How Mathari hospital is mistreating contract nurses

The first thing Alicia* remembers about the day she gave birth is not the labour pains. It is finishing her shift.

She had worked through her entire shift at Mathari National Teaching and Referral Hospital, suppressing labour pains while waiting for the day-nurse to arrive.

Only after handing over did she leave for the maternity ward. “I went into labour while waiting for the day shift nurse to report so that I could hand over,” she recalls quietly.

Months earlier, she says, she had hidden her pregnancy from colleagues. “I was pregnant when I came to Mathari. I hid my pregnancy for a while because I was told if you revealed it and your contract was only three months, you could lose the job.”

Eventually, she says, hiding it became impossible. “I went to my in-charge and told her, ‘I am pregnant and I am due soon. As you arrange duties, can you schedule me in a way that accommodates my condition?’”

The answer she got stings to date: “‘Sorry,’ she told me. ‘You just have to work until the day you deliver.’”

Her story paints a portrait of nearly 100 contract nurses who say have spent years keeping the national psychiatric referral hospital running while trapped in an endless cycle of rolling three-month contracts.

Every contract renewal, for them, brings relief and every approaching contract expiry dread.

For Bob*, the uncertainty has lasted since 2021. “I joined Mathari in 2021 on temporary contract terms. Most of us have been working there for five years now. Our terms have never changed.”

The contracts, he says, were initially presented as a temporary solution to staff shortages. “We were brought in with the understanding that because Mathari is a parastatal, eventually it would employ us while on board.”

That promise, he says, never materialised. Instead, every three months, another contract arrives. And with it, another round of anxiety. “We are always scared as the tenure approaches and end. You might be jobless anymore after the three months.”

For John* the feeling is no different. “We literally walk on broken glass whenever the contract nears its end.”

Every day, the nurses report to work alongside those on permanent and pensionable terms. They care for patients in acute psychiatric wards, respond to violent outbursts and administer medication. They restrain patients when necessary and rotate across departments whenever staff shortages arise. Yet their employment conditions are worlds apart.

“Our permanent colleagues earn up to Sh80,000 with benefits,” says John. “We do exactly the same work, and sometimes even more when they are away.”

Most nurses on contract interviewed by The Standard say they earn a consolidated salary of about Sh30,000 a month. No housing, commuter or risk allowances. No medical cover beyond statutory deductions. And, they say, no payslips.

Mary* says she discovered just how limiting that could be. “I once went to the accounts department and asked for a payslip,” she says. “I was told according to my contract, I can’t get one.”

Without payslips, she says, simple milestones become impossible. “You cannot even get a loan from a bank.”

Then comes the question she keeps asking herself. “Am I really a qualified nurse? After going to school, paying fees, do I deserve this?”

Ironically, some say even healthcare remains out of reach. “We are told SHA deductions are made,” says Bob.

“But when we seek medical services, we are not covered even in Mathari itself,” John adds. “Our SHA cover does not allow us to access treatment here. You are told to go to a lower-level facility or pay out of pocket.”

Some nurses say colleagues injured while handling patients have struggled to receive adequate support from their employer. “We have had people injured at work. I think a Level Six hospital should champion our rights.”

Working in a psychiatric hospital comes with risks that many other healthcare workers rarely face. Patients experiencing psychosis can become aggressive. Some require constant observation. Others need physical restraint. Alicia remembers how a patient slapped her in her second pregnancy.

For Bob, injuries are only part of the burden. “If one of us falls sick, even getting sick leave comes with pressure. So, people come to work even when unwell.”

Motherhood, several nurses say, has become another casualty of contractual employment. After giving birth to her first child, Alicia says maternity leave became a battle. “I was not entitled to maternity leave because according to the rota I was still on duty.”

She says hospital administrators eventually granted three months after intervention. But there was a cost. “When I came back, I had to cover shifts to compensate. On my second pregnancy, I only got one month.”

Bob says Alicia’s experience is far from unique. “We have had people who gave birth and within three weeks they were back at work. They would breastfeed while reporting to duty.”

Paternity leave, he says, is equally unavailable.

And for them, every contract renewal determines whether rent or school fees can be paid; whether families can plan beyond the next three months.

Mary says anxiety is a constant. “You are a nurse in a mental health facility, but you are like a patient yourself. Every three months you are anxious.”

Nancy* sums it up more bluntly. “As you can see, I am even depressed. The money they pay us does not even cater for our own mental healthcare.”

The irony is difficult to ignore. The people caring for patients battling mental illness say they are themselves struggling emotionally.

“It is exhausting. Physically and mentally,” says Bob.

Several nurses also question what they describe as unequal career progression. Mary says she has watched nurses employed after her receive permanent appointments while she remains on contract. “I even orient them. I teach them how the wards operate. Some are general registered nurses and not psychiatric. But they earn more than me.”

The experience, she says, is deeply demoralising. “It hurts,” she said.

In an interview, the nurses said they have repeatedly sought intervention. “We have written letters, engaged hospital management, visited Afya House, sought help from the Kenya National Union of Nurses in vain,” said one of them.

Some, they said, even met Principal Secretary for Medical Services Dr Ouma Oluga, who wrote to Mathari’s HR department in July last year regarding their concerns. Yet little, they say, has changed. Instead, some allege, the meeting was followed by a new wave of intimidation.

“It’s like the management viewed us differently because we had taken the concerns outside the hospital,” one of them said.

They later escalated the case to Ruth Bosire, the head of HR, Directorate of Medical Services at the Ministry of Health. In a letter dated September 15, 2025, Dr Bosire acknowledged their request seeking absorption into permanent and pensionable terms but advised the matter first be considered by the Mathari board.

“Your case has been reviewed and, pursuant to the HR Policies and Procedures Manual for the Public Service, 2016, it is advised that the matter be discussed and deliberated by the hospital board. We appreciate your services at the hospital and encourage you to apply for any advertised vacancies through the competitive recruitment process as outlined in the HR Manual,” the letter reads.

The nurses felt like the response was another disappointment.

“Since we came here, no vacancies have been declared,” John says. “But we see people being employed on permanent and pensionable terms.”

Another concern has deepened their anxiety. They fear ongoing recruitment of Universal Health Coverage nurses could bypass them entirely despite years of service. “What worries us most is seeing UHC workers absorbed while we are skipped.”

The nurses insist they are not asking for special treatment but recognition. “What we want are favourable terms of employment,” says Bob.

John agrees. “If permanent and pensionable terms are not possible, then improve the salaries and extend the contracts. 90 days give us no job security.”

Mathari takes care of some of the most vulnerable patients people living with schizophrenia, bipolar disorder, severe depression and other mental illnesses requiring specialist care. Among those treating them are nurses who say they themselves carry invisible burdens. Not of psychosis. Not of depression diagnosed in hospital records. But of relentless uncertainty.

For them, every patient discharged is a victory. Every shift completed is another day survived. And every three months, they wait once again for the phone call, the signature and the contract that determines whether they will still wear the uniform they have worn for nearly years.

The names Alicia, Nancy, Bob, John and Mary are pseudonyms. The Standard has withheld the individuals’ identities to protect them from possible reprisals.