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Clinical officers demand recognition in latest wave of industrial action
Kenya Union of Clinical Officers (Kuco) Chairman Peterson Wachira (left) speaking during a past demonstration in Eldoret town, Uasin Gishu County on June 19, 2024.
Clinical officers across the country have withdrawn their services indefinitely, bringing critical medical procedures to a halt, in what union leaders describe as a fight against systemic discrimination and unfair labour practices.
The strike, which began on January 19, 2025, has impacted specialised procedures such as cataract surgeries, where clinical officers perform 98 percent of operations nationwide. Thousands of Kenyans requiring these and other essential medical services now face indefinite delays in treatment.
"We are ready for one year," declares Peterson Wachira, chairperson of the Kenya Union of Clinical Officers (Kuco). "Anywhere a clinical officer works, we are withdrawing services until our demands are met."
At the heart of the crisis lies the Social Health Insurance Authority's (Shia) failure to recognise facilities and practitioners registered under the Clinical Officers Council. This exclusion forces patients to travel long distances to access care at SHIA-approved facilities, primarily those registered with the Kenya Medical Practitioners and Dentists Council (KMPDC).
"Our specialists and facilities, which are widely distributed across the country, cannot see patients through SHA. Patients either travel far for care, or pay out of pocket to see clinical officers," Mr Wachira says.
The strike also protests other longstanding issues, including: a Collective Bargaining Agreement (CBA) pending since 2017, discriminatory practices in facility registration, forced double licence requirements and coerced use of KMPDC license numbers for pre-authorisation.
The current crisis follows a four-month strike in 2023, which ended with a Return to Work agreement signed on July 10, 2024. That agreement promised resolution within 60 days, including CBA completion and implementation of health risk allowances.
However, according to Kuco, the government failed to fulfill these commitments.
The current standoff represents a critical point in the long history of clinical medicine in Kenya, which began in 1928 at what was then King George VI Hospital (now Kenyatta National Hospital). Initially training hospital assistants for basic medical procedures, the profession has evolved to produce highly skilled practitioners, who now handle complex medical procedures across various specialties.
Today's clinical officers serve at multiple levels: Registered Clinical Officers (diploma level), Clinical Officers (bachelor's degree) and Clinical Specialists (master's degree and above).
They perform crucial roles across the healthcare system, including 95 percent of anesthesia procedures, complex surgeries and specialised care in reproductive health, oncology, ENT, ophthalmology and pediatrics.
Despite their advanced training and crucial role in healthcare delivery, clinical officers face significant challenges in fulfilling their primary mandate: community health prevention.
"The original vision was for new graduates to spend their first years in community facilities," Mr Wachira explains.
"They would study family health patterns, environmental factors, water sources, and potential disease risks. They would then work with community leaders to prevent diseases before they occurred."
He explains that the orientation of a clinical officer who has just come out of school was supposed to be spent in community health. The first years after graduation were supposed to be spent in a community facility such as a dispensary, doing research and working with the community to prevent diseases.
This preventive approach, he argues, would significantly reduce healthcare costs by addressing health issues before they require expensive interventions. However, population growth has outpaced recruitment, forcing clinical officers to focus solely on curative care.
Community impact
"You get no time to go to the community," Mr Wachira laments. "That's where we lost it because curing diseases is a bottomless pit. Diseases will keep coming up as long as you're not preventing them."
The strike particularly affects rural and underserved areas, where clinical officers often provide the only available medical care. The profession was originally designed to include significant community health work, including disease prevention and health promotion, but staff shortages have forced most practitioners to focus solely on curative care.
"If the president is not going to take measures and streamline SHA, it will not survive the next five years. It will fail terribly," warns Mr Wachira, highlighting concerns about the future of Universal Health Coverage in Kenya.
“The impact is that in the future, we will not have specialists, and at some point we will have to get some of the specialists from other countries. That is why we created Kuco, which was registered on July 5, 2017.”
He explains that after the registration, the union signed a memorandum of understanding, which included adoption of career guidelines.
They also embarked on getting a recognition agreement, which shows that the government recognises the union’s right to represent workers. The agreement was signed in 2019.
What followed was to negotiate a CBA to secure how the government would manage them, based on what clinical officers and the government had agreed upon.
The CBA determines the wage, the terms and conditions of employment, assigning of titles, promotions and designations, how to exit, benefits at the workplace, medical cover, recognition of outstanding work and leadership matters among others.
However, what started nine years ago is yet to be agreed upon.
“In 2021, we went on strike because, despite all the counties and the national government signing the CBA, it was elusive... In 2023, the court realised that there was no negotiation, and that the government was elusive. It gave compelling orders for the ministry and the county governments to come to the table, negotiate, and conclude a CBA. That did not happen,” says Mr Wachira.
“From 2021, every year we have been going on strike. Around April last year, we decided to go on strike to force them) to obey the orders of the court. For four months, we were not reaching a deal. The same courts, noting people are suffering, gave further orders and directed that we enter into a return to work agreement, outlining a clear framework on how those issues are to be resolved.”
The return to work agreement, signed on July 10,2024, stipulated that the Ministry of Health (MoH) and Kuco shall negotiate and conclude the CBA in court within 60 days-by September 1.
The government still did not comply, leading to the current strike, which started on January 19, 2025. Several factors led to the strike, including discrimination by SHA, denial of rights of pre-authorisation, unfair practices in the empanelment of professionals and facilities owned by clinical officers.
Other issues included arbitrary revision of intern payments to the disadvantage of union members, double licensure, where clinical officers are coerced into licensing their facilities with the KMPDC, despite already being licensed by the Clinical Officers Council among other factors.
As the standoff continues, both sides face mounting pressure to resolve the crisis, with patients bearing the brunt of the healthcare system's dysfunction, and pre-authorisation extortion, where specialised clinical officers are compelled to use KMPDC licence numbers from medical officers for pre-authorisation, a practice that is both illegal and extortionate.
Wachira also complains about discrimination by Social Health Authority, beginning with failure to empanel clinical officers and their facilities under the law.
The law dictates that once facilities are registered by the relevant body (like the Clinical Officers Council), SHA is obligated to recognise them by listing them on their website—a process called empanelment.
After empanelment, facilities can contract-, and that MoH would seek the advice of SRC on the CBA. The formula also stipulated that health risk allowance for clinical officers would be considered in the CBA, that MOH would “effect pending merit-based promotion, facilitate promotion as may be applicable,” following KUCO’s submission of a list of clinical officers who were due to promotion.
MOH and Kuco also agreed that the national government would recruit clinical officers subject to availability of resources, that MOH would provide comprehensive medical cover for all actively serving clinical officers in the public sector as from date of signing, that the public service commission had approved career progression guidelines for clinical officers and that MOH had submitted a formal request for renewal of contracts of Covid-19 clinical officers and their confirmation to permanent and pensionable terms, with SHA to provide services.
However, SHA has implemented a policy recognising only facilities registered by the (KMPDC), excluding those registered by the Clinical Officers Council, and thus, excluding clinical officers and their facilities from the SHA system. This prevents clinical officers from seeing patients through SHA, limiting access to care.
The Council of Governors has promised to contract and empanel facilities and practitioners under SHA and the Digital Health Agency, but implementation remains pending. Meanwhile, the strike continues, affecting healthcare delivery across the country.
"We have trained professionals ready to restore vision for thousands of Kenyans suffering from cataracts, yet they are being denied access to the SHA system," Wachira notes.
"People who could be treated today are left to suffer in darkness simply because of bureaucratic bottlenecks and vested interests."
