HISTORY OF THE PAY OF THE MEDICAL OFFICER INTERN AND THE MEMBER OF PARLIAMENT – #PAYMEDICALINTERNS

1963 – 1969
In 1963 Kenya got its independence from the British. In 1969 the President of Kenya, Mzee Jommo Kenyatta, the founding father of the nation ordered The Nairobi University to start training medical students. Previously doctors were coming from the Makerere University in Uganda.

1971
In 1971 the pay for medical officer interns was relatively modest. The role, however, was highly prestigious, and remuneration primarily aimed to cover basic living expenses. Nevertheless in 1971 there was a doctors strike where the government clamped down on doctors. The strike was at Kenyatta National Hospital. This wa the first outward expression of dissatisfaction of doctors with the government on matters health and doctors welfare. Dr J Aluoch the famous chest physician was a young doctor then working at KNH. He was thrown into Langata holding area for a whole weekend. He reports that in Langata they were treated well. The doctors who were thrown into Kamkunji and industrial area cells were not so lucky. They had to use a pail as a toilet and empty it often. The Kenya Medical Association (KMA) Lawyer, Makacha bailed out all the doctors who were guests of the state the next Monday morning.

In 1971 the gross pay of a Member of Parliament of Kenya was about KES 2,500 per month. At the time, this was considered a substantial salary, reflecting the relatively low cost of living and limited government resources.

1978
In 1978 President Jomo Kenyatta died and President Daniel Arap Moi took over as the second president of Kenya. In 1982 there was an attempted coup in Kenya that failed.

1982
In 1982 there as The gross pay of medical officer interns was still modest. So low was the doctors’ pay that it became necessary to supplement income by doing part-time private practice.

On the other side the gross pay of MPs had doubled to KES 5,000 per month. The increase was primarily due to inflation and adjustments to match rising living costs, although it remained modest compared to other countries.

1990s
In the 1990s, Kenyan medical interns generally earned modest stipends rather than full salaries. Their salaries in 1994 were even lower, reflecting the economic challenges in Kenya during that period. The health system in the public sector had been deteriorating and in 1994 a full strike was called. Doctors also began the push for a union asking that the governent should register KMPDU. The doctors were sacked and this strike was never called off. The government clamped down on doctors and many left to the universities, private sector and other countries especially down south.

On the other side, in 1994, MPs in Kenya earned relatively high salaries compared to most public sector workers. By the late 1990s, MPs were already earning substantial allowances and benefits. For example, MPs were known to receive high transport and sitting allowances alongside their base salaries, which were significantly higher than those of medical interns and other civil servants.

The Constitutional Amendment No. 3 of 1999 created the Parliamentary Service Commission strengthening the independence of Parliament and enhanced oversight, representation and law-making capacity.

2001
In the year 2001 KMA approached President Daniel Arap Moi at a Medical Camp in Kabarnet and asked him to look into the poor remunerating doctors. Dr Nyikal asked the President to pay doctors well, commensurate to the work they do and the challenges they faced. He emphasized that the work in the medical field is unique. The President was afraid that increasing the salaries of doctors would have a fiscal ripple effect on the economy because doctors were in the PSC civil service structure. He declined. He asked doctors to go down South as there were many opportunities there.

It was at this point that KMA began to push for a health service commission because, despite the unique circumstances faced by persons working in the healthcare space, the rigid public service structure did not cater for this uniqueness. A proposal was made to the constitutional review process that had started, famously called the Bomas Draft.

