Kenya’s public sector doctors’ strike is entering its third month, with both sides of the dispute digging in their heels as the country’s poorest and frailest are most affected.

On Sunday, February 5, international rights organisation Human Rights Watch (HRW) weighed in on the labour action by appealing to the government to resolve the issue.

“The government should protect Kenyans’ rights to health and life, and work with doctors to reach a solution”, HRW stated.

With lives being lost, the matter certainly requires a swift resolution. However, the causes of the unrest are complex – raising questions about the impact of devolution on service delivery – and the political will to address them is absent: particularly as election campaigning kicks off.

In 2015, the country had 9,734 doctors attending to over 44 million citizens – just over 4,500 people per doctor compared to the World Health Organisation’s recommended ratio of 600 people per doctor.

Clearly, Kenyan doctors are over-stretched and, as strike actions over the years have highlighted, they are under-resourced and underpaid as well.

Striking doctors and other medical staff have made the headlines in Kenya for years.

In 2011, 130 doctors and nurses from the Moi Teaching and Referral Hospital in Eldoret went on strike citing low morale due to a lack of resources at the hospital as their main reason. Two months later, doctors nationwide went on strike for higher wages.

In March 2012, the government sacked 25,000 striking nurses for failing to return to work – the move was dismissed as a negotiation tactic by their unions. In August that year, doctors went on strike again – complaining that the agreement to end the December 2011 strike had not been honoured.

From December 2013 onwards, strikes have focused on issues brought about by devolution – doctors were resisting the decentralisation of the health sector as they feared mismanagement by less competent county governors, as they perceived them.

In August 2014, doctors again downed tools as salaries went unpaid from the month before. The following year saw strikes in April, August and September.

Thus, the current stand-off, though unprecedented in duration and extent, should not be considered an anomaly. This storm has been building for a while.

Discontent within the health sector predates devolution, and striking doctors are not calling outright for a return to the way the sector was previously structured, but devolution has exacerbated the issues and complicated the negotiation process.

Today’s strikers are calling for the Collective Bargaining Agreement (CBA) signed in June 2013 to be implemented. The CBA promised a significant increase in wages (of up to 300%), assistance for post-graduate students and better working conditions.

However, the Senate has said that the CBA was never registered with the Industrial Court and so it is not a legal document.

“They can’t hang on an illegal document. Nobody has prevented doctors from coming up with another legal document,” Dr Wilfred Machage, chairman of the Senate Health Committee, told The Daily Nation.

This attitude, however, appears disingenuous and amounts to authorities backpedalling on their promises.

Authorities have indicated that they are not willing to back down. On December 20, the Employment and Labour Relations Court charged top officials of the Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU), which has coordinated the strike, with contempt of court after they failed to attend a scheduled court session to resolve the impasse.

On Friday, February 3, the court ruled that the one-month sentence would be put into effect in a week’s time if the strike was not called off.

It is still too early to assess the impact of devolution on Kenya’s health sector. In countries like Ethiopia and Ghana, the decentralisation of health services had a positive impact, whereas in Uganda decentralisation (termed districtisation) has been blamed for poor service delivery across the board.

The irony of the situation – vital, overstretched public sector workers being told by overpaid legislators (Kenyan members of Parliament enjoy among the highest salaries of any legislators in the world) that there is not enough money available in State coffers to honour previous agreements – is lost on no-one.

Opposition politicians have called on President Uhuru Kenyatta to honour the 2013 CBA, but so far the issue has not formed a major part in election campaigning.

With so many suffering due to the strike, it is uncertain where the public’s sympathies lie.

Clearly, as HRW emphasised, they should lie with the patients dying and the doctors that want to be better able to serve them.