From Nurses strike to systematic challenges: What troubles KNH

Dr Lesiyampe, there is relief that nurses are back on duty. Can you confirm the situation on the ground?

I want to confirm that all nurses at KNH resumed duty following the signing of the return-to-work formula yesterday. Services have normalised, and patients are receiving care as expected.

What led to the strike in the first place?

The strike was driven by several issues, most of them historical. Some date as far back as 2017, when a return-to-work agreement included commitments such as uniform allowances, health service allowances, and unrelieved allowances. Unfortunately, some of these were never fully implemented.

There were also concerns about staff employment terms, with some nurses having worked on temporary contracts for years. Workload pressures and burnout were also major concerns. Altogether, there were about seven key issues, even though only five were widely reported.

When you took over as acting CEO, were you aware of these longstanding grievances?

When I came in, I conducted an assessment and identified 44 challenges affecting staff at KNH. I prioritized critical areas immediately, particularly those affecting patient care.

For instance, congestion at Accident and Emergency was a major issue. We expanded oxygen capacity from 32 to 72 points and reorganized patient flow to improve efficiency. We also focused on acquiring essential equipment and addressing financial leakages within the system.

At the same time, I engaged staff directly. I held a meeting with about 2,000 nurses, and one of their main concerns was the need for transparent and competitive appointments. Within two months, we had advertised and filled those positions.

One of the biggest issues raised by nurses is workload. They claim one nurse is handling up to 35 patients. Is that accurate?

That figure is exaggerated. Workload varies depending on the unit. In general wards, the ratio is closer to one nurse to 20 patients. In intensive care units, it can go as low as one nurse to one patient, depending on severity.

However, I acknowledge that we have a staffing deficit of about 400 nurses. This gap becomes more pronounced during surges especially when other hospitals experience strikes and patients flock to KNH.

So the workload problem is real?

Yes, but it’s influenced by broader systemic issues, particularly the failure of the referral system. Ideally, patients should first visit primary healthcare facilities and only come to KNH when referred.

But in reality, many patients bypass lower-level facilities. During crises, such as strikes in county hospitals, we can see double the expected number of patients—for example, handling 80 deliveries a day instead of 40. That inevitably stretches our staff.

What measures are you taking to address this?

We have agreed to recruit additional nurses and healthcare assistants. We are engaging the National Treasury for funding to hire at least 100 more nurses.

In the meantime, we are using locum staff to bridge the gap. We are also introducing healthcare assistants to handle non-clinical duties, allowing nurses to focus on specialized care.

Another major concern is employment terms. What progress has been made there?

We have already secured board approval to transition 601 staff including nurses from temporary contracts to permanent and pensionable terms. This will take effect from July 1, subject to budgetary approvals.

We are also addressing similar issues for medical officers, clinical officers, and laboratory staff who are currently on contract.

Medical cover has also been a contentious issue. What changes are coming?

Previously, staff relied on an in-house medical scheme, which had limitations. We have now secured approval for an external insurance-based medical cover that will allow staff and their families to access healthcare across the country.

This will also take effect from July 1. In the interim, staff are being allowed to access services through the hospital’s private wing.

There have also been complaints about delayed remittances. What is being done about that?

It is unacceptable for staff deductions not to be remitted. We are working to correct this.

However, part of the challenge stems from changes in the healthcare financing system. Previously, hospitals received payments quickly through NHIF or cash. Now, under the Social Health Authority (SHA), payments are centralized and disbursed monthly.

We have adjusted our financial calendar accordingly and engaged banks and SACCOs to ensure staff are not penalized due to delays.

Some nurses also cited lack of consultation over the transition of Mwai Kibaki Teaching and Referral Hospital. What is your response?

That transition is being handled through a structured process. A ministerial committee involving the Ministry of Health, KNH, and the Mwai Kibaki Hospital has completed its report.

The facility has already been elevated to a national referral hospital with its own board and CEO. The transition will take effect on July 1.

We acknowledge that some staff have concerns, especially those who were initially deployed there under KNH. We are committed to engaging them and ensuring a smooth transition.

Let’s talk about equipment and services. There have been concerns about cancer treatment capacity.

We have made significant progress. One LINAC machine has already been repaired and is operational. Another is on its way from Mombasa, and Parliament has approved funding for a third.

Ideally, we need four machines to adequately handle the cancer burden, which currently stands at about 45,000 new cases annually.

What about access to medication, especially for cancer patients?

Cancer treatment requires a wide range of drugs, sometimes up to 50 different types. It is not always easy to have all of them in stock.

To address this, we are exploring partnerships with private pharmacies within the hospital’s private wing. This will ensure patients can access drugs that may not be available in the public system.

We are also working closely with KEMSA to improve supply consistency.

The big question remains: why should nurses trust that this agreement will be honoured?

I understand their concerns. Trust has been eroded over time due to unfulfilled promises.

But what is different now is that we have already taken concrete steps board approvals, budget allocations, and clear timelines. Promotions will be effected by May 30, and most other commitments will be implemented by July 1.

We are not just making promises we are following due process to ensure delivery.

What is your long-term vision for KNH?

KNH is one of the largest referral hospitals in Africa. We have the expertise, the specialists, and the capacity to deliver world-class care.

Our focus is on digitization, improving efficiency, strengthening the referral system, and ensuring staff welfare. If we address these areas, we can transform KNH into a truly modern healthcare institution.

As nurses return to their stations and patients stream back into wards, the spotlight now shifts to implementation. For many healthcare workers, this is not just another agreement—it is a test of whether Kenya’s public health system can finally break the cycle of crisis and response, and build lasting trust.