Medical Intern

Single Business Permits: County Governments Must Stop Harassing Health Facilities This morning I received a distress call from one of the doctors running a health facility in Kajiado County. Officers from the County Government’s Finance Department — popularly known as kanjo— had descended on the facility with one intention: to arrest the doctor for allegedly failing to pay a Single Business Permit (SBP). The demand was unlawful. Medical practitioners and health facilities licensed under the Kenya Medical Practioners and Dentists Council (KMPDC) are not ordinary businesses. They are regulated professions established and licensed under Acts of Parliament. Doctors and health facilities already pay substantial statutory licensing fees to @Kmpdc before they can legally practice or operate. Demanding that the same professionals pay an additional Single Business Permit amounts to double taxation — and where both the facility and the individual practitioners are separately licensed, it effectively becomes triple taxation. This principle has been affirmed repeatedly by Kenyan courts. In Medina Hospital Ltd & Others v County Government of Garissa (2015), the High Court held that once medical practitioners, hospitals and pharmacies have been licensed by the national regulatory bodies, a county government cannot impose another licence fee on the same activity because this amounts to double taxation. The Court further observed that the two levels of government should determine between themselves who licenses medical practice, but they cannot both levy licensing fees for the same purpose. Unfortunately, despite these judicial pronouncements, many counties continue to harass doctors and healthcare facilities. Kenya Medical Association has fought this battle before This is not a new struggle. For decades, the Kenya Medical Association (KMA) has defended doctors against unlawful county levies. In 2020, KMA wrote to the Council of Governors highlighting widespread harassment of doctors by county enforcement officers, particularly in Nairobi, Kajiado, Kisumu and Embu. The Association reminded counties that Schedule Four of the Constitution excludes regulation of professionals from county governments and urged them to stop demanding trade permits from doctors. The letter also cited earlier government guidance that requiring professionals to pay parallel licences amounts to double jeopardy. More recently, in Kenya Medical Association v Nairobi City County Government & Others (Petition E050 of 2022), the High Court once again declared that Nairobi’s requirement for doctors to obtain a Single Business Permit violated the Constitution. The Court held that Paragraph 1.5 (Row 12) of the Nairobi City County Trade Licensing Act was inconsistent with Section 7(b) of Part Two of the Fourth Schedule of the Constitution — which reserves trade licensing to counties excluding regulation of professions. The Court issued declarations of invalidity and prohibited Nairobi from demanding or enforcing Single Business Permits against doctors. The law could not be clearer. Yet counties continue collecting illegal fees One statement from a Kajiado County enforcement officer struck me. He asked: “What is so special about this hospital? Every other hospital in Kajiado has paid the Single Business Permit.” My answer was straightforward: If other hospitals were unlawfully compelled to pay, then Kajiado County should refund every cent collected illegally — not use previous illegal collections as justification for continuing the practice. The fact that many people have complied with an unlawful demand does not make the demand lawful. It merely means many have paid under pressure. Silence encourages injustice This is where professionals must remain vigilant. Many doctors pay simply to avoid confrontation, disruption of services or intimidation by county officers. That is understandable. But every illegal payment strengthens an unconstitutional practice. The issue is no longer about the amount of money involved. It is about the principle. If professionals quietly surrender constitutional protections today, tomorrow counties will invent yet another licence, levy or permit. Constitutional rights are defended one unlawful demand at a time. Nairobi’s “Unified Business Licence” needs urgent reform Nairobi County has adopted a particularly problematic approach. Rather than separating the various county licences, it bundles them into a Unified Business Licence, making it almost impossible for exempt professionals to pay only those charges that are legally applicable while excluding the unconstitutional Single Business Permit component. That system should be redesigned immediately. Each county charge should appear separately so that regulated professionals can comply with lawful county requirements without being compelled to pay unconstitutional levies. Counties need health facilities—not the other way round Counties are understandably under pressure to raise revenue. However, revenue collection cannot violate constitutional principles. Running a health facility in Kenya is already extraordinarily difficult. Healthcare providers comply with licensing requirements from multiple regulators, employ hundreds of Kenyans, invest heavily in infrastructure and equipment, pay taxes, stimulate local economies and provide essential services that county governments themselves are constitutionally obligated to facilitate. Every hospital creates employment. Every clinic attracts economic activity. Every healthcare worker contributes to the county’s development. County governments should therefore be supporting healthcare providers—not treating them as easy targets for unlawful revenue collection. The way forward This matter requires national leadership. I will engage the @KenyaGovernors (CoG) to issue a formal advisory directing all county governments to cease demanding Single Business Permits from doctors and health facilities licensed by KMPDC. Similarly, I will continue engaging the Association Of Professional Societies in East Africa @apseakenya where discussions are already underway on developing a common position for all regulated professions. The Chief Justice @CJMarthaKoome needs to pronounce herself on yhis matter and give a national guidance once and for all based on previous court declarations. Rather than forcing professionals to file county-by-county litigation, Kenya needs one consistent national policy respecting the constitutional distinction between trade licensing and professional regulation. The struggle continues This is not a new fight. Twenty-seven years ago, the Kenya Medical Association successfully challenged the then Thika Municipal Council after one of its members was arrested for operating a KMPDC-licensed clinic without a municipal trade licence. Today, nearly three decades later, health professionals are still being forced to defend the same constitutional principle. That should concern every Kenyan. The Constitution is not suspended because a county needs revenue. Nor should healthcare providers be punished for choosing to provide essential services. Defending constitutional governance is a civic duty. It is one that the @KenyaMedics_KMA has consistently undertaken over the years, and one that we must continue pursuing until every county government fully respects the law. Dr. @simonkigondu is Emeritus President, Kenya Medical Association