A weary physician at a county referral hospital logs into their banking portal, expecting the long-promised salary adjustment to be reflected in the March payroll. Instead, they find the same figure they have seen for months, coupled with a cryptic note citing a bureaucratic dispute over "overpayments." It is a scene playing out across Kenya, where the promise of standardized compensation has collided with the impenetrable wall of county administration.

The Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) has launched a stinging rebuttal against the narrative emanating from various county governments. The union asserts that the vast majority of doctors in the devolved units remain underpaid, trapped in a cycle of administrative errors and stalling tactics that have turned legitimate salary adjustments into a volatile, multi-year conflict. At stake is not merely the financial stability of thousands of medical professionals, but the operational continuity of a healthcare system already strained by staffing shortages and recurring industrial actions.

The Anatomy of the Overpayment Paradox

At the heart of the dispute lies a fundamental disagreement over payroll calculations. While county administrators have flagged certain payments as "overpayments," the KMPDU has dismissed these claims as mathematically flawed and strategically designed to obfuscate the reality of outstanding arrears. According to the union, the confusion arises from a systemic inability to correctly reconcile basic salary adjustments with the accrued interest and annual increments mandated by the 2020 Employment and Labour Relations Court (ELRC) judgment.

KMPDU Secretary General Dr. Davji Atellah has been categorical in his assessment of the situation. Following a tense two-day consultative meeting with the Principal Secretary for Public Service, Jane Imbunya, the union leadership reiterated that approximately 95 percent of doctors across the 47 counties are still waiting for their full dues. The union argues that the "overpayment" narrative is an interpretation that ignores the legal weight of the court-mandated adjustments, effectively treating legitimate entitlements as administrative mistakes.

• Initial Gross Estimate: KES 450 million.
• Revised Estimate (Post-February 2026 circular): KES 330 million.
• Primary Dispute: Inclusion of annual salary increments in arrears computation.
• Regulatory Stance: SRC directive of March 10, 2026, mandates immediate implementation of adjustments.

A Regulatory Maze of Conflicting Directives

The implementation of salary adjustments has been hampered by a disjointed regulatory environment. The Salaries and Remuneration Commission (SRC), the body tasked with providing advisories on public sector pay, issued a fresh directive on March 10, 2026. This instruction, addressed to all county governments, mandates that basic salary adjustments be implemented with immediate effect, explicitly requiring that all accrued arrears be included in the computation. Yet, in practice, the adherence to this directive remains inconsistent.

The Council of Governors (CoG) and the Department of Public Service Management have long been locked in a tug-of-war with the union. While the national government often signals a path to resolution, the actual disbursement of funds rests with individual County Public Service Boards. This fragmentation allows individual counties to interpret the SRC circulars through their own fiscal lens, often citing budgetary deficits or alleged payroll discrepancies to justify withholding funds. The KMPDU has signaled that it will no longer entertain these excuses, viewing them as a direct violation of the collective agreements adopted by the courts.

The Human Cost of Institutional Stasis

For the doctor on the frontline, these policy debates translate into tangible domestic crises. The delay in implementing salary adjustments affects not only the current monthly take-home pay but also the accumulation of pension contributions, statutory deductions, and mortgage repayments. In several counties, the morale of medical staff has reached a nadir, with many professionals considering exit strategies—either migrating to the private sector or seeking opportunities abroad.

Medical practitioners argue that they are being punished for bureaucratic inefficiencies that predate their employment. The insistence on auditing "overpayments" often feels, to the staff on the ground, like a tactic to exhaust the patience of the union and avoid paying out the total sum. When a surgeon at a sub-county facility cannot predict their monthly income with accuracy, the stability required for clinical excellence is compromised. This instability is the hidden driver of the frequent, short-lived strikes that continue to plague various counties despite the existence of signed return-to-work formulas.

Beyond the Numbers: A Crisis of Trust

The ongoing dispute over salary adjustments highlights a wider, more entrenched issue within Kenya’s devolved healthcare system: the lack of trust between the employer and the workforce. The KMPDU’s rejection of the "overpayment" claims is as much about protecting the principle of their collective bargaining rights as it is about the money itself. By consistently challenging the government’s narratives, the union is attempting to set a precedent that basic salary adjustments are non-negotiable legal debts, not discretionary items on a county budget.

As the March 2026 cycle of payroll processing concludes, the union has vowed to track compliance county-by-county. The KMPDU leadership has made it clear that they are prepared to verify the figures independently, stripping away the layers of bureaucratic accounting that have fueled this standoff. Whether this resolve will finally force a permanent resolution or plunge the health sector into another season of industrial unrest depends on whether the devolved units choose to honor the spirit of the March 10 directive or continue to hide behind the veil of administrative audit.

Until the payrolls align with the reality of the agreements made, the healthcare workforce remains in a state of suspended animation—waiting for the pay they have earned, while the public waits for a system that functions without the constant threat of collapse.