Little is known about how the health professions organize in low- and middle-income countries (LMICs). Recent strikes among health workers in many LMICs have directed interest toward measuring their impacts and understanding their causes. Yet, much of this literature belies a technical understanding of a social problem. By drawing on theoretical developments in organizational studies, this article proposes health sector movements be understood through attendant social processes of sensemaking as organizations seek to expand pragmatic, moral, and cognitive forms of legitimacy. Kenya, a lower middle-income country in sub-Saharan Africa, is an interesting case for such research. The intersubjective construction of meaning among medical doctors fashions narratives to order institutional change in the Kenyan health sector. This analysis shows how the strong legacy of colonial biomedicine shaped medical professionalism and inherent tensions with a deteriorating state following independence. In 2010, a new constitution and devolution of health services caused a fractured medical community to divide and pursue industrial action in its quest for organizational legitimacy. In this way, strike behavior, as a form of legitimation among union doctors in Kenya, is a risky path to universal health coverage.

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