Nurses Warn of Fresh Strike if Government Delays Implementation of 2017 CBA After 43-Day Walkout
Kenyan nurses have warned that they could return to the streets if the government and county administrations fail to honour the latest agreement on the implementation of their long-awaited Collective Bargaining Agreement, CBA.
The warning comes immediately after nurses called off a 43-day nationwide strike that had disrupted services in public hospitals and placed enormous pressure on Kenya’s already strained healthcare system.
The Kenya National Union of Nurses and Midwives and the Council of Governors signed a Return-to-Work Formula on Wednesday, September 9, 2026, bringing the prolonged industrial action to an end and directing nurses to resume their duties. The agreement gives the parties 45 days to conclude negotiations on the implementation of the 2017 CBA.
The agreement has offered temporary relief to thousands of patients who had struggled to access healthcare services during the strike. It has also given the government an opportunity to address the grievances that pushed nurses to withdraw their services in the first place.
However, the return to work does not mean that the underlying dispute has been permanently resolved.
At the centre of the conflict remains the implementation of the 2017 CBA, an agreement that nurses have been demanding for years. The agreement was reached after an earlier labour dispute but has remained largely unimplemented, with government authorities repeatedly citing financial constraints and other administrative challenges.
For nurses, the latest 45-day window is therefore being viewed as a test of whether the government is finally prepared to translate years of promises and negotiations into concrete improvements in their terms of service.
The threat of another strike is significant because the health sector has barely recovered from the disruption caused by the latest industrial action.
The 43-day strike affected public health facilities across the country, with some hospitals operating below full capacity and relying on alternative staffing arrangements to keep essential services running.
At Mbagathi Hospital, for example, management had brought in qualified locum nurses to help maintain services during the strike, although the facility was operating below its normal human-resource capacity.
The situation demonstrated the central role nurses play in Kenya’s healthcare system.
Nurses are among the largest groups of healthcare workers in the country and are involved in almost every level of patient care. From maternity wards and emergency departments to outpatient clinics, surgical units and community health services, their work is critical to the functioning of public hospitals.
When large numbers of nurses withdraw their labour, the impact is felt almost immediately.
Doctors are forced to deal with increased workloads, patients experience longer waiting times and hospitals struggle to maintain routine services.
The latest dispute has already demonstrated those consequences.
Doctors also warned that they could join the industrial action because the nurses’ absence was placing additional pressure on them. Kenya Medical Practitioners, Pharmacists and Dentists Union Secretary-General Dr Davji Bhimji Atellah said doctors were being overburdened by the situation and could issue a strike notice if the nurses’ grievances were not addressed.
The doctors’ warning added another layer of urgency to the dispute.
A simultaneous strike by nurses and doctors would have placed Kenya’s public healthcare system under even greater pressure, particularly in counties where hospitals already face shortages of personnel, equipment and funding.
The possibility of such a scenario has now been reduced following the return-to-work agreement, but the underlying concerns remain.
The government and county administrations therefore have a limited window to demonstrate that the latest agreement is different from previous commitments that failed to produce the expected results.
Nurses have experienced several rounds of negotiations and return-to-work agreements over the years.
The repeated cycle of strikes, negotiations, promises and delays has contributed to growing frustration among health workers.
For many nurses, the problem is no longer simply about the amount of money they receive.
It is also about trust.
When workers sign agreements with their employers, they expect the commitments contained in those agreements to be implemented within the agreed timelines.
When implementation is repeatedly delayed, confidence in negotiations begins to decline.
That is one of the reasons the 45-day period contained in the latest agreement will be closely watched by nurses and their union.
The Kenya National Union of Nurses has previously insisted that its members would not be satisfied with promises that were not backed by clear implementation measures.
During the previous strike, KNUN Secretary-General Seth Panyako said nurses would continue their industrial action until the 2017 CBA was addressed.
The union’s position reflected the frustration that had accumulated over several years.
The 2017 agreement is not a new demand. It has been part of the nurses’ negotiations with government for years, making the continued delay particularly sensitive.
Nurses have argued that they should not have to repeatedly return to industrial action to secure benefits and improvements that were already agreed upon.
