The Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) has formally opposed a proposed policy that would automatically reject insurance claims pre-authorised by public sector doctors during official working hours, warning that the move is impractical, arbitrary and disconnected from the realities of Kenya’s overstretched public health system.
The union’s National Executive Council (NEC) said it “formally objects to the use of fixed clock-time (8:00 a.m.–5:00 p.m.) as a basis for automatic rejection of insurance claims pre-authorized by public sector doctors,” describing the approach as “operationally unrealistic,” “administratively arbitrary,” and “disconnected from clinical and workforce realities.”
The position statement was signed by KMPDU Secretary General Dr. Davji Atellah, Chairman Dr. Abidan Mwachi and Treasurer Dr. Mercy Nabwire.
The statement follows public remarks by Health Cabinet Secretary Aden Duale indicating that the Social Health Authority (SHA) and the Digital Health Agency (DHA) could be directed to reprogram insurance systems to block pre-authorisations issued by public sector doctors during official duty hours, allowing such approvals only outside the 8 a.m. to 5 p.m. window.
Duale has argued that the measure is aimed at curbing conflicts of interest, preventing diversion of public service time into private practice, and controlling rising insurance costs.
He said some doctors were abusing dual practice arrangements at the expense of public facilities.
According to the Cabinet secretary, the practice deprives public hospitals of both patients and revenue, despite doctors being on government payrolls during official working hours.
“We are losing public resources while patients are being deliberately diverted to private facilities,” Duale said.
KMPDU acknowledged the legitimacy of concerns around accountability and prudent use of public and insurance resources but warned that blunt, time-based administrative controls would fail to address the underlying problems.
The union pointed to chronic health workforce shortages, low doctor-to-patient ratios and extended working hours that blur the distinction between “on-duty” and “off-duty” time in public hospitals.
“Time-based administrative controls do not effectively reflect the operational realities of public hospitals and risk arbitrary, disproportionate, and inequitable enforcement,” KMPDU said, adding that dual practice has emerged as a coping mechanism amid staffing gaps, delayed remuneration and heavy workloads.
The union also criticised the lack of consultation, saying the proposed mechanism had not undergone formal engagement with organised labour or other key health sector stakeholders, contrary to constitutional guarantees and existing collective bargaining agreements.
In its resolution, the NEC urged the Ministry of Health, SHA and DHA to pursue “evidence-based and negotiated alternatives,”
They include structured and transparent dual-practice frameworks, roster-based or facility-verified authorisation mechanisms instead of rigid time stamps, incentivised exclusivity where required, and accelerated recruitment and retention of healthcare workers.
The union said it would seek urgent engagement with the Ministry of Health and the two agencies, demand suspension of any unilateral implementation, and consider “appropriate industrial, legal, or advocacy action” should the policy proceed without consultation or undermine labour rights and service delivery.
“The NEC reiterates that the Union remains committed to strengthening public healthcare delivery and protecting patient welfare,” the statement said, adding that sustainable reform must address systemic constraints rather than “individualize structural failures.”
