A New Standoff Over Kenya's UHC Workforce
A renewed disagreement between Kenya's national government and county governments has placed more than 7,000 Universal Health Coverage (UHC) workers at the center of a growing employment crisis. What began as an effort to transition these healthcare workers into permanent and pensionable employment has evolved into a dispute over constitutional mandates, financing, and accountability.
While both levels of government agree that the workers play a critical role in Kenya's health system, they remain divided over who should employ them, how their salaries should be financed, and whether counties have sufficient long-term funding to absorb them.
The continued uncertainty has left thousands of healthcare workers frustrated after nearly six years of waiting for job security, while public health facilities risk staffing disruptions if the impasse is not resolved.
Who Are the UHC Workers?
The Universal Health Coverage workforce was recruited during the COVID-19 pandemic to strengthen healthcare delivery across Kenya.
These professionals include:
- Nurses
- Clinical officers
- Laboratory personnel
- Public health officers
- Pharmaceutical technologists
- Nutritionists
- Other frontline healthcare workers
Since their recruitment, they have become an essential component of healthcare delivery, especially in county hospitals and primary healthcare facilities where staffing shortages have persisted.
Their contribution extends beyond emergency response, supporting maternal health services, child immunization, disease surveillance, outpatient care, and community health programmes.
The Promise of Permanent Employment
When the UHC programme was launched, healthcare workers were assured that their contracts would eventually be converted into permanent and pensionable employment.
Over the years, several government announcements renewed that commitment.
Earlier this year, the Ministry of Health announced that the transition would begin in July after Cabinet approval and the development of a financing framework. This created renewed optimism among workers who had spent years on short-term contracts.
However, implementation has stalled as disagreements emerged between the Ministry of Health and county governments over how the transition should be funded and managed.
Why Governors Are Opposing the Current Plan
The Council of Governors maintains that county governments are not opposed to employing UHC workers permanently.
Instead, governors argue that the current financing model exposes counties to long-term financial obligations without guaranteed funding.
Their main concerns include:
- Counties have only been allocated funding for a limited period.
- Permanent employment creates obligations that extend for many years.
- Future funding is uncertain if allocations remain conditional.
- County governments cannot legally commit to permanent employment without sustainable financing.
Governors have therefore called for the funds to be incorporated into counties' equitable share rather than relying on conditional grants that may be withdrawn in future budget cycles.
Ministry of Health's Position
The Ministry of Health has maintained that the transition process should proceed so that healthcare workers receive the employment security they have awaited for years.
Government officials have indicated that payroll information has already been prepared for transfer to county governments and that technical support is available to facilitate the migration process.
The Ministry believes the transition is necessary to stabilize Kenya's health workforce and strengthen Universal Health Coverage implementation across all counties.
Constitutional Questions at the Centre of the Dispute
Another major issue concerns constitutional responsibility.
County governments argue that employment decisions involving county staff fall under County Public Service Boards.
Some governors have questioned whether national government officials can instruct counties to absorb employees without formal consultation and adequate financial arrangements.
This has transformed the issue from a labour dispute into a broader debate about the relationship between the national and county governments under Kenya's devolved governance system.
Why Funding Remains the Biggest Challenge
The central disagreement revolves around one question:
Who will guarantee long-term funding?
Governors argue that:
- Salaries must be paid every year.
- Pension liabilities continue indefinitely.
- Counties require predictable budget allocations.
- One-year funding commitments are insufficient for permanent employment.
Without a sustainable funding framework, counties fear they could inherit financial obligations that exceed their available resources.
The Human Impact
Beyond policy disagreements are thousands of healthcare workers whose lives remain on hold.
Many have:
- Worked continuously for six years.
- Served during the COVID-19 pandemic.
- Delayed career and financial decisions while awaiting confirmation.
- Experienced repeated extensions of temporary contracts.
The prolonged uncertainty has affected morale, career progression, financial planning, and confidence in government commitments.
Potential Effects on Healthcare Services
If the deadlock continues, Kenya's health sector could experience:
- Increased staff shortages.
- Reduced healthcare service delivery.
- Longer patient waiting times.
- Higher workload for permanent employees.
- Lower staff motivation.
- Disruptions to Universal Health Coverage implementation.
Primary healthcare facilities, which depend heavily on UHC staff, may be particularly affected.
Why the Issue Matters to Every Kenyan
Although the dispute concerns employment, its consequences extend far beyond the affected workers.
A stable healthcare workforce directly influences:
- Access to healthcare.
- Maternal and child health services.
- Disease prevention programmes.
- Emergency response.
- Rural healthcare delivery.
- Achievement of Universal Health Coverage goals.
Every delay in resolving the dispute increases uncertainty for both healthcare workers and patients.
Possible Solutions
Health policy experts suggest that a lasting resolution could include:
- Sustainable multi-year funding through the national budget.
- Clear agreements between national and county governments.
- Respect for constitutional roles under devolution.
- Transparent payroll transition mechanisms.
- Continuous consultation with healthcare worker representatives.
- Long-term workforce planning.
Collaboration rather than confrontation will be essential to protect both workers and public health services.
Looking Ahead
The future of more than 7,000 UHC workers remains uncertain, but the need for a lasting solution has never been more urgent.
Both the national government and county governments share responsibility for ensuring that Kenya's healthcare system remains functional and adequately staffed. Resolving this dispute will require cooperation, sustainable financing, and respect for the constitutional framework governing health services.
For thousands of frontline healthcare workers who have served the country through one of its most challenging public health periods, a clear and lasting employment solution would provide long-awaited stability while strengthening Kenya's journey toward Universal Health Coverage.
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