- Hillary Muhalya examines Seth Panyako’s call for predictable financing of recruitment and promotions in county healthcare.
- He argues persistent staffing gaps and delayed career progression ultimately affect workers, hospitals and patient care.
- Counties are challenged to shift from reactive hiring towards sustainable, long-term health workforce planning.
Kenya’s persistent healthcare staffing crisis has once again come under scrutiny, with Kenya National Union of Nurses Secretary General Seth Panyako challenging county governments to rethink how they plan, budget and manage their healthcare workforce.
Speaking on Citizen DayBreak, Panyako drew a sharp comparison between the way the Teachers Service Commission (TSC) plans for teachers and the manner in which healthcare workers are managed at county level.
His argument was simple but profound: while the TSC plans and budgets for the recruitment and promotion of teachers, many county governments continue to struggle with delayed promotions, inadequate staffing and overreliance on contractual workers in public health facilities.
“The Teachers Service Commission ensures that it has a budget for hiring more teachers and promoting them, but healthcare workers are not doing well at the county level,” Panyako said.
The remarks expose a structural challenge that has followed Kenya’s devolved healthcare system for years. Since the transfer of most health functions to counties, county governments have become the principal employers and managers of many healthcare professionals working in public hospitals and health centres.
Yet, according to health-sector concerns repeatedly raised by unions, the transition has not always been matched by adequate workforce planning.
Panyako’s comparison with TSC therefore raises an important question: if Kenya can establish a predictable national mechanism for recruiting, deploying and promoting teachers, why can’t counties develop equally reliable systems for healthcare workers?
Different systems, similar workforce needs
The answer lies partly in the difference between the two employment structures.
TSC operates as a national employer with a centralised workforce management system. Teacher recruitment, deployment and promotion are incorporated into national planning and budgetary processes. This gives the Commission a framework within which staffing needs can be assessed against available resources.
Indeed, TSC’s proposed 2026/27 spending priorities included funding for recruitment, promotion and teacher training, illustrating how these workforce requirements are incorporated into its budget planning.
Healthcare, on the other hand, is heavily influenced by the financial priorities of individual counties. The result can be significant variations in staffing, remuneration practices, recruitment patterns and promotion opportunities from one county to another. Research on Kenya’s devolved health workforce has similarly identified county budget constraints as an important factor affecting recruitment, training and promotions.
For healthcare workers, this creates uncertainty.
A nurse may possess the qualifications and experience required for career progression but still wait for a promotion because the county has not provided sufficient funding or created the necessary positions. Another professional may remain on a temporary contract despite performing essential duties for years.
The consequences go beyond the welfare of individual workers.
A health facility cannot function effectively without adequate numbers of skilled professionals. When hospitals operate below the required staffing levels, existing workers are forced to shoulder heavier workloads. Fatigue can increase, morale can decline and the quality of patient care can ultimately suffer.
This is why workforce planning should not be treated as an administrative afterthought.
Counties need predictable workforce financing
Counties need to recognise healthcare workers as a strategic investment. Recruitment should be guided by actual population needs, hospital workload, disease patterns and staffing gaps rather than short-term budgetary considerations.
Equally important is the need to institutionalise career progression.
Healthcare professionals need to see a future within the public health system. Clear promotion structures, timely recognition of qualifications and predictable progression can improve motivation and retention. Without such mechanisms, experienced workers may seek opportunities elsewhere, leaving counties to repeatedly recruit and train new personnel.
Panyako’s call for counties to emulate the TSC model is therefore not simply about copying an employment structure. It is about adopting the principle of predictable workforce financing.
County assemblies and executives should ensure that annual budgets deliberately provide for recruitment, promotions, training, deployment and replacement of healthcare workers who leave service.
Such allocations should be informed by actual staffing establishments and projected healthcare demands.
There is also a case for stronger coordination between county governments and the national government. Although counties manage devolved health services, healthcare remains a national priority. A coordinated workforce strategy could help reduce disparities between counties and establish minimum standards for staffing and career progression.
Health reforms need healthcare workers
The debate also comes at a time when Kenya is undertaking major reforms in the health sector. The success of these reforms will ultimately depend not only on policies, financing models or digital systems, but also on the people who deliver care at the point of service.
A modern health financing system cannot compensate for a hospital that does not have enough nurses, doctors, clinical officers, laboratory technologists and other essential professionals.
That is why Panyako’s comparison with TSC deserves serious attention.
The lesson is not that teachers and healthcare workers face identical circumstances. They do not. Rather, it is that every essential public service requires deliberate workforce planning and predictable financing.
Kenya cannot build resilient hospitals while treating healthcare staffing as a recurring emergency. Counties must move from reactive recruitment to long-term workforce planning, from delayed promotions to structured career progression, and from temporary fixes to sustainable employment systems.
Ultimately, patients are the biggest beneficiaries when healthcare workers are adequately staffed, properly motivated and given opportunities to advance professionally.
The challenge before county governments is therefore clear: budget for healthcare workers with the same seriousness with which Kenya budgets for other essential public servants.
Because hospitals do not run on buildings alone. They run on people.
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And when those people are neglected, the entire health system pays the price.
By Hillary Muhalya
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Kenya National Union of Nurses Secretary General Seth Panyako speaks during a television interview on challenges facing healthcare workers.