As an immediate short term measure, the KMA executive then set to look for immediate alternative ways in which the pay of doctors and indeed other health personnel could be improved to cater for their prevailing difficult circumstances. KMA NEC then with Dr James Nyikal as its chair tasked Dr Elly Opot Nyaim to draft a document that the Ministry of Health would adopt to increase doctors pay, without rattling the Public Service wage bill. KMA’s document proposed payment of allowances for unique areas faced by doctors, without changing the basic pay. The document was adopted and Kenyan doctors working in the public sector then started receiving several allowances in addition to their basic salary. These allowances were critical in enhancing their overall compensation and addressing the unique challenges of their profession. Some key allowances include:
1. Non-Practice Allowance (NPA)
This compensates doctors for forgoing private practice to work in the public sector. It is a significant part of their remuneration and is protected by collective bargaining agreements (CBAs). The amounts paid though were still low as compared to what was paid in the private sector.
2. Risk Allowance
Doctors are exposed to various health risks in their line of work, such as handling infectious diseases. The risk allowance is designed to mitigate this by providing additional financial compensation .
3. Extraneous Allowance
This allowance covers the demanding and irregular working conditions that many doctors face, such as long hours and working in remote or underserved areas .
4. Call Allowance
Doctors who are required to be on call, especially those in emergency or critical care units, receive this allowance to compensate for their availability outside regular working hours .
5. House Allowance
To address accommodation needs, doctors receive a housing allowance. The amount varies based on the region and job group .
6. Commuter Allowance
This allowance helps cover transportation costs to and from work, particularly for doctors working in urban areas .
7. Leave Allowance
Paid annually, this allowance supports doctors during their leave periods, ensuring they maintain a stable income even when taking time off .

2002
In 2002 President Mwai Kibaki was elected the 3rd President of the Republic of Kenya by popular vote.

By 2002 the salary for medical officer interns ranged between KES 30,000 and KES 50,000, reflecting inflation adjustments and government restructuring doctors pay in line with the Kenya Medical Association proposal.
In 2002 the gross pay of an MP was about KES 250,000 per month.
This significant jump reflects economic growth and the increasing importance of parliamentary roles in the new multiparty system established in the 1990s.

By 2004 The Kenya Medical Association had managed to get the Health Service Commission into the Bomas Draft of the new Kenya Consititution.

2005
By 2005 the pay of of medical interns had improved slightly, ranging between KES 40,000 and KES 60,000, as the government began addressing a shortage of healthcare workers by making medical training more attractive. Doctors though had no car loans nor medical insurance. They had a meagre medical allowance. The gross pay of Members of Parliament was around KES 400,000 per month, including allowances. MPs also received generous benefits such as car loans and medical insurance, making the position highly sought after.

2010
In 2010 the new constitution was promulgated. The Health Service Commission that had been placed in the consitution by Kenya Medical Association was unfortunately relegated from being in the commission, to a commission that could be brought back to the constitution via an Act of Parliament within 3 years of the promulgation.

2011
In 2011 in line with the newly found constitutional freedoms the Kenya Medical Practitioners Pharmacists and Dentists Union (KMPDU) was officially registered. The basis of its formation was that medical students who had completed medical school found the remuneration for doctors ridiculous in light of the prevailing harsh economic times viz-a-viz the work that doctors do and also compared with what other professionals were earning in the private sector. KMPDU’s strike under the chairmanship of Dr Victor Ngani, a private practitioner, increased the pay of all doctors in public sector by KES 60,000. This was after President Mwai Kibaki instructed the then minister of Finance, Hon. Uhuru Kenyatta to enter into a deal with the doctors to end the strike.

In 2011 the gross pay for MPs was KES 851,000 per month, inclusive of allowances.
The Salaries and Remuneration Commission (SRC) was established during this period to regulate salaries, though MPs continued to negotiate for higher allowances and benefits. Because the pay of SRC commissioners was also subject to parliament, SRC was arm twisted to move away from its primary role which was to SET salaries of MPs. Instead they started trying to regulate the salaries of all other public officers while allowing MPs to determine their pay. SRC became a barrier to collective bargaining in a sense. At one time I suggested that we should replace the SRC with a Health Service Commission because it became captive of the executive.

2013
In early 2013 President Uhuru Kenyatta was elected President of the republic of Kenya under a new devolution dispensation. 47 county governors were also elected. Health workers were hurriedly devolved in a fashion that led to three court cases challenging the devolution of health workforce and many health workforce strikes.

2017
In 2017 many Governors lost their offices for mismanaging health workforce. The Jubilee Government also faced tough opposition, health being one of the matters that the populace was unhappy with.

By 2017, intern salaries were set at approximately KES 120,000 to KES 140,000. This reflected ongoing collective bargaining negotiations and inflation, as well as increased public scrutiny over healthcare service delivery.

