Governors have rejected a push by the national government to place more than 7,000 Universal Health Coverage (UHC) workers on permanent and pensionable terms, saying counties cannot take on the responsibility without guaranteed long-term funding.
The disagreement has now turned into a major stand-off between the two levels of government, leaving thousands of health workers uncertain about their future.
The Council of Governors (CoG) has accused the Ministry of Health of shifting responsibility to counties without first resolving the question of how the workers will be financed in the years ahead. While the ministry maintains the workers have already been transferred to county governments, governors insist employment cannot proceed until funding concerns are settled.
The latest dispute comes after months of promises by the national government that the workers would finally secure permanent jobs after serving on contract since the Covid-19 period.
Council of Governors Chair Ahmed Abdullahi blamed the national government for the continued uncertainty facing the workers.
"If the national government respected all the agreements that we have heard in respect to UHC workers, there would be no health workers on the street but in hospitals attending to sick Kenyans," said Abdullahi.
"The challenge we are having is that there is a mismatch between the mode of financing and the kind of contract they want us to give the UHC workers."
On July 21, 2026, Principal Secretary for Public Service and Human Capital Development Jane Imbunya informed Medical Services Principal Secretary Ouma Oluga that more than 7,000 UHC workers had already been assigned to county governments and that their payroll records were ready to be transferred.
"This State Department is committed to providing technical assistance to ensure a smooth transition of the UHC staff," Dr Imbunya wrote, adding that it was awaiting county governments to verify and integrate the staff into their payrolls.
Following that communication, PS Oluga directed County Public Service Boards to begin integrating the workers into county payrolls on permanent and pensionable terms.
The directive, however, was immediately challenged by governors.
Mombasa Governor Abdulswamad Nassir, who heads the CoG Health Committee, responded by saying counties could not take over the payroll until all outstanding issues on funding had been resolved.
"We wish to state that the proposed central transfer of payroll is not practical until outstanding matters relating to availability of resources for payment of salaries by county governments are addressed conclusively. Until that is done, migration of payroll data by the Ministry of Health to respective county governments will not be tenable," Nassir wrote.
He further argued that employment decisions fall under County Public Service Boards and cannot be directed through a letter from a Principal Secretary.
"Translating the UHC staff’s terms of service to permanent and pensionable terms remains the mandate of county governments through their respective County Public Service Boards. This mandate cannot be unilaterally exercised by the Principal Secretary through a letter."
The Council has since advised County Public Service Boards not to implement the ministry's directive, widening the disagreement between the two sides.
Although both governments agree the workers should eventually secure permanent jobs, they remain divided over how the exercise should be financed.
Health Cabinet Secretary Aden Duale announced in April that all UHC workers would move to permanent and pensionable terms from July 2026 using funds provided through the Division of Revenue Bill. He also said the Cabinet had approved the plan and that the Salaries and Remuneration Commission had cleared the salary structure.
Governors, however, argue that the money released only caters for one financial year under the County Government Additional Allocation Act, which has not yet been assented to.
"They want us to absorb UHC workers on permanent and pensionable terms, but they have only provided the money for one year under the County Government Additional Allocation Act, which is yet to be assented to," Abdullahi said.
He said counties cannot issue permanent employment contracts while relying on funding that could expire after one year.
"The money is there; they sent Sh9 billion. All we are saying is that instead of giving it to us for one year as a conditional grant, give it through the Division of Revenue Act, which can be amended so that this money is available in coming years. We will then have no issue giving UHC workers permanent contracts," Abdullahi said.
He said counties want the funds moved into the equitable share allocation, arguing that such funding offers long-term certainty.
"We will not allow the PS to intimidate counties by writing letters to us. We are not answerable to them."
The UHC workers were recruited during the Covid-19 pandemic under short-term contracts after the government pledged they would later be employed permanently as Kenya expanded Universal Health Coverage and transitioned from NHIF to the Social Health Authority (SHA).
That commitment has been postponed several times despite repeated assurances.
The workers have been on strike since June 30, 2026, demanding permanent and pensionable employment together with gratuity equal to 30 per cent of their basic salary as promised in 2020.
Abdullahi also spoke about the Kenya Medical Practitioners and Dentists Union's planned strike, saying counties are now ready to implement the doctors' Collective Bargaining Agreement after receiving the required payroll codes.
"Beginning August, we will start paying doctors the CBA rates as agreed. We know there is an element of arrears. We were waiting for a special code from the Ministry of Public Service because it was taking those doctors above what was in the HR system. We have waited one year to allow us to pay the agreed rates. We have obtained it. We will pay it."
He also opposed proposals to return health services to the national government.
"The solution is not to return the health docket to the national government. In any case, national government hospitals are not run any better than county government hospitals. To take health back to the national government requires a referendum, and it is Kenyans who can do that, not us. Let every person keep their part of the bargain, put the money where we have agreed it should be paid, and we will pay the UHC workers."