Patients in public hospitals across 17 counties could find no doctor on duty from November 25 after the Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) served a 21-day strike notice over salary adjustments it says counties have already been paid for.

KMPDU Secretary General Davji Atellah issued the notice in Nairobi on Wednesday, saying doctors would down their tools unless the outstanding adjustments appear in their payslips before the deadline expires.

"Today, November 4, 2026, we issue a 21-day strike notice to these 17 counties that have not implemented basic salary adjustment," Atellah said.

The counties on the list

According to the union, the counties that have not complied are:

  • Murang'a, Nyandarua, Nyeri, Kirinyaga and Kiambu
  • Lamu, Taita-Taveta and Tana River
  • Machakos and Makueni
  • Laikipia, Narok and Kajiado
  • Embu, Isiolo, Meru and Vihiga

The union says the other 30 counties have already implemented the changes.

Why the doctors say talking is over

The adjustments are part of the return-to-work formula signed on May 8, 2024, which ended that year's nationwide doctors' strike and was adopted as a court order on the same day.

Atellah said the Council of Governors directed counties to implement the adjustments at a meeting with the union on July 22, 2026, and that the council confirmed all 47 counties had received the money. The funds, he said, were released across the 2025/2026 and 2026/2027 financial years. Counties that had not acted by the end of October were warned they would face action.

An audit by the National Advisory Council, discussed at a meeting on October 16, then found the 17 counties still had not moved.

"We are not ready for any negotiations... County governments must honour their commitments as healthcare cannot operate on broken agreements," Atellah told journalists. The union also warned county officials against trying to strike separate deals with its branch leaders or county liaisons during the notice period.

Governor points to SRC and payroll codes

Murang'a Governor Irungu Kang'ata, whose county is on the list, defended the delay in a radio interview on Wednesday. He said counties cannot raise salaries on their own because a national payroll system now covers county workers, and changes require codes from a ministry in Nairobi that cannot be issued without the Salaries and Remuneration Commission's approval.

"We can only increase our salary upon the gazettement and the advice of the Salaries and Remuneration Commission," Kang'ata said.

The standoff leaves counties with three weeks to either find a way through the approvals or face a walkout that would hit outpatient clinics, theatres and maternity wards in some of the country's busiest regions, including Kiambu, Machakos and Meru.

Photos: Kenyans.co.ke/KMPDU (KMPDU leaders leading a doctors' strike march); People Daily/@HonKangata on X (Murang'a Governor Irungu Kang'ata). Thumbnail design: HAMASTA MEDIA.