The government and county governments, however, have faced questions over the financial implications of implementing the agreement.
County administrations have previously argued that the demands contained in health-sector agreements have significant budgetary implications and must be considered alongside other competing priorities.
This has created a difficult balancing act for the Council of Governors, which represents the county governments that employ most nurses working in devolved health facilities.
Since healthcare was devolved to the counties, county governments have carried major responsibility for primary and secondary healthcare services.
That arrangement has also created complications whenever national-level labour agreements affect workers employed by county governments.
The nurses’ dispute has therefore involved several institutions, including the unions, county governments, the Council of Governors and the Salaries and Remuneration Commission.
The different responsibilities have sometimes made it difficult to determine who should take the final responsibility for implementing specific aspects of workers’ agreements.
For nurses, however, those institutional complications do not change the reality they face at work.
They remain responsible for treating patients, working long shifts and responding to emergencies.
They have consequently argued that their working conditions and compensation should reflect the importance of their responsibilities.
Another concern raised during the dispute has been the need for improved allowances.
According to reports during the strike, nurses said allowances agreed upon years ago had not been adequately improved and that some payments had accumulated over several years.
These allowances include areas such as risk and uniform-related payments, which nurses argue are connected directly to the conditions under which they work.
A proposed improvement in risk and uniform allowances was among the issues that helped move negotiations forward before the return-to-work agreement was eventually signed.
The latest deal is therefore expected to address several outstanding concerns rather than focusing exclusively on the broader CBA.
The agreement also provides for the development of a model career guideline for nursing personnel within the 45-day period.
Career progression has been another longstanding concern among healthcare workers.
Nurses have complained about delays in promotions, stagnation in certain job grades and unclear or inconsistent career progression structures.
Such challenges can affect morale, particularly among experienced workers who may remain in the same position for years despite acquiring additional qualifications and responsibilities.
A functioning career progression system is therefore important not only for workers but also for the health system itself.
When healthcare workers see opportunities for promotion and professional growth, they are more likely to remain motivated and committed to their institutions.
When those opportunities are delayed, some workers may seek employment elsewhere or become increasingly dissatisfied with their working conditions.
The latest agreement provides an opportunity for the government and county governments to address those concerns alongside the CBA.
But the greatest challenge will be implementation.
The history of the dispute means nurses are likely to judge the government by actions rather than announcements.
The 45-day deadline will therefore become a critical period for both sides.
If meaningful progress is made, the agreement could mark the beginning of a more stable relationship between the nurses’ union and county governments.
If the deadline passes without satisfactory progress, however, the possibility of another confrontation could quickly return.
That is why the warning of a fresh strike should not be dismissed as a routine labour threat.
Kenya’s public healthcare system cannot afford another prolonged disruption so soon after emerging from a 43-day strike.
Patients have already endured weeks of uncertainty, cancelled services and reduced access to healthcare.
Hospitals have also had to deal with the consequences of staff shortages and increased workloads.
The Kenya National Commission on Human Rights previously warned that the nurses’ strike had developed into a national public health and human rights crisis.
The commission reported concerns over deaths during the strike and called for urgent action to protect patients’ rights while also respecting the rights and dignity of nurses.
The commission’s intervention highlighted the difficult balance involved in health-sector strikes.
Nurses have a right to pursue better working conditions and to engage in lawful industrial action, while patients have a right to access healthcare, including emergency treatment.
A prolonged dispute can therefore affect two groups whose interests should ultimately be protected by the same public system.
The challenge for government is to resolve workers’ grievances before they reach the point where patients become caught in the middle.
For nurses, the latest agreement provides an opportunity to demonstrate that their concerns can be addressed through negotiation.
For county governments, it provides an opportunity to show that they can honour agreements entered into with their healthcare workers.
For the national government, the situation presents a broader test of its commitment to strengthening Kenya’s public health system.
Healthcare workers are a critical component of the government’s Universal Health Coverage agenda.
The country cannot expand access to healthcare without sufficient numbers of trained and motivated health workers.
Hospitals require doctors, nurses, clinical officers, pharmacists, laboratory specialists and other professionals to function effectively.
