Oparanya said the current demand to raise monthly risk allowances for nurses from a minimum Sh3,000 to Sh19,000 is untenable.

“An increase in any allowances has a budget implication to the counties,” he told journalists Wednesday.

All health workers received salary increments of between Sh20,000 to Sh60,000 in 2017 when they successfully negotiated the current CBAs. At that time, doctors went on strike for 105 days and nurses for five months.

“The total cost for allowances awarded in 2017 for all the healthcare workers totalled Sh5.3 billion annually,” Oparanya said.

Health gets lion's share of budget

He said all counties devote a minimum of 30 per cent of their budgets to health,  most of it on salaries.

CoG head of human resources James Ongwae said the fat salaries of health workers had created disparities with other professionals earning considerably less money.

For instance, entry-level engineers and economists with degrees earn a maximum of Sh65,750 a month.

Comparatively, the highest-paid nurse in Kenya earns Sh428,430 while the top-earning economist or engineer bags Sh269,200.

“We’ve increased allowances of these health cadres to a level now we have a serious problem,” Ongwae said.

“Where is fairness. We have given nurses almost twice. We know about educational qualification of an engineer and nurses.”

Unable to employ more medics

The governors also said the high salaries meant counties are unable to employ more nurses because it is expensive.

Last week, the nurses and the Ministry of Health signed a return-to-work formula, which was rejected by governors.

Kenya National Union of Nurses' secretary-general Seth Panyako said the RTWF gives all nurses a 500 per cent increase in nursing allowance to Sh15,000.

Panyako, who is campaigning to be re-elected at the helm of KNUN next month, urged governors to sign the agreement.

“It is not right for the CoG to try to run away from the process they know and a process which they are not being asked to generate any income,” he added.

On Wednesday, Health CS Mutahi Kagwe said the ministry had already given its input to the RTWF and will not interfere with further discussions between CoG and the unions.

"We have listened to the CoG at the moment they are engaged in discussions with the various unions but as far as the national govt is concerned it's clear," he said. 

He added: "From a policy and philosophy point of view we continue to urge that the county governments continue and agree on various working protocols with healthcare workers. But as I say and repeat, we will not interfere. We cannot, by law, tell a county to hire or fire any of their workers, let alone healthcare workers."

Oparanya said any increase in allowances has to be authorised by the Salaries and Remuneration Commission and Treasury must commit to providing the cash.

He said CoG cannot legally sign any return-to-work agreement on behalf of counties and so a full council would be required to ink a deal.

Oparanya said the doctors' strike was resolved quickly on December 24, last year because there was no demand for extra allowances.

He said all other civil servants including drivers are also at risk of contracting Covid-19.

“Therefore, in the unlikely event that all workers demand a Covid allowance and increase in other allowances, the country will grind to a halt. We urge that health workers put the country first and adhere to the oath of allegiance to service,” he said.

Last year, all health workers were paid Sh3 billion Covid-19 allowances for three months from April.  

The allowances ranged between Sh5,000 and Sh20,000 for different cadres of health workers including doctors, nurses, laboratory technicians.

Baringo Governor Stanley Kiptis, who attended Wednesday’s meeting, said it was no longer possible to devote more money to three cadres – doctors, nurses and clinical officers – yet healthcare has 17 cadres.

“In Baringo 55.7 per cent goes to health and we can’t stretch further,” he said.

Rampant shortage

The Kenya Health Service Delivery Indicator Survey 2018 Report shows a rampant shortage of staff in public facilities.

The survey, conducted by the World Bank and Kenyan government also noted rampant absenteeism of 60.7 per cent by doctors followed by nurses (54.5 per cent) and clinical officers (49.5 per cent).

“During the unannounced visit, more than half of the clinical staff were absent. In fact, most of these absences were approved,” the report says.

Currently, the strike has failed in 13 counties where all health staff are working. 

These are Bomet, Tharaka Nithi, Marsabit, Kirinyaga, Murang'a, Laikipia, Samburu, Narok, Siaya, Turkana, Mandera, Wajir, Nyeri and Machakos.

The nurses strike is ongoing in 33 counties while clinical officers are only on strike in eight counties. 

Doctors from six counties — Migori, Nairobi, Nyamira, Mombasa, Garissa and West Pokot — are also on strike. 

Last week, medical lab technologists from five counties also announced they were on strike. These are Kakamega, Isiolo, Homa Bay, Baringo and Machakos.

In Garissa and Mombasa public health services are virtually non-existent, with doctors, clinical officers and nurses being on strike.

The governors also said they will not reinstate sacked health workers even through a return-to-work formula.

They said several courts have also issued orders to suspend the strike, and as is, the strike is not protected in law.

(edited by o. owino)