Bone of contention between union, ministry and counties

For 73 days, doctors across the country have been agitating for the implementation of a collective bargaining agreement that was signed in 2013.

Wananchi might try to wrap their head around the contentious CBA, which was meant to have been registered in a court of law giving it a green light to be implemented.

The CBA is simply a 27-page document with nine articles that in a nutshell address doctors’ concerns on their pay, allowances, medical interns, working conditions among other things.

In particular, the CBA directly addressed under staffing, with the Health ministry asked to employ at least 1,200 doctors per year for the next four years.

It was signed by a government representative, Mr Mark Bor, who was the Health Permanent Secretary while the Kenya Medical Practitioners Pharmacists and Dentist Union (KMPDU) representative was Dr Sultani Matendechero, the then union secretary-general of the union. Dr Victor Ng’ani, who was the chairman of KMPDU, was the witness.

However, even as the three appended their signatures on the document, there were some articles that were not agreed upon by either parties such as doctors job groups, residency positions (masters medical students), and on the entry grade for interns.

These concerns were to be ironed out and then the CBA would be deposited to the Industrial Court for registration.

Once registered, the CBA binds parties to comply with the commitments therein. Failure by either party can give rise to a trade dispute which can only be dealt with in accordance with the provisions of the Act.

The Labour Relations Act requires that such agreements be registered with the court, but to date it had not been done by either the government or the KMPDU.

With the latter insisting it was the responsibility of the employer—the government—to see that it was registered.

But this did not happen and on June 23, 2015, the doctors moved to the Employment and Labour Relations Court to compel the government to honour the CBA by having it registered in court. But this did not yield much as the CBA was never registered.

In the preceding days, the government, specifically counties said they were not party to the signing of the agreement and as such could not implement it unless a new one was drawn up that would factor them in.

The national government on its part maintained that the CBA did not comply with the guidelines of the Salaries and Remuneration Commission on public servants pay scales and implementing it as is, would be too costly for the public wage bill to handle.

The doctors have said the public coffers would spend about Sh8.1 billion to implement the CBA annually but the government gave them a 40 per cent deal which would cost on or about Sh4 billion to roll out.

It is the failure of this registration and ultimately, its implementation that the public health sector is reeling from the brunt of the 73-day-old strike whose end is uncertain.


How did we get here?

What: The 27 pages Collective Bargaining Agreement between the Ministry of Health and the Kenya Medical Practitioners, Pharmacists and Dentists’ Union was signed on June 28, 2013. It came into effect on July 1, 2013.

Objective: To “promote industrial relations, the economic well-being of the workers and the employer and overall improvement of healthcare delivery in the public sector…. In the interest of the health of the Kenyan people.”

Some of the issues the union wanted addressed in the 2013 CBA:

1. Job Groups: The union wanted intern doctors to be at Job Group M up from the current Job Group L: This was not worked on. Then they were to progress to Group N as medical officers upon completion of internship. However, the ministry said the interns shall continue to enter the service at Job Group L and an evaluation for the job upgrade by the Ministry of Devolution and Planning and the Public Service Commission. This was to be revised by January 2014.

2. Promotions: Promotion would be based on merit, and would apply if a doctor serves in the same job group in three years within the same establishment. “Any doctor who shall require additional training, except masters programmes, prior to promotion shall be facilitated and sponsored.” The ministry was to increase job groups to accommodate these promotions.

3. Transfers: “A doctor shall not be transferred by the ministry more than once within a period of two years unless under exceptional circumstances or following a promotion. In the event of a transfer, the doctor shall be paid a transfer allowance. Such transfers shall be genuine with regard to service need or own request.”

4. Training, Development and Research: The union called for continuous professional development aligned to the realisation of Vision 2030. “These trainings shall be available locally and internationally. The training budget shall be one per cent of the recurrent budget of the ministry.

Doctors employed by the government shall be eligible for full sponsorship to post graduate training after completing two years of service after internship. During these training, they shall continue to earn their monthly salary and all allowances. After their training, they shall be bonded. All doctors shall be facilitated to undertake at least one short course on life supported courses per year for a maximum of 5 days.”

5. Research Fund: “A non-remunerative Medical Research Fund which will be used to carry out medical research which shall be disbursed to consultants upon submitting a proposal.”

6. Medical Internship: “Doctors’ interns shall be posted to respective stations within 90 days after completion of studies. The internship can be extended with full salary provided it did not arise from disciplinary action.” The union and the ministry was to develop an internship policy.

7. Remuneration: “Basic salary should include allowances such as house, commuter, medical risk, extraneous, and responsibility allowance for those with administrative roles. Working hours shall be 40 hours a week and extra hours shall be compensated. Each facility shall have a doctor’s room which shall be adequately furnished with a computer, internet access, lounge chairs, and a television set.”

Each doctor in whichever facility was to be reasonably equipped with the tools and equipment necessary for the performance of their job. “Where doctors are expected to attend to calls at night, they shall be provided with transport and security to and from the hospital where necessary. To address under staffing, the ministry shall employ at least 1,200 doctors per year. Doctors are entitled to health insurance, annual leave, mortgage and car loan.”

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Inside the doctors’ agreement that has wreaked havoc