Nurses are particularly important because they provide continuous bedside care and remain with patients throughout much of their treatment.
Any attempt to strengthen healthcare must therefore address the welfare of nurses alongside infrastructure, medicine supplies and equipment.
The government has repeatedly spoken about improving healthcare access, but such ambitions depend heavily on the workers responsible for delivering those services.
The current dispute has therefore raised a broader question about whether Kenya is investing enough in the people who operate its healthcare system.
The financial difficulties facing county governments are real, but labour disputes also carry significant costs.
When hospitals are disrupted, patients may seek treatment in private facilities where they are forced to pay more.
Some may delay seeking treatment altogether.
Others may travel long distances in search of functioning hospitals.
The economic consequences also extend to families who lose income while caring for sick relatives.
A prolonged strike can therefore have effects far beyond the hospital gates.
The government must also consider the cost of repeatedly negotiating the same disputes.
Each strike requires mediation, court interventions, negotiations and eventually another return-to-work agreement.
If the underlying agreements are not implemented, the same cycle can repeat.
That is why the current 45-day period should be used to address the structural issues behind the dispute rather than simply buying more time.
The union and government will need to establish clear timelines, responsibilities and mechanisms for monitoring implementation.
Nurses will also need assurance that the commitments reached at the negotiating table will translate into actual changes in their employment terms.
Transparency will be particularly important.
If certain elements of the CBA cannot be implemented immediately because of financial or legal constraints, the government should clearly explain the challenges and provide realistic timelines rather than allowing another period of uncertainty to develop.
The Council of Governors will also have an important role to play because county governments are directly responsible for many of the nurses affected by the dispute.
The governors cannot afford to treat the latest agreement as simply a temporary arrangement to end the strike.
They will need to work collectively to ensure that individual counties do not move at different speeds in implementing agreed measures.
Uneven implementation could create fresh disputes and undermine the return-to-work agreement.
The nurses’ union, meanwhile, will be expected to monitor progress and hold the government accountable to the commitments made.
The union has already demonstrated its willingness to mobilise members when negotiations fail.
A fresh strike would be disruptive, but the possibility of industrial action remains an important bargaining tool for the union.
The priority, however, should be to prevent the situation from reaching that point.
Both sides have now experienced the consequences of a prolonged dispute.
Nurses have lost income and faced the pressure associated with remaining out of work.
Hospitals have struggled to provide services.
Doctors have faced heavier workloads.
Patients have suffered disruptions.
The government and county administrations have faced increasing public criticism.
There is therefore a strong incentive for all sides to make the latest agreement work.
The return of nurses to hospitals is only the first step.
The more difficult task is ensuring that the grievances that caused them to leave are permanently resolved.
The 45-day period should not be treated as another deadline that can be extended indefinitely.
It should be used to finalise the outstanding CBA issues, clarify the financial requirements and establish a practical implementation framework.
If that happens, the latest agreement could become a turning point in Kenya’s health-sector labour relations.
But if negotiations stall again, nurses could once more find themselves preparing for industrial action.
The warning of a fresh strike is therefore a message to both national and county governments that the return to work should not be mistaken for the end of the dispute.
It is a chance to resolve it.
For millions of Kenyans who depend on public hospitals, that distinction matters enormously.
Patients need to know that when they walk into a public hospital, they will find healthcare workers ready to serve them.
Nurses need to know that when they sign agreements with their employers, those agreements will be honoured.
And the government needs to demonstrate that its commitments to healthcare workers are more than promises made during moments of crisis.
The coming 45 days will therefore be crucial.
The nurses have returned to work, but their grievances have not disappeared.
The government and county governments now have a limited opportunity to demonstrate that the latest return-to-work agreement will lead to meaningful implementation of the long-delayed CBA.
If they succeed, Kenya could avoid another damaging healthcare strike and begin rebuilding trust with one of the most important groups in the country’s health workforce.
If they fail, the country could once again face the prospect of nurses withdrawing their services, hospitals struggling to operate and patients bearing the greatest burden.
For now, the standoff has been suspended.
Whether it has truly been resolved will depend on what happens during the next 45 days.