In 2017 there was a hundred-day doctors strike. The doctors were protesting the failure by the government to honor the CBA signed in 2013. Following many nights of negotiations by the KMPDU national executive, In 2017 medical officer interns were etched in the Collective Bargaining Agreement (CBA) between KMPDU and 48 governments. They were to earn the basic salary of a civil servant in Job Group L, and the allowances that doctors earn as per the CBA. This was put in the CBA and deposited in court. After the strike the interns gross pay, depending on the house allowance was about KES 185,000 to 205,000.

At the same time in 2017, the gross pay of MPs was about KES 1.2 million per month, inclusive of allowances and benefits like car grants and sitting allowances Kenya’s MPs were among the highest-paid globally, despite public criticism over the widening income inequality.

2019
From 2019 the allowances have been a point of contention between the government and doctors, particularly when proposals to reduce or abolish certain benefits arise. The Salaries and Remuneration Commission (SRC) has faced pushback from medical unions like the Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU), especially regarding attempts to review or abolish the non-practice allowance. The court sided with the doctors.

2022
In 2022 August the Kenya Kwanza (KK) Government was elected on the backdrop that it would improve the lives of Kenyans. The catchy frace of Bottom-Up-Economic Transformation Agenda (BETA) spoke to the heart of Kenyans at least at the ballot. The reality for doctors was though very different.

The Health Service Commission that had been aptly captured in the KK manifesto has not yet materialized. KMA had proposed this as a way forward to the difficulties faced by human resources for health. Instead the government chose to go with the Kenya Health Human Resources Advisory Council (KHHRAC) that has not been seen to be effective in sorting out HR issues in the health sectors.

The ineffectiveness of KHHRAC was evident when the Ministry of Health reallocated the health budget that was meant for medical interns to other ‘priorities’. To add insult to injury they asked the CS of Health to write to SRC to rubber stamp a proposal to pay medical interns a stipend of KES 70,000, going against the previously established practice of paying medical interns a salary as protected in the CBA. Unfortunately the SRC, in a record 24 hours, gave an interpretation that seemed to suggest that MOH could actually disregard the CBA. The speed of advice and personnel giving the advice pointed to a collusion between MOH and SRC. This marked a significant reduction from the previously negotiated KES 200,000, sparking protests and concerns among interns and healthcare stakeholders. In 2024, the gross pay was set at a maximum of KES 70,000 following a court ruling that upheld the Salaries and Remuneration Commission’s (SRC) directive. Ironically the courth though asked the Ministry of Health to enter into collective bargaining with the doctors.

Remarks by the CS Health on medical interns and doctors generally did not go down well with the medical fraternity and it was only a matter of time that the CS Health was shown the door following industrial action by the doctors in Kenya protesting the mistreatment of medical interns.

At the same time the gross pay of MPs was set at KES 725,502 per month. This amount consists of a basic salary of KES 435,301, a house allowance of KES 150,000, and a market adjustment of KES 140,201. With additional benefits like committee sitting allowances, car maintenance, and mileage claims, MPs can earn over KES 1.5 million per month .

Over time, MPs in Kenya have enjoyed consistent salary increases, often outpacing the growth of wages in other sectors, leading to criticism regarding the equity of these increments compared to the earnings of civil servants and the general workforce. This imbalance in remuneration has contributed to ongoing debates about wage disparities and the need for equitable pay structures across different sectors in Kenya.

All in all the Kenya Kwanza government became the first government in independent Kenya to guillotine the pay of medical interns, a cadre of staff who work harder that Members of Parliament. The Kenya Kwanza government is thus changing the practice of medicine where the medical profession will be forced to put medical interns on shifts, remove calls, allow them to engage in private practice and not to come to work if they feel tired. Over the years this has formed some basis for the training of interns. The medical profession intends to produce doctors who are capable of accurately diagnosing and treating. The Kenya Kwanza policies are a danger to this. We must refuse and ask the Parliament and the President to #PayMedicalInterns their due.

Dr Simon Mucara Kigondu
Past Medical Intern
President Kenya Medical Association