Somewhere in Murang'a, Meru or Machakos, a mother who will need a caesarean section in late November has no idea that her operation may now depend on what appears on a doctor's payslip.

On Wednesday, the Kenya Medical Practitioners, Pharmacists and Dentists Union issued a 21-day strike notice to 17 counties, The Star and Kenyans.co.ke report. Unless the basic salary adjustments agreed after the 2024 doctors' strike appear in doctors' payslips, the union says its members in those counties will down tools on November 25. "We are not ready for any negotiations," secretary general Davji Atellah said, according to The Star.

This is not a fight over money that does not exist

What makes this dispute so frustrating is that, on the union's account, the hard part is done. The adjustments come from a return-to-work formula signed on May 8, 2024 and adopted as a court order the same day. At a meeting on July 22, 2026, counties committed to implement them, and the Council of Governors confirmed that all 47 had received the funds, released across the 2025/2026 and 2026/2027 financial years, the union says.

Thirty counties have complied. The 17 that have not are Murang'a, Nyandarua, Nyeri, Kirinyaga, Kiambu, Lamu, Taita-Taveta, Tana River, Machakos, Makueni, Laikipia, Narok, Kajiado, Embu, Isiolo, Meru and Vihiga, as listed by The Star and People Daily.

Some governors argue that they need approvals before changing pay. Murang'a Governor Irungu Kang'ata has said counties cannot process increases without clearance from the Salaries and Remuneration Commission, People Daily reports. That is a fair procedural point, but it raises a simple question: if 30 counties found a way to comply with a court-backed agreement, why could the other 17 not?

Patients always pay the price

Kenya has been here too many times. The 2024 strike, which the court-backed formula was meant to end, kept patients waiting for weeks. Every strike pushes the poor towards private clinics they cannot afford, delays surgeries and costs lives that never make the news.

Doctors are not blameless in every dispute, and a flat refusal to talk can harden positions. But in this case the union is asking for one thing: that counties honour what was signed, ordered by a court, and funded.

What should happen before November 25

  • Each of the 17 governors should publish, this week, how much they received for the adjustments and where that money is now.
  • The Council of Governors should set a compliance deadline well before the strike date, instead of waiting for the walkout.
  • County assemblies should summon health executives and finance officials to explain the delay in public.
  • Where SRC approval is genuinely the hold-up, the SRC should say so openly and clear it fast.

Health is devolved because counties promised to run hospitals better than Nairobi did. Honouring a funded, court-backed agreement is the least that promise demands. Patients in these 17 counties deserve to know, before November 25, whether their governors intend to keep it.

Photos: George Oyunge via Kenyans.co.ke; KMPDU/X via The Star. Thumbnail design: HAMASTA MEDIA.