Kenya’s Healthcare Meltdown: Austerity, Job Cuts, and the Fight for Worker Dignity
UHC Staff during one of their industrial actions
Introduction: “We Won’t Be Dumped” – Health Workers Push Back Against Job Losses
In a country that once promised universal health coverage for all, over 8,000 health workers in Kenya now stand on the edge of joblessness. From nurses to lab technicians, these frontline workers were hired under the government’s flagship Universal Health Coverage (UHC) programme. But now, with shifting responsibilities and shrinking budgets, their jobs and the nation’s fragile healthcare system are in peril.
As the national government plans to offload payroll responsibilities to cash-strapped county governments, health workers are being forced to fight for their livelihoods, with the Kenya Union of Clinical Officers (KUCO) and the Kenya National Union of Nurses (KNUN) calling the move a betrayal of the very people who kept the country alive during the pandemic and beyond.
“We will not be dumped,” one health worker shouted during a recent protest in Nairobi. “We shall fight to the end.”
This is not just a bureaucratic dispute. It’s a class struggle unfolding in white coats, exposing the structural neglect of healthcare workers across Africa under austerity regimes and donor-driven health reforms.
For decades, international donors and financial institutions have shaped health systems across the continent through conditional funding tied to efficiency, cost-cutting, and vertical, disease-specific programs. While these reforms have led to targeted gains such as in HIV/AIDS treatment, they have often undermined comprehensive, public health infrastructure by prioritising short-term metrics over long-term resilience. This has left frontline workers overstretched, underpaid, and politically sidelined, as governments adopt externally driven models that fragment care, limit state responsibility, and sacrifice labour rights in the name of “sustainability.”
The Numbers Behind the Crisis
As of July 2024, the national government is shifting payroll responsibility for UHC staff to counties, despite no clear assurance of additional funding. County administrations, already overwhelmed, have warned they cannot absorb the costs without new budget lines.
The looming layoffs could affect over 8,000 workers, disrupting service delivery in facilities that are already overstretched. A KSh46 billion (USD 350 million) shortfall in the national health budget has further complicated the crisis, threatening not only salaries but essential services like HIV, TB, and maternal health care .
The roll-out of the new Social Health Insurance Fund (SHIF), meant to replace the old NHIF system, has introduced further chaos. Clinics report that patients are being turned away due to confusion and delays in fund disbursement, while healthcare workers say they’ve been left in the dark about what the new system means for their employment terms.
Power, Austerity, and the Price of Donor Dependency
At the heart of this crisis lies the failure of Kenya’s neoliberal development model; one that relies on donor funding, decentralisation without resources, and top-down reforms that ignore frontline realities.
According to ActionAid, austerity measures imposed through international lending agreements are directly undermining the capacity of African governments to pay teachers, nurses, and civil servants . In Kenya, the reduction of donor support for critical health programmes has left gaps that neither the national nor county governments are prepared to fill.
This tension between state commitments to global financial institutions and local obligations to workers and patients is playing out in clinics and hospitals every day. Health workers have become collateral damage in a battle they did not start.
Unions Fight Back: Labour’s Role in Defending the Public Health System
Health worker unions, particularly the Kenya Union of Clinical Officers (KUCO), the Kenya National Union of Nurses (KNUN), and the Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU), have been vocal in their rejection of the layoffs and have demanded that the government either retain the workers on national payroll or provide full budgetary allocations to counties. These unions, which represent clinical officers, nurses, and doctors respectively, have long been at the forefront of advocating for the rights and welfare of healthcare professionals across the country.
Their advocacy goes beyond wages. Unions are insisting on:
Clear terms of service under SHIF.
Consultation in the design of healthcare reform.
Job security and protection for UHC health workers.
An end to austerity-driven budget cuts in the sector.
These unions represent thousands of healthcare professionals, most of whom work in precarious conditions, without permanent contracts, pensions, or legal protections.
Across Africa, similar struggles are underway. In Zambia, nurses have protested salary delays and unpaid overtime. In Nigeria, midwives recently threatened to strike over insecurity in rural health posts. And in Ghana, public health unions are resisting a hiring freeze imposed through an IMF loan agreement.
The message is clear: Africa’s healthcare workers are under siege; not only by viruses but by policies that devalue their lives and labour.
Conclusion: Protect the Workers, Protect the System
Kenya’s health crisis is not just about numbers, it’s about whose lives matter in policy decisions, and whether workers can expect dignity in the very systems they uphold.
If frontline health workers are expendable, then so too is the promise of universal health care. The fight for job security, decent work, and fair treatment in healthcare is a fight for the soul of public service itself.
As one Nairobi nurse put it during a recent protest, “We are not asking for handouts. We are asking to be treated like human beings. Like workers. Like the backbone of the health system we are.”
References
The Africa Report. (2025). Kenya faces health sector meltdown as job cuts loom. Link
Who Owns Africa. (2025). Kenya’s health sector in turmoil: Job cuts and system failures. Link
ActionAid. (2024). Austerity in Africa: Cuts to education and health. Link
AllAfrica. (2025). Kenya: Health budget shortfall threatens HIV and TB services. Link